Oxycodone

Working in a first available GP clinic gives me the wonderful opportunity to see how other doctors in my practice are managing these patients who come in to see the first available doctor. I must admit, sometimes I am scared.

Take the case of Mrs X, a woman in her mid thirties. She came on a Saturday at 7pm. Having had a read of her medical summary at the start of the consult, I note that she has had issues with back pain, having had a recent back injury, likely a simple musculoskeletal back strain. I quickly glance over at the previous treating GP’s notes, and see a few prescriptions of endone. I seriously hope she doesn’t ask me for more endone.

“What brings you in today Mrs X?”

“Well, there’s really only two things today doc. I’ve been having these flu like symptoms for the past 3 days. And the other thing was that I just wanted a pregnancy test. I’ve heard that there have been some recalls with some brands of home pregnancy kits with false negatives.”

After doing the usual history and examination, I give the patient a urine jar to collect a urine sample, and advised to come back into the room afterwards.

With the patient out of the room, I snoop back to the previous GP’s notes and the entries made.

2nd March 2017 – Presents for review of back pain. Wants Endone repeat.  


Scripts written: Endone 5mg, quantity 120. 5mg QID PO

 

15 March 2017 – Review of back pain. Needs more pain relief.


Scripts written: Endone 5 mg, quantity 120. 5mg QID PO

 

Having had a read of these notes, there are many things wrong. First are the extremely brief notes. Having read many of this doctors notes, his notes are at maximum 2 sentences. They hardly document anything at all, and I would believe theses notes will not hold up in a court should he need to give evidence.

Secondly, the fact that a whopping 120 tablets of endone needed to be given. Add to the shock, that 120 tablets should last 30 days, yet this patient has needed to get another script in just about 2 weeks.

Having been at this practice for just 6-7 weeks, I have only prescribed 10 tablets of 5mg endone to one patient who had excruciating hip pains from a work place injury. Even then, I had trialled him on just some panadeine (paracetamol + codeine) prior to stepping up to endone.

This makes me conclude that some GPs probably just end up giving anything the patient asks so that the consult won’t extend over 5 minutes (which in my opinion, is a very shocking way to practice medicine – at the end of the day, I will make my own decisions according to my own independent assessments, not on recommendation of the patient). I have had the temptation to do that at times just because it seems like the easy way out, but I always tell myself, the easy way out may sometimes be the wrong way out and end up later on, being the hard way out (eg when asked to justify decisions, or when in court for such decisions).

 

 

The AHPRA Registrations Are Pretty Brutal

I had once looked up on the AHPRA website (the Australian medical register of pracititioners), and looked up my name, displaying it proudly to my parents.

“Look, I’m a fully qualified doctor” I showed to my parents.

They displayed a look that only any parent would display at one of their child’s proud achievements. They were proud of me.

But aside from that, I had learnt earlier as a medical student, that you could look up the list of deregistered medical practitioners. This was on my anaesthetics term, speaking to the registrar.

“One thing I hold to high regards, is practicing ethical medicine” she had told me.

“If you go on the AHPRA website, there is a list of deregistered practitioners, and the website also outlines in great detail why that medical practitioner was deregistered”.

I was pretty shocked about that, as the registrar went on to tell me how she recognized a classmate’s name amongst those names of deregistered doctors, explaining how her classmate had got involved in intimacy with a vulnerable patient.

I never really thought much more about that AHPRA website, but come a few months back, it got me thinking again. I had been studying some ethics in preparation for a GP interview that is coming up. Taking a bit of time out from study, I decided to have a read about what the deregistrations were about. And let me tell you, the website borderlines on intrusion and voyeurism.

For one, not only is the practitioner’s name fully placed on the site, but the practitioner’s place of practice as well, and several paragraphs outlining exactly why that practitioner was deregistered/suspended. I must admit, it did make for some entertaining read, but I just felt that it was really creepy and intrusive, especially the amount of detail they outline in those reports. And the fact that anyone with internet access can see that information. It’s pretty much the “hall of shame” for the entire world to see. That makes me that little more careful about being ethical as a doctor.

http://www.ahpra.gov.au/Registration/Registers-of-Practitioners/Practitioners-who-have-agreed-not-to-practise.aspx

For those interested, it’s up there. On a note, when I visited the site a few months back, there were several more entries, and the amount of detail was so much more. Looks like they scaled the details down a little bit.