How do you identify a doctor shopper?
There are the obvious signs that you may have a doctor shopper in your consulting room. They:
- have lost or misplaced their medications
- are a long way from home
- request a drug by its specific name or a specific dosage – and refuse all other therapeutic options
- seek opioids, benzodiazepines or stimulants
- display signs of anxiety or agitation when discussing their prescriptions
- may exhibit the classic physical signs of drug abuse: dilated or constricted pupils, extreme excitability or fatigue, and poor personal hygiene.
But are doctor shoppers becoming harder to spot?
Doctor shoppers have certainly become more sophisticated.
Recently a doctor shopper gave a GP the mobile phone number of his “regular doctor”. This doctor was, in fact, an accomplice playing the role of friendly medical colleague over the phone.
In another recent case, a doctor shopper impersonated a policeman and convinced a GP that he needed drugs for an “undercover case” he was working on.
Others employ an older patient on pain medication to supplement their income by being a proxy doctor shopper for a third party. Among doctor shoppers this practice is known as ‘fossil farming’.
How do you handle a drug dependent patient?
Anytime a patient requests a medicine that is subject to abuse a doctor should be very circumspect.
Before prescribing for the patient the doctor must be satisfied – based on clear and reasonable medical judgement – that the medication requested is the most appropriate for the situation.
If you suspect a patient is drug-dependent it is illegal to prescribe them Schedule 8 medications – such as OxyContin, Fentanyl, MS Contin, and Xanax - without prior written approval from the NSW Ministry of Health (For more information see the Hot Button Issue in this newsletter).
If someone you suspect is drug dependent requests an S8 medication you should politely but firmly decline such a request.
You could refer the person to a community Drug and Alcohol Unit, or for general advice on handling drug-seeking patients you could call the Duty Pharmaceutical Officer at Pharmaceutical Services (NSW Ministry of Health) during business hours on (02) 9391 9944.
What are some techniques for managing a doctor shopper?
Managing an encounter with a doctor shopper can be frustrating, and sometimes a bit frightening.
The first question you should ask yourself is simple: what kind of doctor shopper are you dealing with?
Are they already heavily dependent on the drug they are seeking? Maybe they seeking prescription drugs to deal with withdrawal symptoms from illicit drugs? Depending on the patient’s state, it might be possible intervene clinically to help them.
But it’s also possible that the doctor shopper in your consult room is simply a criminal, drug dealer hoping to sell prescription drugs to support their illicit habit or just to make money?
Be firm and polite and refuse their request.
How can I cut off trouble before it starts?
If a doctor suspects that a patient is a doctor shopper, they can call Medicare Australia’s Prescription Shopping Information Service on 1800 631 181 to obtain a summary of what PBS medicines have been supplied to the patient from community pharmacies. But remember: doctors must first register with the service.
As it’s easy for a doctor shopper to add an extra zero to a digit, remember you are required to record the amount to be dispensed in both words and numbers on the prescription.
Also, always put several lines through unused space on the prescription and keep your prescription pad or spare script paper for eprescribing in a secure location.
To register with the Prescription Shopping Information Service, go to: https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/prescription-shopping-programme
For more on handling drug dependent patients, see this resource from the NSW Ministry of Health: http://www.health.nsw.gov.au/pharmaceutical/doctors/Pages/faq-medical-practitioners.aspx
For more on making general practice a safe place, see this resource from the RACGP: https://www.racgp.org.au/download/Documents/PracticeSupport/17185-general-practice-a-safe-place.pdf