Breaking Up

They say that breaking up is hard to do
Now I know, I know that it\’s true
Don\’t say that this is the end
Instead of breaking up I wish that we were making up again

There are times that relationships need to end.  Usually something happens to undermine trust; it\’s hard to build trust, but it\’s very easy to destroy it.

I had a discussion today with the other physicians in my practice as to when patients should be \”discharged\” from our practice.  I have always found it somewhat ironic that we use the term \”discharge\” when we are basically telling patients we don\’t want them to be our patients anymore.  Doctors deal with discharges of various sorts – most of which are not pleasant.  Here is a dictionary definition of discharge: the emission of pus, mucus, or other liquid from an orifice or from diseased tissue. True, there are other definitions of discharge that don\’t cary that connotation (we discharge patients from the hospital), but if I see an appointment on my schedule with the word discharge as part of the reason for visit, I am not excited.  I am praying for a no-show.

So what constitutes a reasonable reason to terminate the doctor/patient relationship (terminate is another word that carries bad medical connotations)?  The breaking of trust is usually at the center.

Patients Dumping Doctors

From the patient standpoint, the doctor is paid both to do a job and entrusted with something of enormous value.  Patients are both customers wanting to get their money\’s worth, and people with needs looking to be cared for.  A doctor can betray the patient\’s trust in either of these areas.  Yet in spite of the way that some doctors honor neither end of the deal, most patients feel very guilty cutting off the relationship.

I have had numerous patients who are very unsatisfied with specialists be amazingly reluctant to change.  They are afraid what the doctor will think of them.  The don\’t want to be \”one of those patients.\”  And so just like a spouse of an alcoholic will enable the drinking, bad doctors will continue to treat patients poorly because people keep coming to them.  It usually takes a strong affirmation from me that they do have the right to good treatment (especially because they are paying a lot for it), for people to make the switch.

The language used from the patient perspective is that they leave the doctor to find another, just like the ending of many relationships.  Patients don\’t, however, usually leave a note saying why they \”just can\’t live in this relationship anymore.\”  They are one of thousands of patients, but they have only one doctor of that specialty.

Doctors Ditching Patients

The other side is quite different.  The patient often comes into the relationship broken and needy.  They are looking for help, guidance, and care.  Less is expected of them because they don\’t give, they receive.  So the ending of the relationship can feel like abandonment.  You are telling them that you won\’t meet their needs anymore.

Those of us who are tormented quick to feel guilt find it very hard to end the relationship.  It takes a lot for me to discharge a patient – more than most doctors.  For me, there are three main reasons I discharge patients:

  1. They don\’t pay their bill when they can afford to – this tells me that they don\’t value me or my services.  It\’s a big insult to doctors to feel less valued than cable TV or cigarettes.
  2. They lie to get controlled substances – this not only undermines our trust in the patient, but it puts our career at risk.  I can lose my license by carelessly prescribing controlled drugs like Xanax and Percocet.  I didn\’t go to medical school and residency to become a vending machine.
  3. They mistreat my office staff – this one is a little harder to judge.  Some people just don\’t relate to others well (ie. they are jerks).  This shouldn\’t be a complete barrier to care, but if it goes far enough, I will discharge them.  Losing a good staff person is far worse than losing a patient, and an unsupportive boss can kill morale.  I spend every day with these people and rely on their hard work; I can\’t afford to discourage them.

Honey, You Don\’t Love me Anymore

Some doctors would include medical noncompliance on that list.  If a patient doesn\’t follow a doctor\’s instructions, then why should they continue to come?  I have heard many doctors say that they fear the legal liability of someone who doesn\’t follow instructions and gets sick as a consequence.  What if a patient\’s family gets upset that grandma died of something that should have been treatable?  Why didn\’t she get the antibiotic?  Why didn\’t she get the mammogram?  Why wasn\’t a CT scan ordered?  The noncompliant patient, to many doctors, is a problem waiting to happen.

I think they are wrong.  Yes, it may be a small risk to keep a noncompliant patient, but most of that risk can be mitigated by documenting the patient\’s refusal of care.  Besides, the practice of medicine is anything but safe.  We are taking people\’s lives in our hands.  It is not a low-risk thing to do.  I have always felt that discharging noncompliant patients was more a case of injured pride on the part of the doctor.  How dare you ignore my good advice!  I went to medical school and have practiced for 15 years, and you are ignoring what I say? It wounds your pride to be ignored.

But patients don\’t usually disregard doctors\’ instructions because they don\’t trust them.  Why would they go to the doctor in the first place if they didn\’t trust them?  Emotions are really complex when people are dealing with their own health.  They don\’t want to seem like they are over-reacting, but they also don\’t want to admit their weakness.  Taking medications and getting tests done is an admission of mortality, which nobody likes to do.  Some of my most noncompliant patients, ironically, are doctors.

I just chalk it up to human weakness/stupidity, which all of us have in abundance.  Seeing my patients doing dumb things reassures me that I am not alone in the dumb department.  It just means more business for me in the long run.  It\’s job security.

Maybe it\’s just my fear of confrontation, or maybe I am more patient than most, but I am in the business of treating weak people.  Why should I get angry at them and ask for my class ring back when they show that weakness?

33 thoughts on “Breaking Up”

  1. Maybe you can help me understand something that happened to me. I had a GP who came highly recommended by doctors that I trust. She ordered a sonogram for some abdominal pain that I am having. It came back normal. Her nurse called me with the report. I asked the nurse what I should do next. She didn’t have the answer. I expressed dismay that the doctor had not considered the next step. From that point on for months I could not get any response from my doctor to my phone calls. I wrote a letter which was put in my file. There was no response to the letter. I talked to the office manager who confirmed that the letter was there and said that she would talk to the doctor. Still no response. My cardiologist who is a friend of the GP talked to her and still no response. My cardiologist said I should not wait any longer and recommended some tests for my gut pain. I went to a gastroenterologist that I knew and found a new GP.I can understand the GP having hurt feelings because I questioned her. I don’t understand at all why I was not notified that she did not want me as a patient.

  2. Maybe you can help me understand something that happened to me. I had a GP who came highly recommended by doctors that I trust. She ordered a sonogram for some abdominal pain that I am having. It came back normal. Her nurse called me with the report. I asked the nurse what I should do next. She didn’t have the answer. I expressed dismay that the doctor had not considered the next step. From that point on for months I could not get any response from my doctor to my phone calls. I wrote a letter which was put in my file. There was no response to the letter. I talked to the office manager who confirmed that the letter was there and said that she would talk to the doctor. Still no response. My cardiologist who is a friend of the GP talked to her and still no response. My cardiologist said I should not wait any longer and recommended some tests for my gut pain. I went to a gastroenterologist that I knew and found a new GP.I can understand the GP having hurt feelings because I questioned her. I don’t understand at all why I was not notified that she did not want me as a patient.

  3. I’m like you in my reluctance to discharge patients purely for medical noncompliance. I figure if they keep coming to me, maybe I can get through to them someday. This has actually happened, and it’s tremendously gratifying.

  4. I’m like you in my reluctance to discharge patients purely for medical noncompliance. I figure if they keep coming to me, maybe I can get through to them someday. This has actually happened, and it’s tremendously gratifying.

  5. Absolutely. You lost trust and you went to someone else. I don’t think your GP should have hurt feelings – it is your right (and responsibility sometimes) to question your GP. Being questioned is part of the territory, and the GP should be questioning herself as well. I am 100% in your court on this, Greg.

  6. Absolutely. You lost trust and you went to someone else. I don’t think your GP should have hurt feelings – it is your right (and responsibility sometimes) to question your GP. Being questioned is part of the territory, and the GP should be questioning herself as well. I am 100% in your court on this, Greg.

  7. I agree – it is a huge victory when you get through. I’d rather err on the side of trust than mistrust. I am glad to hear you are in the same boat as I am on this. It doesn’t surprise me really.

  8. I agree – it is a huge victory when you get through. I’d rather err on the side of trust than mistrust. I am glad to hear you are in the same boat as I am on this. It doesn’t surprise me really.

  9. If the p4p train keeps gaining momentum, you may soon risk the label “poor quality physician” if you keep your non-compliant patients around and other doctors discharge them.
    their non-compliance will contribute to your “bad numbers” on quality guidelines.

    I find this most unfortunate, these are the patients who need the most help, but it may become too painful (to reputation and finances) to keep them around in the future.

    Unintended consequences anyone?

  10. If the p4p train keeps gaining momentum, you may soon risk the label “poor quality physician” if you keep your non-compliant patients around and other doctors discharge them.
    their non-compliance will contribute to your “bad numbers” on quality guidelines.

    I find this most unfortunate, these are the patients who need the most help, but it may become too painful (to reputation and finances) to keep them around in the future.

    Unintended consequences anyone?

  11. I agree. Quality must be measured by behavior as much as it is by outcomes. If I attempt to lower blood pressure and if I take on higher complexity patients, it must be a bonus for me regardless of the outcome.

  12. I agree. Quality must be measured by behavior as much as it is by outcomes. If I attempt to lower blood pressure and if I take on higher complexity patients, it must be a bonus for me regardless of the outcome.

  13. I agree with all of your reasons for discharge, Rob. I would add that I terminate when I feel our relationship isn’t working. Be it noncompliance or mistrust on the patient’s part, If I’m not feeling effective I can’t continue in good conscience.

  14. I agree with all of your reasons for discharge, Rob. I would add that I terminate when I feel our relationship isn’t working. Be it noncompliance or mistrust on the patient’s part, If I’m not feeling effective I can’t continue in good conscience.

  15. We are in the opposite position. Our rheum admits he doesn’t know exactly what is wrong with our daughter but will not let us see anyone else in the practice – it’s their policy. He is a very nice person and has followed her for 8 years, but he has missed the boat multiple times and doesn’t seem to care. I have made it clear -by saying it to him directly-that I don’t trust him or have any faith in his ability to treat her. He still won’t let us see anyone else. They are the only group with in 5 hours that will see ped. patients. Otherwise it is go out of state and all that stuff. We need his methotrexate and lab orders so we continue seeing him. Breaking up is hard to do.

  16. We are in the opposite position. Our rheum admits he doesn’t know exactly what is wrong with our daughter but will not let us see anyone else in the practice – it’s their policy. He is a very nice person and has followed her for 8 years, but he has missed the boat multiple times and doesn’t seem to care. I have made it clear -by saying it to him directly-that I don’t trust him or have any faith in his ability to treat her. He still won’t let us see anyone else. They are the only group with in 5 hours that will see ped. patients. Otherwise it is go out of state and all that stuff. We need his methotrexate and lab orders so we continue seeing him. Breaking up is hard to do.

  17. I’m contemplating a break up with my neurologist, despite the fact that he is a caring, talented physician. In fact, after reading your post, I realize that our separation is overdue. We share the blame: He’s to blame for repeatedly bad-mouthing two of my other doctors; I am to blame for not calling him on it, immediately and clearly. By the time I worked up my resolve, I only managed to look weirdly noncompliant (he had strongly “suggested” that I “get rid of” one of the two, and when I didn’t, he assumed I misunderstood his “directions” — when actually, I simply know the tremendous value of that doctor ). The feeling you get when you see “discharge” next to a patient’s name in your schedule? I get the same feeling when I see my neurologist’s name on my kitchen calendar! It’s a shame… it is precisely due to what I’m going to call his “independent spirit” that he won me over in the beginning. He diagnosed a problem that was politically problematic for his hospital and its staff, saying “my allegiance is to my patients, not to the hospital corporation.” Unfortunately, the window of opportunity for treatment had closed by the time I found him — but he remained a real source of encouragement. I hate that this has happened, but am tired of feeling put in the middle between him and doctors with whom he has issues.
    Wow. I think I just had a therapy session here in your comment section. Thank you for providing the impetus! (That’s me over there on the freudian looking chaise longue. Next to the llama…)

    Free Zippy!

    I r

  18. I’m contemplating a break up with my neurologist, despite the fact that he is a caring, talented physician. In fact, after reading your post, I realize that our separation is overdue. We share the blame: He’s to blame for repeatedly bad-mouthing two of my other doctors; I am to blame for not calling him on it, immediately and clearly. By the time I worked up my resolve, I only managed to look weirdly noncompliant (he had strongly “suggested” that I “get rid of” one of the two, and when I didn’t, he assumed I misunderstood his “directions” — when actually, I simply know the tremendous value of that doctor ). The feeling you get when you see “discharge” next to a patient’s name in your schedule? I get the same feeling when I see my neurologist’s name on my kitchen calendar! It’s a shame… it is precisely due to what I’m going to call his “independent spirit” that he won me over in the beginning. He diagnosed a problem that was politically problematic for his hospital and its staff, saying “my allegiance is to my patients, not to the hospital corporation.” Unfortunately, the window of opportunity for treatment had closed by the time I found him — but he remained a real source of encouragement. I hate that this has happened, but am tired of feeling put in the middle between him and doctors with whom he has issues.
    Wow. I think I just had a therapy session here in your comment section. Thank you for providing the impetus! (That’s me over there on the freudian looking chaise longue. Next to the llama…)

    Free Zippy!

    I r

  19. That is a very lousy problem. How often do you need a Rhematologist? Is there any way you can go to an adult Rheumatologist? If you don’t go more that 2x/year, it may be worth the 5 hour drive. I hate it when doctors do this kind of thing.

  20. That is a very lousy problem. How often do you need a Rhematologist? Is there any way you can go to an adult Rheumatologist? If you don’t go more that 2x/year, it may be worth the 5 hour drive. I hate it when doctors do this kind of thing.

  21. She goes every two months. He is an adult dr. and part of the only group that will do pediatrics here. She has been to Duke and Cin to see ped. rheums. who aren’t able to give a clear dx either. No big deal there. Lots of rheumatology isn’t clear cut. This guy is a nice person and we have some social contact with his family. Great wife, great kids. But he seems frustrated and doesn’t listen or try to figure it out any longer. After throwing out some wrong ideas and blowing off issues that other drs finally acted on (neutropenia, the need for finger splints, etc) I have no faith in his treatment at all. If I had any better ideas, or if Cin or Duke come up with any, I would push to change her meds. Since we have tried everything from high dose aspirin to Enbrel, there doesn’t seem to be much reason to pursue it. I need his MTX script and standing orders. We show up every couple of months to be compliant and get the refill. It isn’t a hostile situation, just useless and a waste of time, effort and money. I usually get her lab results when I am at work (our Children’s hosp) and only talk to the office if something has changed enough to act on. We aren’t hostile or anything. Odds are he thinks I am happy with what is going on since I don’t keep bringing it up. But truth be known, I won’t go along with any ideas that weren’t my ideas to start with. For now we consult with a ped rheum. every year and hope for the best.

  22. She goes every two months. He is an adult dr. and part of the only group that will do pediatrics here. She has been to Duke and Cin to see ped. rheums. who aren’t able to give a clear dx either. No big deal there. Lots of rheumatology isn’t clear cut. This guy is a nice person and we have some social contact with his family. Great wife, great kids. But he seems frustrated and doesn’t listen or try to figure it out any longer. After throwing out some wrong ideas and blowing off issues that other drs finally acted on (neutropenia, the need for finger splints, etc) I have no faith in his treatment at all. If I had any better ideas, or if Cin or Duke come up with any, I would push to change her meds. Since we have tried everything from high dose aspirin to Enbrel, there doesn’t seem to be much reason to pursue it. I need his MTX script and standing orders. We show up every couple of months to be compliant and get the refill. It isn’t a hostile situation, just useless and a waste of time, effort and money. I usually get her lab results when I am at work (our Children’s hosp) and only talk to the office if something has changed enough to act on. We aren’t hostile or anything. Odds are he thinks I am happy with what is going on since I don’t keep bringing it up. But truth be known, I won’t go along with any ideas that weren’t my ideas to start with. For now we consult with a ped rheum. every year and hope for the best.

  23. We have seen several of our patients in our PT office abandoned by their specialists. What is the difference between discharging a pt. and abandoning them? Sometimes there is not another specialist in the area. Even if they are difficult or non-compliant they have a right to medicare care.

  24. We have seen several of our patients in our PT office abandoned by their specialists. What is the difference between discharging a pt. and abandoning them? Sometimes there is not another specialist in the area. Even if they are difficult or non-compliant they have a right to medicare care.

  25. Hi Rob – Great post and so clever with the breakup theme. I am hearing the song in my head as I type. You are such a compassionate doc and I know that i would be thrilled to go to you and my family too if you were here in NJ. 🙂
    You might be surprised to hear this, but …I am a chatty patient 😉 and admittedly…they have to reign me in sometimes, but we have a good rapport. My pcp is also chatty and we both could go off on other topics and my urologist is more quiet.. but is a good listener and they both take good care of me and as I have written many times …am most grateful that I have such terrific doctors. I have other ones but these two have done the most and my urologist has worked hard to facilitate healing with this stubborn urological condition. When it looked like I had to have the reconstructive surgery because it would be a high risk..he was referring me out so I could be in a tertiary facility, with uro wing and docs 24/7, etc.

    Even tho I understood why… i was immediately upset and afraid because I only wanted him and his partners and the community hospital, etc..

    However, I have the utmost respect for any physician who encourages patients to get a second opinion or refers them out when necessary. Fortunately ..I’ve been able to avoid the surgery thus far. (I wonder why Sari’s child’s doc doesn’t consult with his partners? I know the docs at the uro group consult on their patients because my doc has told me. i see that as a sign of strength and wisdom if a doc is willing to consult and refer out. Then I know sometimes they refer out for self preservation… but I am thinking of the docs secure enough to not be afraid of 2nd opinions, or more.

    I was just thinking the other day how good it feels to know my urologist knows my difficult case inside out, knows my physical and probably emotional reactions, knows what meds work, trusts me as a historian with symptoms and we work well together. that does not happen over night, but has evolved over the last 3 1/2 yrs. i have experienced quality care and concern from him both in the hospital and in the office. Even the hospital nurses told me how he checked often on me in the hospital. I thought how vulnerable and afraid I’d feel all over again if I had to start over, Obviously there are many fine doctors that could take over care… but I think the Dr/pt bond is a sacred trust… unspoken …but grows with time.

    My mother’s doc really hurt her. she had gone to him for yrs. he was a surgeon who also saw reg patients..including gynecology patients. he let irregular cells go to long in my mother (6 mos) then said she should have a hysterectomy (at around 70) because after all she’s not having anymore babies. per and ED doc’s suggestion (worked with him), I brought her to my gyne doc. He did cryosurgery and she was perfectly fine after that. her doc said it was time for her pap and Mom said she’d be keeping the gyne doc for that and would stay with him for the rest. he said “if you don’t want me for everything… then you don’t want me for your doctor.” he dropped her..just like that after around 18 or more years. She was so hurt. I believe they call that abandonment and doctors can be sued for patient abandonment. We would never so that.. but it is a serious thing.

    And of course..as you wrote.. doctors certainly have a right to discharge a pt when it’s not working… but not the way it was done with mom.

    I’m sorry do long with this.

    If any DR had such little respect or concern for our child or our concerns because he had to keep his ego intact…I’d move mountains to get away from him. How selfish and egregious on his part! I would NOT trust him to provide quality care. i would think there are regulations against what he is doing.. holding you captive by being the only one who can provide a prescription, etc. in the area.

    And like in breakups… why would he even want a patient that does NOT want to be there?

    I also could not go to a doctor I did not feel a food rapport with. Mutual trust is key.
    *****************************************
    As far as discharging patients if they are non-compliant *in the future if new regulations force the issue*… wouldn’t doctors lose a high percentage of patients because obesity would seem to be a non-compliant situation and it is pervasive in the American population?

    I have wrestled with yo-yoing weight and overweight. Obesity is a very complex issue! Yes..simple in calories consumed and energy expended/calories burned… but the causes varied and often more complex. If it was so easy.. more people would lose weight and we’d all maintain that weight loss. Even Oprah with her trainers, chefs and money can’t keep it off. i am not trying to make excuses… but that is certainly not a black and white issue. What about addictive behavior in the equation?

    I agree with Bianca… blogging cathartic.. like therapy.. but free. 😉

  26. Hi Rob – Great post and so clever with the breakup theme. I am hearing the song in my head as I type. You are such a compassionate doc and I know that i would be thrilled to go to you and my family too if you were here in NJ. 🙂
    You might be surprised to hear this, but …I am a chatty patient 😉 and admittedly…they have to reign me in sometimes, but we have a good rapport. My pcp is also chatty and we both could go off on other topics and my urologist is more quiet.. but is a good listener and they both take good care of me and as I have written many times …am most grateful that I have such terrific doctors. I have other ones but these two have done the most and my urologist has worked hard to facilitate healing with this stubborn urological condition. When it looked like I had to have the reconstructive surgery because it would be a high risk..he was referring me out so I could be in a tertiary facility, with uro wing and docs 24/7, etc.

    Even tho I understood why… i was immediately upset and afraid because I only wanted him and his partners and the community hospital, etc..

    However, I have the utmost respect for any physician who encourages patients to get a second opinion or refers them out when necessary. Fortunately ..I’ve been able to avoid the surgery thus far. (I wonder why Sari’s child’s doc doesn’t consult with his partners? I know the docs at the uro group consult on their patients because my doc has told me. i see that as a sign of strength and wisdom if a doc is willing to consult and refer out. Then I know sometimes they refer out for self preservation… but I am thinking of the docs secure enough to not be afraid of 2nd opinions, or more.

    I was just thinking the other day how good it feels to know my urologist knows my difficult case inside out, knows my physical and probably emotional reactions, knows what meds work, trusts me as a historian with symptoms and we work well together. that does not happen over night, but has evolved over the last 3 1/2 yrs. i have experienced quality care and concern from him both in the hospital and in the office. Even the hospital nurses told me how he checked often on me in the hospital. I thought how vulnerable and afraid I’d feel all over again if I had to start over, Obviously there are many fine doctors that could take over care… but I think the Dr/pt bond is a sacred trust… unspoken …but grows with time.

    My mother’s doc really hurt her. she had gone to him for yrs. he was a surgeon who also saw reg patients..including gynecology patients. he let irregular cells go to long in my mother (6 mos) then said she should have a hysterectomy (at around 70) because after all she’s not having anymore babies. per and ED doc’s suggestion (worked with him), I brought her to my gyne doc. He did cryosurgery and she was perfectly fine after that. her doc said it was time for her pap and Mom said she’d be keeping the gyne doc for that and would stay with him for the rest. he said “if you don’t want me for everything… then you don’t want me for your doctor.” he dropped her..just like that after around 18 or more years. She was so hurt. I believe they call that abandonment and doctors can be sued for patient abandonment. We would never so that.. but it is a serious thing.

    And of course..as you wrote.. doctors certainly have a right to discharge a pt when it’s not working… but not the way it was done with mom.

    I’m sorry do long with this.

    If any DR had such little respect or concern for our child or our concerns because he had to keep his ego intact…I’d move mountains to get away from him. How selfish and egregious on his part! I would NOT trust him to provide quality care. i would think there are regulations against what he is doing.. holding you captive by being the only one who can provide a prescription, etc. in the area.

    And like in breakups… why would he even want a patient that does NOT want to be there?

    I also could not go to a doctor I did not feel a food rapport with. Mutual trust is key.
    *****************************************
    As far as discharging patients if they are non-compliant *in the future if new regulations force the issue*… wouldn’t doctors lose a high percentage of patients because obesity would seem to be a non-compliant situation and it is pervasive in the American population?

    I have wrestled with yo-yoing weight and overweight. Obesity is a very complex issue! Yes..simple in calories consumed and energy expended/calories burned… but the causes varied and often more complex. If it was so easy.. more people would lose weight and we’d all maintain that weight loss. Even Oprah with her trainers, chefs and money can’t keep it off. i am not trying to make excuses… but that is certainly not a black and white issue. What about addictive behavior in the equation?

    I agree with Bianca… blogging cathartic.. like therapy.. but free. 😉

  27. P.S. Sorry about the typos …especially “food rapport” should be good rapport …although I suppose could be a Freudian slip … since I like to bring them food. 🙂
    Actually …I’m typing in the dark.

  28. P.S. Sorry about the typos …especially “food rapport” should be good rapport …although I suppose could be a Freudian slip … since I like to bring them food. 🙂
    Actually …I’m typing in the dark.

  29. What can be done to a doctor that discharged me for what my exwife did to break her contract ( which had nothing to do with me) and I didn’t break my contract. I have been on oxycontin for months now , I haven’t been able to work in two years so the doctors office worked out a payment plan with the hospital that owns it anyway now that my doctor discharged me i can’t afford the vists much less the prescription, isn’t it harmful to stop taking oxycontin all at once and if so what can i do? I’m starting to wonder if she’s sampling her meds.

  30. What can be done to a doctor that discharged me for what my exwife did to break her contract ( which had nothing to do with me) and I didn’t break my contract. I have been on oxycontin for months now , I haven’t been able to work in two years so the doctors office worked out a payment plan with the hospital that owns it anyway now that my doctor discharged me i can’t afford the vists much less the prescription, isn’t it harmful to stop taking oxycontin all at once and if so what can i do? I’m starting to wonder if she’s sampling her meds.

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