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Pismogirl 07-28-2014 09:26 AM

15 mins early and bring all medications?
Hey fellow PMP's,

My pm office called this morning to remind me of my appt tomorrow (they've never done so) and asked me to come in 15 minutes early and bring all medications. Is this normal? Random UA? It would seem odd to me if so since they pushed my appt back one week leaving me 5 days without meds (this is the 3rd time this has happened. The doc has some sort of illness and is out often) so what would be the point of a UA?

I guess I'm just wondering if this is a UA and if so, should I remind them when my meds ran out at my appt tomorrow? I don't want to pay for a pointless UA.

Anyone else experience this request before? Never had a UA (after 1st appt) or request to bring meds in. I bring them every appt though since it's in my contract to do so.

TIA :)

Whoopee 07-28-2014 10:23 AM

Re: 15 mins early and bring all medications?
I got the "come in early" deal last month and I was wondering what was up, as are you. Turns out they are updating their systems and are having every patient update their records. I have never had a pill count but have had numerous UA's. I have also told them once not to bother because I ran out early. I got a warning and we moved on. Honestly, you are probably OK, but good luck!

oldnbroken 07-28-2014 11:19 AM

Re: 15 mins early and bring all medications?
What kind of meds are you on that you can go 5 days without them or the doctor allow you to go 5 days without???That is kinda odd especially if these are schedule meds due to withdrawl issues. Did you notify them that you would be out when they called to change your appointment? and if so, what directions did they give you.

With the UA's the doctor looks to see if you have the correct level of Rx'd meds in your system- as well as drugs that shouldn't be in your system and illegal drugs.

And yes, tell them you ran out early due to appointment schedule changes made by them and that you followed their direction (if given any)

You should be okay as long as you are on count, followed their directions...etc....,however, if you ran out early and didn't have any problems due to not having any pain meds-they might think you don't even need them...hard to say without more back-info on your situation.

Most pain management doctor have you sign a contract for UA's, pill counts, missed/changed long as you followed it-the coming in early might be for the pill count along with a random UA which isn't abnormal for PM's.

Good luck and let us know what happened at your appointment..

Pismogirl 07-28-2014 11:58 AM

Thanks for the replies :)

I'm on Norco 1 every 4 hrs and so I had to make due with get this....12 pills for the week! My pain levels are ridiculous right now. They're aware and they themselves told me to "spread them out". The doctor is ill (something terminal I believe as he's been sick for months and wears a face mask) and they were booked solid and said they couldn't get me in to see the PA.

It's been fun to say the least being with this PM practice. I am grateful for the pain management when I actually get it but I've had to go through mild withdrawals 3 times now from this exact situation.

So they expect that when I go in tomorrow I will be in more pain than normal. I'm glad they at least called me the day before so that I could stop taking as I was and stretch them out as best as possible.

I think they're the only PM option in our county too :/

oldnbroken 07-28-2014 12:38 PM

Re: 15 mins early and bring all medications?
Wow...what a least they do know that you will be short on medications-so you should be fine as far as that goes.

It sounds like you need to ask for a referral to another/different PM doctor-if your current doctor is that sick he may not be open much longer and it would really bite if you went in to your appointment and there was a sign on the door "Closed due to death" or something like that-I have seen that happen on some other chronic pain forums I am a member of-The patient is left high and dry when an office closes, however, since you are just on Norco the PA could Rx that as long as they had an MD to supervise.

Good luck and I would ask for a referral if I was you before its too late.

Pismogirl 07-28-2014 12:56 PM

Re: 15 mins early and bring all medications?
I definitely will ask for another referral. Great point you made! Thanks so much. I wouldn't want to be left high and dry. Best to get everything figured out now.

tortoisegirl 07-28-2014 05:44 PM

Re: 15 mins early and bring all medications?
Agreed that is quite the mess. Regardless of what is going on, they need to get their patients their meds on time. For example, they could have you come pick up your scripts every month but only be seen every 2 months. It is my pain clinic's standard practice to do that with patients they can when they need to free up appointments. If they are in such dire straights as to have done this to you three times, they should be proactive and refer patients out.

I think my contract says to bring all meds at every appointment, but mine are always on my fill date, so I don't have many pills left to bring in, and they've never checked. I think if they were to do an actual pill count it would be between appointments, and when they suspected something was going on. If you get a UA or not, definitely bring up how long your appointment was delayed. That is something they need to handle. At this point I honestly wouldn't trust them even if they said that it wouldn't happen again and explained how they say they would ensure it. Its frightening how dependent we are on these doctors.

Three strikes and they are out in my books. Easier said than done I know. Even if you get a referral, there is no guarantee that clinic will accept you as a patient, be willing to continue your current regimen, be within reasonable driving distance, take your insurance, etc. If they won't give you a recommendation, I'd ask your primary doctor, or worse case, research online and go to initial consults to get an idea of their treatment plan (just don't sign any contract or accept any prescriptions until you formally end your relationship with your current clinic). Best wishes.

Pismogirl 07-29-2014 09:33 AM

Thanks for the replies :) It was a great appt today! They did a UA and a "pill count". The pill count wasn't really a count as the doc just opened my meloxicam bottle, shook it a bit and closed it. He checked the dates in my norco bottle to verify it should've been empty.

He told his office manager in front of me that patients on controlled meds must never go without while in treatment. No matter how booked they are, they are to make sure everyone on controlled meds gets their medication. He was very clear lapses should never happen again. Fingers crossed.

He explained that it's their office policy for those on controlled meds to be seen every 30 days and they won't deviate from that but that he understands staff needs to also hold up their end of that bargain for patients. Worst case scenario the PA needs to write a script for patient pick up.

He stated he expects with my UA's there may be times when I won't have hydrocodone in my system since my meds are "as needed" but that they do the UA to also make sure there are not other drugs in my system. All makes sense to me.

He also clarified that every time I'm asked to come in 15 mins early it is for a UA and pill count. They have a software program that selects randomly for UA's and they choose to do pill counts at the same time.

Thanks again for the replies!

Whoopee 07-29-2014 10:31 AM

Re: 15 mins early and bring all medications?
All's well and that's great! I'm really glad he made the point about controlled med patients clear as that has always been my understanding. In fact, because the meds I'm on are really hard to find, mine PA will usually write mine "on" day 30 so I don't have to scramble the day I'm out of meds. Not a pretty sight! Good deal and continued success with PM!

oldnbroken 07-29-2014 12:55 PM

Re: 15 mins early and bring all medications?
Awesome, sounds like everything went well and your doctor is on top of things for you...that alone can relieve must have felt good walking out of the doctor office today-knowing the doc supported you and understood your needs/importance of not running out of medications-
A doc wouldn't allow a diabetic run out of insulin they are dependent on...So why should a chronic pain patient be any different....sadly, we are viewed different and that is so wrong......anyway....I tend to

The unknown and being without our pain medications we depend on to help us function somewhat at a normal level-is not fun when we have to cut back or worse do without from no fault of our own-especially when already on doses that barely keep us at a functional level to start with.

I am pretty lucky with my PM team-they don't worry about fill dates on the most part, plus, they want you to re-fill before your start date anyway-I usually fill mine 3-5 days early without issue, however, past 8 days they will write a fill date 2 days before the start date on the Rx which isn't an issues other than having to drive back to town since I live out in the woods so-to-speak...

I am UA'd every month and that too isn't an issue for me-IMO, UA's and pill counts are for me/my health and overall well being- as much as for my PM team-as well as the yearly liver and Vit D levels they run-I don't mind at all and feel that I am well cared for.....

tortoisegirl 07-29-2014 07:49 PM

Re: 15 mins early and bring all medications?
Glad everything worked out ok. I do hope they stand by what they said. Its troubling to hear of office staff practicing medicine in that way. So by saying that did the doctor imply they knew nothing of you going without meds for multiple days three different times? It shouldn't have got to the point it happened, let alone more than once. But there is unfortunately only so much we can do about it. Switching doctors can be quite the process.

I think that topic is something that should be included in contracts...what their office policy is on if your appointment has to be delayed and what they will do to ensure patients will not run out of meds (assuming the patient has followed by the rules). Best wishes.

EJM3 07-30-2014 11:56 PM

Re: 15 mins early and bring all medications?
I have been taking Norco for over 2 years with NO contract, but when I switched to Oxycodone 5mg TID I had to sign the contract. I can understand this as the DR I see has patients of all kinds of pain/pain levels, as well as "regular" patients. Plus there are some strange Federal regulations for prescribing Class II narcos.

I am subject to UA and pill counts at anytime, but have not had one since my first. AND I can go and pick up my prescription if I am near the 28 day mark (I am given a prescription for 84 pills every 28 days), but cannot get in to see my DR. I guess I have a very lenient DR, but I can guarantee you that ONE screw up on my part and I'll be on a tight leash with a spiked collar!!

I am glad your DR had a chat with his office manager with you present about your and other patients meds and how important they are for us to have at ALL times. Sounds like a good DR with new staff maybe??

Anyway, best of luck to you with your pain control..

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