Diagnosis

Ihe diagnosis of drug-seeking behavior may not be possible in the ED. Ihe medical record can provide a wealth of information regarding the patient, including documentation proving the patient is supplying false information. Often the diagnosis is suspected in the ED but cannot be confirmed. In such cases, a notation should be made in the chart listing the physician's concerns, but physicians should be careful when using diagnoses such as "drug-seeking behavior" without solid evidence. A listing or card file at the nurses' desk of "drug seekers" violates patient-physician confidentiality unless it is part of the patient's permanent medical record and subject to the same controls restricting access. Drug-seeking behaviors can be divided into two groups: "predictive" and "less predictive" of drug-seeking behavior (lable. , . 34-5). The behaviors listed under "predictive" are illegal in many states and form a solid basis to refuse narcotics to the patient. However, the possibility still exists that the patient could have pain and should be evaluated for a medical or surgical illness and possibly treated with a nonnarcotic drug.

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