Dr. Marcona is a psychiatrist and pain management specialist. One of only a handful in tristate area and owner of a successful practice. She has been written of in the local press and asked to speak at national conferences due to her excellent reputation and care of patients. With her success, has come an increase in the number of patients looking for treatment. Her ability to treat patients is limited due to the large practice she already has built. In recent years, she has offered her services as a consultant to other physicians. Patients are referred to her care and receive a detailed physical examination and history. After meeting with the patient and reviewing their medical history, she offers recommendations for further treatment to be monitored by their primary care provider. Dr. Marcona is compensated for her time by charging a substantial fee for her one time consultation service.

Paul Baxter, a construction foreman, has been undergoing treatment for chronic back pain for 5 years now. He was injured on a worksite when a scaffold gave way and fell on him and two other workers. Since his accident, he has been unable to work and has been on disability and workman’s compensation. His inability to work and the limited income he earns have been emotionally difficult for him and his family. His physician felt Dr. Marcona might be able to assist in the care of Mr. Baxter and offer a better course of treatment with advice on his emotional needs.

Dr. Marcona met with Mr. Baxter and felt that the pain medication he has been using is no longer effective and has not been adequately assisting with the pain he feels. She prescribes Oxycontin to Mr. Baxter with enough to last him 4 to 5 weeks. The medication is very effective but also very powerful and highly addictive, if used improperly. Dr. Marcona provided detailed instructions to Mr. Baxter regarding the use of the new medication and asked him to call in three days to report how he was feeling.

Three days later, Mr. Baxter called to say he was feeling wonderful and the best he has in years! He expressed his gratitude to Dr. Marcona and had decided to take a weekend trip to celebrate. Dr. Marcona was unable to speak with Mr. Baxter, but read the message left for her by the answering service.

On Monday, Dr. Marcona arrived early in order to prepare for a full day of patients. In between patients, she read an urgent message from Mr. Baxter. He had called Monday morning to ask for a new prescription for the medication she had written for him the week before. He said that he had gone to Las Vegas and that one of his bags was stolen on Saturday afternoon. Mr. Baxter said the medication was in the bag taken and he now needed more pills. He was planning to come into the office in about an hour to pick up his new prescription.

Discussion Questions?

1. Should Dr. Marcona write a new prescription for Mr. Baxter?
2. What is your reason for answering? If yes – would you write a new prescription if his medication is lost or stolen in the future? If no – how would you explain your decision to Mr. Baxter? What words would you use?
3. Do you feel Dr. Baxter’s physician was involved enough in the decision to prescribe the new medication?
4. What questions do you think should be asked in Dr. Marcona’s examination and interview before prescribing a medication like the one in this case study?