Up onto the scaffold, pain "management" clinic

Or, “So you’re in pain, eh? You’ll manage!”

This is not about me (but it is uncharacteristically long).

A close relative (let’s call her ‘my mother’) had surgery about a month ago to replace old implants that she received after a prior mastectomy, and to perform some kind of reconstruction of surrounding tissues that had collapsed. Since then, she has experienced daily and constant severe pain, particularly on one side. The surgeon, unable to find an infection or anything unusual, referred her to a pain management specialist.

“Great,” I foolishly thought—from what I’d heard of pain clinics, they were strictly regulated and monitored their patients carefully, but in turn were allowed to prescribe stronger (or greater amounts of) pain medication than a “regular” doctor might feel comfortable with. And the regulation part certainly panned out: my mother was drug-screened (and handed a consent form afterward, oops we forgot to have you sign this) and required to sign pages and pages of legal forms consenting, among other things, to not seek treatment elsewhere while they were treating her.

After all the hoop-jumping, the doctor—who was arrogant and aloof, rushed through the exam, and directed my mother to ask questions of his nurse rather than answering them himself—prescribed her little more than JACK SHIT: some anesthetic patches and an anticonvulsant drug, neither of which did anything for the pain, although the latter did render her unconscious for more than 20 hours and left her with a terrible hangover.

When called and informed that the medication wasn’t helping, the snotty gatekeeper advised my mother to bring in the remainder of her unused prescription when she comes in for her next visit in eleven days. “Sorry,” they told her, “you’re not an established patient, so we don’t know that you won’t try to sell your pain meds. Blame it on the bad apples who ruin it for everyone else.”

So, mother—a woman in her mid-sixties with no history of prescription drug abuse, who drinks a single beer once in a blue moon, and who’s never touched an illegal drug, even pot, in her entire life—is sitting at home in tears, suffering and unable to seek alternate treatment from someone who actually gives a shit. Her son, meanwhile, is fighting an overpowering urge to pay a visit to the pain “specialist” and wring his neck—or better still, shatter his kneecaps with a crowbar and tell him to “walk it off.”

And I’m not buying the “bad apples” bullshit; if your default assumption is that your patients are drug-seeking criminals who somehow must prove otherwise, there is something seriously wrong with your practice (and whatever soiled tatters remain of your empathy). Forcing legitimate patients to suffer because of the possibility someone might misuse drugs? Does that not, in fact, create more overall harm than the abuse itself, where and when it does occur?

My mother is the farthest thing from a “drug seeker” these people will likely ever see—she hates taking painkillers, and most of her prescriptions expire in her medicine cabinet long before they are consumed. If she’s asking for pain meds, it’s because she really, really needs them.

And I am one pissed-off Turnip.

I assume this is US health “care”?

I don’t blame you for being pissed.

A few years ago, I asked for a referral to the local pain management clinic for serious chronic neck pain. It’s not a surgical problem, so medication and physical therapy are the only things that work for it.

Anyway, I called the clinic for an appointment. The receptionist told me that I had to fast for six hours before the appointment and bring someone “in case Doctor decides to give you a shot.” Now, I know about spinal injections. They’re sort of a last-ditch thing if nothing else works. I also know that they’re not something that “Doctor” decides unilaterally – at least not with me.

Fortunately, PT works well and I found a combination of drugs that work. “Doctor” and his receptionist can fuck themselves.


Hijack: Did I miss a medical care meeting in which it was decreed that this is the proper way to refer to the doctors you work with? I hear that All The Freaking Time when I call other medical offices. “I can consult with Doctor and get right back to you,” and so on. WTF. That is not their given name, as much as some of them seem to think so at times. Please use “a doctor,” “the doctor,” “Dr. [Lastname],” and other conventional, accepted phrases in American English, thank you. At least no one in my department uses that weird-ass phrasing.

Don’t bother being angry at him. He’s only acting like that because of the hospital, the state licensing boards, the DEA, Congress, and the entire Drug War siege mentality that has obtained since Mexicans introduced weed to our virginal youths and maidens in the 1920s, in that order. The fact those immoral, nasty drugs have legitimate uses is only grudgingly accepted; ideally, they’d all make you violently ill and be impossible to crush or dissolve without forming deadly and ineradicable toxins.

But you’ll be pleased to know it’s perfectly legal and moral according to the most stringent Federal, state, and local standards.

Tis a far, far better thing to have thousands suffer with untreated or mis-treated pain than to have even one oxycontin pill diverted to a trailer park loser.

Yes, exactly. The pain management clinic is being forced to operate by a rulebook written by the same pinheads who decided to put Sudafed behind the counter at the pharmacy. It sucks, but blame ultimately resides upstream.

Most pain management physicians don’t run their practices that way. IME, they can’t wait to give somebody the good stuff.

This is where my mistaken impression came from, as I’ve seen people online praising their own pain management clinic/doctor. Sadly, it appears to be a crapshoot, and my mom rolled snake eyes and got a diffident, bureaucratic sadist. Or perhaps a sadistic bureaucrat—I’m not sure how he prioritizes. I don’t know what kind of crap she had to sign before they agreed to “treat” her, but I imagine it’s going to make changing doctors difficult at best. The surgeon now refuses to prescribe her anything further while she’s under the “care” of this pain clinic.

Vinyl Turnip, your doctor may have been a jerk, but you are definitely going way overboard here. Calm down, because you’re not helping and are just going to get addicted to Rageahol. The doctor did was he had to, and it’s very difficult to predict how people will respond to medication. His manners might be better, but that’s as good as medicine gets right now.

He isn’t my doctor and I haven’t raged anywhere but in this thread. And sorry, but rationalizing that the doctor had no other choice / that’s just the way things are nowadays doesn’t fly. If she’d been referred to a different doctor/clinic, she may have had a completely different outcome. There are rules, but that doesn’t render every doctor a brainless automaton.

Some achieve that state on their own, but in most cases the patient is free to look elsewhere for better treatment. Not so in this case, which is why it’s so frustrating.

This is a totally bullshit post. This doctor is in the business of pain management. His JOB is to ensure that his patients experience less pain - if he’s prescribed something that hasn’t worked it’s his responsibility to ensure that the patient has something that does work, and not make them wait 11 days to see him.

The same bullshit happened to my grandmother when she was being diagnosed with cancer. She had metastic bone cancer pain and was advised to take Advil for a long weekend because her Dr. was too busy to see her.

Complete and total crap. Frankly, the fact that Vinyl Turnip hasn’t ripped this douchy doctor’s lungs out speaks to his self control.

Bullshit. She can, and should, seek care elsewhere RIGHT NOW. Your physician CANNOT forbid you from seeing another physician.

Jeez. I’ve got to assume you’re didn’t read the OP closely and just tossed off a quick response.

A decent doctor doesn’t casually leave a patient in terrible suffering for eleven days. Especially a doctor specializing in pain management.

No decent person acts that way.

Sounds like my practice, all right! :smiley:

Seriously, it’s not easy to run a pain clinic. Og knows I do my best with chronic pain patients, here behind the razor wire.

But it sounds like the pain clinic in the OP’s tale sure could do a better job.

IME, physiatrists on average run better pain clinics than anesthesiologists. YMMV.

But there may be laws about “doctor shopping” that might be relevant here. Some drug users will go to several different doctors to get pain medication, so they can get more than would ordinarily be prescribed.

If there’s no schedule room…

As it happens, this doctor is an anesthesiologist, so our mileages align pretty well so far.

I agree that leeway should be given on scheduling— I wouldn’t expect them to drop everything to fit her in. At the same time, I don’t think it’s unreasonable to expect them to do something for her in the meantime, rather than saying “come back if you’re still in pain 11 days from now.” I’m sorry, Mrs. Turnip, but the doctor is completely booked—but we’ll phone in a prescription for 20 Lortab for you until your next visit. (Or if they can’t do that for some reason, have her come in to pick up the script.) I’ve had doctors work with me that way before, and so has she— so what makes this situation so problematic? They already have a piss-cup full of evidence that she’s not a druggie, and it’s highly unlikely that a retirement-age woman is going to embark on a criminal enterprise diverting narcotics from a single prescription.

Anyway, I think I’m done ranting.

I’m sorry, but this is a whole bunch of bullshit. Pain kills people. Slowly and awfully. Fuck a bunch of “the doctor did what he had to.” He didn’t have to make this cancer surviving senior citizen wait nearly two weeks for a follow-up appointment when his first efforts failed. He didn’t have to have his receptionist use the “you could be a drug-seeker or seller” excuse to the patient herself as a reason for not providing any additional help until this ridiculously late date second appointment. It was all choice and it all sucks.

usually pt contracts to not seek other care are along the lines of ‘we’ll drop you as a pt if we find out your getting pain drugs from other places,’ which is a very common occurence, and a perfectly reaonable practice precaution on the part of pain management clinics.
You might consider contacting the office again, letting them know in advance that she’s still in severe pain and if they can’t fit her in you’ll take her to the ER. If you do, be clear to the ER staff that she’s a new pain management pt who hasn’t achieved relief yet and get copies of her treatment for the pain doc. It’s unlikely that the ER will give you anything but temporary relief, but that may be worth it to you for now. Also you should try to go during office hours so the ER can call the pain management doc if they want. Give the pain doc a follow up report and if they drop you anyway, file a grievance. You might consider starting the search for another doc sooner rather than later.