A Country Doctor Writes:

Jeremy Jones’ back surgery didn’t seem to have done much for his pain. He came to me on long-acting narcotics and generous doses of short-acting painkillers to take as needed.

His spine surgeon had nothing more to offer, and it was up to me to prescribe and monitor his medications.

Last month he produced the right number of pills for his random pill count. He didn’t seem surprised when Autumn, my nurse, called him in for a pill count; it is part of the narcotic contract he signed when he first came to our office.

Some doctors don’t accept new patients with pain issues, even if they are in dire need of care for diabetes and other medical problems. Our office doesn’t discriminate like that, but we try to be firm and fair in our enforcement of the office’s narcotics policy.

The random urine drug screens sometimes reveal that a patient isn’t taking the pain medicines we prescribe. The “street value” of these drugs is ten dollars per pill and up.

Other times we find medications not prescribed by us or illegal substances like cocaine – all reasons to stop prescribing pain medications or to discharge the patient from our practice.

Jeremy’s first random urine drug screen didn’t happen.

“I just went before I left the house”, he explained. Several cups of water and an hour later it was almost closing time.

“We’ll catch you another time”, I said casually, not realizing how prophetic that sounded until after I had said it.

Several weeks went by. Then, last week, Jeremy had a morning appointment.

“Let’s have you do that urine drug screen today”, I insisted.

“Oh, I just went while I was waiting to see you. I couldn’t hold it”, Jeremy explained.

“No problem”, I reassured him. “We’ve got all day.”

“But I have an appointment with Dr. Anderson over at the hospital in an hour.”

A quick call confirmed this was true.

“No problem”, I told Jeremy. “I’ll write you a lab order and you can just go to the hospital lab after your appointment with Dr. Anderson. After all, that’s where your sample would be going anyway.”

“Great, I’ll just stop in there, then”, Jeremy smiled nervously.

“Fine”, I said.

I got busy and a couple of days went by. Then Dr. Anderson’s report from Jeremy’s appointment arrived. That reminded me – I had not seen Jeremy’s urine drug screen yet.

Two minutes later I knew that there was no record of a urine sample on Jeremy Jones at the hospital.

I reached over to the keyboard and started typing: 

Dear Jeremy…