Worley Julie, Johnson Mary, Karnik Niranjan
Julie Worley, PhD, FNP, PMHNP, Rush University, Chicago, IL, USA
Mary Johnson, PhD, RN, PMHCNS-BC, FAAN, Rush University, Chicago, IL, USA.
J Am Psychiatr Nurses Assoc. 2015 Sep-Oct;21(5):309-18. doi: 10.1177/1078390315612262.
Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs.
“医生购物”是处方药物转移的主要方式。除阿片类药物外，苯二氮䓬类药物和兴奋剂是接下来最常被非医疗使用的处方药物。研究表明，参与“医生购物”的患者觉得这样做有趣、刺激且容易。目前缺乏关于开处方者对“医生购物”现象看法的研究。本研究调查了精神科开处方者与参与“医生购物”患者打交道的经历。对15名在门诊精神科工作的开处方者进行了访谈，包括精神科医生和精神科执业护士，以获取他们与参与“医生购物”患者打交道经历的详细信息。访谈中发现的主题是，精神科开处方者与参与“医生购物”患者打交道的经历包括：（a）发现危险信号；（b）负面情绪反应；（c）处理患者及问题；（d）预防措施执行不一致。在开具管制药物时发现危险信号时，精神科开处方者自身会产生失望和怨恨等负面情绪反应，同时也会感受到患者的愤怒等负面情绪以及其他极端情绪反应。精神科开处方者以多种方式应对患者的“医生购物”行为，如改变行医方式、让患者出院或采取措施不接纳某些被认定有“医生购物”风险的患者，以及与患者交谈并试图提供帮助。尽管经历过“医生购物”情况，但开处方者在执行预防措施方面并不一致，比如检查处方药监测程序。
