The pains of pain management

Had a pleasant female patient today that was referred to me by her son. The interesting thing was that I had discharged her son from my practice a month ago for getting prescriptions from another physician. For those who are unaware, in pain medicine, we have contracts with patients that they can only get their pain medications from us. This patient got pain meds from their surgeon but then also got pain meds from me only a week later. Anyway, the mother was irate that I did this to her son and that worst of all, I only sent a letter and didn’t do it in person. I apologized of course but also mentioned that this is typical and that if every person that was released had a personal interview, I would never get my work done. I say this because these exit interviews would take an hour apiece since most of these people would not accept the release without a “fight”. They would try to convince me to take them back. What many don’t realize is that at least 25% of the people who first come to see me are “drug seekers” that want the peoples for reasons not related to pain. This leads to the revolving door associated with pain patients. People come in and people go out. This is far different than what it used to be years ago where my days were just procedures and surgeries and the primary care docs took care of the meds. But now with all the problems with narcotic abuse, the state feels that we are better trained to do the work. Obvious we have more experience with these meds but primary care doctors also can quite adequately manage simple cases. Nonetheless, we are the ones who manage the pain meds, we determine who gets them and who doesn’t. We have a lot of responsibility but with little reward. Patients fail to realize the stress we are under having to deal with people who all day are in pain and are unhappy. We have to push those along who would rather just take pain pills and we have to sometimes act like parents telling patients that they either do this or that or else we have to release them. It is a stressful job. This is especially true since you get paid only around $50 per patient visit and the liability is outrageous. In fact, most pain docs would only do injections as we used to do except that today no one would send anyone to you. Thus, you have to take the good with the bad in private practice. Thus, the point to all this is please give us pain doctors a little slack. We are not trying to be mean. We are trying to cause pain by reducing your meds. We are not evil for cutting you off. We are just doing our jobs and trying to not lose our licenses. So next time you see your pain doc, tell him he’s doing a good job. I would say hug him but I don’t like being hugged.

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