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By Dan Schulte, J.D.
MDA Legal Counsel
From the July 2010 issue of the Journal

This month’s column will address several questions received recently regarding prescribing pain medication under questionable circumstances:

  • “I cover several dental offices and occasionally take phone calls from people claiming to be patients of the practice I’m covering asking for pain medications. I question whether these people are actually patients and/or are really in need of the medications. What should I do?”
  • “I received a call from someone claiming to be in severe pain. He wanted to set up an appointment but was not going to be able to come in for several days. He asked that I prescribe something for the pain immediately. What should I do?”
  • “When speaking to some dentist colleagues recently I heard that they had been contacted by a women claiming to be in pain and seeking medication. One of my colleagues prescribed ‘a pill or two’ to relieve her pain until her appointment. She was a no-show for the appointment. Another colleague said the same thing had happened to him. I have now received a similar call. Can I e-mail all of the members of my component dental society giving them this person’s name and letting them know that I think she is scamming dentists for pain medication?”

Answers: The scenarios described in the first two questions raise the same issue: Should a dentist prescribe a drug without first physically examining and evaluating the patient’s condition? The answer is no. A dentist should prescribe drugs only to his or her patients of record. This includes only those who have been examined, diagnosed and whose treatment has been planned by you.

The results of the exam, your diagnosis, and treatment plan should be documented in the patient’s dental record. This would include documentation of the nature and intensity of the pain being experienced, any current and past treatments for the pain and, if any, underlying or coexisting diseases or conditions that may be contributing to the pain. If you are covering another dentist’s practice you must verify whether the person calling is, in fact, a patient of the practice and, if so, review their dental record. Your professional judgment, following your review of the patient’s dental record, will dictate whether you need to physically see the patient prior to writing a prescription.

Under no circumstances should you be writing a prescription for someone who is not your patient of record or a patient of record of the practice you are covering.

The third question raises a different issue: What information can I share with my colleagues regarding a patient who I suspect is “dentist shopping” for pain medications?

The answer depends on whether this person is actually your patient. If the person is your patient (i.e., a patient of record — someone you have examined, diagnosed and treatment-planned), then anything the patient tells you regarding his dental treatment is privileged and cannot be disclosed by you. You should not engage in conversations using specific patient information at component dental society meetings or otherwise. Does this privilege apply to a caller if you are speaking to him for the first time and have never seen him?

There is no clear answer to this question. If the caller provides personal information regarding his or her condition it will likely be presumed that it was disclosed in the confidence of the dentist-patient relationship. The best practice would be not to make disclosures of specific information regarding this person.

If you have a suspicion that someone is looking for drugs for illicit purposes, there is a system available to you to independently obtain the person’s prescription information (at least for prescriptions of Schedule 2-5 drugs). As a licensed dentist, you may use the Michigan Automated Prescription System (“MAPS”) to obtain patient-specific prescription reports. Go to www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_55478---,00.html to register to use MAPS.

Posted in: Treatment Issues

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