Bucks Montgomery Physician Spring 2021 - 20

CREATIVE CORNER

Testing -
Urine Drug Testing
by Christopher Drumm, M.D., Norristown Family Physicians

P

hysicians often say the hardest thing about
medical school was getting in. I am not sure
that I agree but the rest of the experiences do
not happen if you do not get in. How do you get into
medical school? A test score is the main answer. We all
had to take the MCAT. I remember realizing that many
of my friends had taken a full prep course for this test
while I had been teaching myself from a workbook to
take a test that would decide whether or not my life's
dream would come true. I cannot imagine where my
life would be if I had not done decent on that test.
Medical school was all about tests. We had different
systems taught in modules ending with a test. The first
2 years were more about passing tests than learning
for me. It was biochemistry and physiology, and I was
still trying to process how this information would help
me take care of patients. Third year of medical school
things start to come together. Each rotation was followed
by a test but at least these tests were asking clinical
information. We have Step 1 and then Step 2 and Step
3 and then board certification. The tests keep coming.
But one has finally been canceled. The Step 2 Clinical
Skills exam has been canceled. This was the test that
cost over 1000 dollars. It was also only held in 4 cities
at the time I was in medical school. This test consisted
of medical students interviewing standardized patients.
I think that this cancellation was a step in the right
direction. Medical schools have the patient interaction/
experience added into their curriculums. This test was
a money grab for the boards. The financial and mental
stress that adding this test in was too much for medical
students. From the time it was started many knew this test
was wasteful. All we needed was a pandemic to end it.
It is a new year and we have been updating our
controlled substance contracts in my office. Which
means I have been testing my patients' urine. This
is a test that one cannot study for. Most patients are
taking medicine for the right reasons but the UDS does
shed some light on the substance abuse issues that

18 BUCKS/MONTGOMERY PHYSICIAN

winter 2021

patients are not also forthcoming about. In medical
school there is a plan to focus on certain areas if a
particular test is failed. Tutoring and extra study time.
But what to do if a patient fails a urine drug test?
Do I cut the patient off immediately? Do we taper down?
I many times have asked the patient if they had issues with
substance abuse. But often times patients do not want to
admit. There was a mistake. My pills got flushed down
the toilet, so I had to take something else. I promise that
I did not take that. One even wanted to do a lie detector
test. I do not argue about the validity. This is not meant to
be punitive: I am trying to find ways with these failed tests
to see in which ways I can help this patient going forward.
But in a way without prescribing controlled medicines.
Tests are bad. Tests are stressful. We need to find a way
if someone does not do well on a test to help them
perform better in the future. I love seeing patients but
still hate discussing their urine drug tests. I am getting
ready to take the Family Medicine Boards again. At this
point in my career, I would do well in the Step 2 CS, but
I am glad it is gone. Due to the opiate epidemic, we need
to work together to make sure that urine drug tests that
are abnormal can lead to ways to help patients. Everyone
needs to find ways to use this to help improve patients'
lives. We can figure this answer out together. If you do
not have the answer right now that is ok. It is not a test.
Bucks Montgomery Physician Spring 2021

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