Urine Drug Tests

Physicians 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 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 with 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 patient’s 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 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 oftentimes 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 had. 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 patient's 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.

Christopher Drumm M.D.

Norristown Family Physicians