I had a lady come in with low back pain. She had been seen in the ED and was given Nubain. She was new to my area and was referred to me from the ED. When she presenedt to the office, she was dragging her right leg and wouldn't sit in the reception area because of pain. In the exam room, she mentioned how helpful the nubain was at least 5 times. Her exam was entirely normal. There were no radicular symptoms whatsoever! She also screamed when I asked her to point to the area that she had the most pain! SLR's were normal, normal neuro. I explained that I would not administer nubain to her, but that nsaids plus acetominophen, along with Physical therapy and stretching exercises and deep water walking should work wonders. She followed me out of the exam room and loudly insisted on an injection. My nurse came around the corner asking what was wrong and I said,"this woman wants nubain but I don't feel it's indicated." She then marched out of the office, without dragging her leg, accusing me of a hippa violation because I told my staff what she wanted! She reported me to the state board of medical examiners and they did a full review. Fortunately the documentation was excellent and they found in my favor. I did submit her bill immediately and was reimbursed for the visit! I wrote her a letter dismissing her from the practice. I also spoke informaly to the ED and other Doc's in the community about a new patient who might be looking for nubain. The report to the state boardwas a first for me after 22 years of practice.
