Manchikanti classified 4 types of troubled physicians who write prescriptions for controlled substances. A provider who matches one or more of these types is likely to get into trouble eventually. The author is from the American Society of Interventional Pain Physicians.


Types of troubled doctors (the 4 D's):

(1) deficient or dated

(2) duped

(3) deliberate or dealing

(4) drug dependent


A deficient doctor has deficient or dated knowledge:

(1) limited knowledge of drugs and non-drug options, especially for pain control

(2) prescribes for family and friends without maintaining a patient record

(3) unaware of signs or symptoms of drug dependency

(4) may be isolated from peers

(5) does not try to expand knowledge and learning


A duped doctor:

(1) gullible

(2) leaves prescription pads readily accessible to others

(3) presigns blank prescriptions

(4) writes prescriptions for patients who come in asking for a specific drug

(5) co-dependent with addicted patients and never refuses any request


A deliberate or dealing doctor:

(1) sells drugs for money, sex, street drugs, or services

(2) attracts drug-seeking patients

(3) writes prescriptions for known addicts


A drug dependent doctor:

(1) may have started using samples of controlled substances

(2) asks staff to pick up prescriptions written in their names

(3) uses another doctor's DEA number to write prescriptions

(4) calls in prescriptions for family members or patients and then picks up the prescription


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