An Enlightened Moment

I really try to pride myself on being a caring and compationate guy. Thus, I was very susprised the other day when a patient told me that I treated him poorly. I appologized for anything that I might had done but he felt that I didn’t take his pain seriously enough. Those who know me know that truly want to help people and if you want to get better, then I will try and help you get there. Nonetheless, in the business of pain medicine you can sometimes get jaded. What most of my patients don’t t realize is that probably 25% of the people that walk through my doors are drug seekers. Every month, I have to discharge people who simply means that I will not treat them anymore. Imagine if you were in a profession where one out of four of whatever you worked on, be it cars, appliances, whatever were bad or broken. You too would get jaded, especially if your job depended on you reconizing these people. Obviously, that is not an excuse to not treat people with great respect but as one would image, you have to be on your toes and be observant of these potential abusers. This is the ultimate catch-22 where you have to believe everyone but at the same time trust no one. I think most of Board Certified Pain Medicine doctors do a fairly good job of this, but we are not perfect. Thus, I hope potential patients understand our hardship and that we have to protect our licenses and be suspicious but at the same time caring and compationate. It is almost like you have a teenage daughter that you have one eye on all the time because you feel they’re up to no good but at the same time you are hugging them and telling them that you love them. It is a fine line in our business. This is why we regularly drug test people. I had a friend who was a primary care doctor and he was providing pain medications to some of his patients and I told him to be very careful and drug test them since he was not doing that. after he started drug testing his patients he came to me in shock at the number of people who couldn’t pass their drug tests and he said that he understands why the state doesn’t want primary care people providing controlled substances because people slip through the cracks. These people who abuse these controlled medications are bad people for multiple reasons but the main reason is because they make it more difficult for legitimate patients from being able to get pain medications. The problem with abuse is so severe that recently an organization called PROM (Physicians for responsible Opiate Management) lobbied the DEA and FDA to try and get any long term usage of pain medication eliminated beyond 90 days. They failed to get the legilation that they desired because their wants were too restrictive but there are people who are very concerned about pain medication usage. It is a well known fact that more people die each year from opiate abuse then car accidents. That isn’t a typo, over 30,000 people die each year from abusing pain medications and laws are changing to solve these problems. In Florida, the pendulum when far to the other side and the laws are very restrictive since 2010. These changes have also reduced the number of overdoses significantly and other states are following Florida’s lead. Expect things to get tighter for pain medications whilst they get easier for other baby boomer drugs like marijuana. Why do I bring this up? Because if we are to protect your rights to realistic and reasonable pain control for real problems then these changes are needed. This is why we in pain management sometimes seem tough or hyper-vigilant. This is why we drug test all the time. This is why some of us do random pill counts and abuse questionaires. It is not only to protect our licenses but to protect your right to pain control. In few medical practices do doctors and patients see each other more than in pain maganement. A lot of my patients I know without looking at their charts. But i cannot be complanent. The past month I have been giving my patients a shorter version of above plus I have mentioned how they could confirm that they are compliant with their pain magement program. A compliant person is one who doesn’t get released or discharged. Amazing simple are these suggestions and they will work with any pain medicine doctor.
1. Do what we request of you. If we refer you for a study, test, injection or referral then do it in a timely manner. People who really want to get better actually will do something to get better!
2. Take your medications as prescribed and don’t run out of medications. People who are capable of living a week without pain medications can easily live a month without them or even a year and thus probably don’t need them. People who run out of medications are abusing their medications
3. Don’t Share medications with others. Believe it or not but this is considered drug trafficing and you might as well be sharing heroin as far as the government is concerned. This is a felony and it doesn’t matter if the person is your brother or your wife or the guy down the street.
4. Don’t take illegal drugs. One of the interesting things about pain medicine is that patients think that we make a lot of money prescribing pain medications. Nothing could be further from the truth. Most pain management doctors are anesthesiologists and thus are trained in procedures. Procedures is what we are trained to do and what we get paid to do. We take care of pain medications because it is part of our job. Thus any pain medicine doctor is going to drop you very quickly for abusing illegal substances. I thought process on it is as such, if you have the ability to purchase illegal drugs then you also have the ability to sell drugs. Taking illegal drugs is a felony (usually) so don’t do it.
5. Only get pain medications from one doctor unless it has been approved. Getting pain medications from multiple sources is considered doctor shopping and is also a felony. Today, there are state run DEA portals where we can find out about every drug that you are getting. Insurance companies regularly send us lists of what medications you are on and from whom you are getting them. It is very difficult to doctor shop nowadays for any length of time.
Amazingily these are fairly simple requirements but it is also how amazing it is that people fail to follow them. I have had patients call my office for an appointment because the pain doctors in panama city or pensacola have blacklisted them. Obviously, I don’t want them because they have abuse problems. I can understand getting discharged for some minor reason but repetitive discharges usually mean abuse issues. In closing, please remember that we as pain management physicians are on your side and we want to help you but we also have to be on the look out for people who are ruining the system. Its just the way things are and they aren’t going to change anytime soon.

One Comment

  • Sharia Zones in Britain? Only in the minds of a very small number of Islamic eeisxmtrts and the tabloid press. This was a story that the rightwing press in the UK then blew out of all proportion and in so doing, gave a whole heap of publicity to a bunch of fantasists. Your reference to Sharia Zones as if they were fact just helps sell the lie.Pity the stats got taken down before I could see them. As someone who works in the NHS, I’d have loved to see the latest skewed version of reality’ being spouted in order to attack basic healthcare for all.

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