Ethical Practice

Last week, I was given a chance to meet an 82-year old female patient who was accompanied by her husband, and was in the clinic for a narcotic medication refill. She said she has been suffering from moderate to severe pain on her dislocated right shoulder and needing medication refill to manage the pain. The doctor and I found out that she came back to the clinic a few weeks earlier than usual for the narcotic medication refill, which means she has finished her narcotic medications too soon. When interviewed in the clinic, the patient is calm while the husband is disheveled, aggressive and too demanding in asking the doctor for the narcotic medication refill. The policy in the clinic is that once a patient is on narcotic medication and needing regular refills of it, the patient should be referred to a pain management doctor to help in the medication dose management and especially for the pain management. All these information were explained to the patient and the husband but the husband continued to be pushy in getting more than one month of medication supply and wanting more than 30 pills per bottle refills on the narcotic medication. While on the other hand, the patient is calm about the doctor’s statement and was agreeing with the doctor’s recommendation. As a clinician, I assessed that the patient is in sound mind and body, able to comprehend and decide for her own. Though there were some contradictions on the part of the husband not wanting the referral to be done, the patient agreed to be seen by the pain specialist and understood the policy about the narcotic prescription. In this scenario, the doctor and I observed patient autonomy by going forward in sending the referral for pain management consultation to be able to further address patient’s pain issue, regardless of patient’s husband’s disagreement to it.


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