Interacting with Healthcare professionals

tennis matchInteraction with a healthcare professional should be like a “tennis match”… one party asks a question… other party answers and vice versa…

Everything that a healthcare professional does should be guided by BEST PRACTICES and STANDARD OF CARE for a particular disease state.

I am hearing from a lot of chronic pain pts that the seemingly the first question out of the healthcare professional’s mouth is “what medications can we reduce”.. it is understood that they are talking about opiates or other controlled meds that the pt is currently taking…

Of course, the pt automatically gets defensive… because they understand that what is going to happen is their pain is going to increase, their quality of life is going to decrease and they are going to end up being house, chair, bed confined. If they are still working.. they may have to quit their job, and their ability to be a good spouse or parent is going to be compromised.

Instead of becoming defensive.. perhaps the pt should become offensive…. such as the follow conversation …

HCP… let’s see you have been on this med (opiate) for several years… we need to start reducing your dose..

PT… Good.. let’s also talk about reducing my other meds ( hypertension, diabetes, cholesterol, thyroid )….

HCP… I can’t reduce those other meds… you need those to properly manage your chronic conditions …

PT… So I don’t need to properly manage my chronic pain… like I have to manage my other conditions…

HCP… well, chronic pain is different …

PT… So you don’t believe that I am in pain ?  that I am lying to you about my pain ?

HCP… No… it just that the DEA is saying that I should prescribe less opiates…

PT… so the DEA has established a standard of care and best practices for treating chronic pain… can I get a copy of those ?

HCP.. I don’t have them here right now…

PT.. give the HCP this quote from the DEA

The U.S. Drug Enforcement Administration is not trying to limit or ration access to opioid painkillers, according to a DEA spokesman who says “nothing should stand in the way” of a patient getting a legitimate prescription for pain medication filled.

“We’re not doctors. We’re regulators and enforcers of the law. If something is prescribed for a legitimate medical purpose, we’re certainly not going to get in the way,” said DEA spokesman Rusty Payne.

PT… so lets get back to discussing of my pain management and how the DEA is telling you to prescribe less !

If the healthcare arena.. there is this common saying… “if it is not documented… it did not happen…”.. the pt has just documented what the DEA has said and the HCP can’t produce documentation to give them cause to reduce your dose…  CHECK MATE !

24 Responses

  1. How do you find a doctor who will help you ? What a mess this is my doctor is always telling me I can’t keep writing for your pain medication. I am always so stressed out over losing help with this chronic pain. One reason I was put on pain medication is because my heart rate went so high with pain that it worried them. Ant one where do you find a doctor in Washington state , where ?

  2. then your disharged as a problem patient.

  3. Love reading all these perspectives but in 5 years I have never been cut off due to exceeding a morphine dose when I am not even on morphine due to severe allergies & out of the blue needing prior authorization which took 15 phone calks & 72 hrs no meds. My question if this happens again what should I do as I truly wanted to die. Is tge re anything. I am already concerned about this month & a delay. Tx u for the impending response I live in PA. E,

  4. Wish they had chronic pain said “How do companies that manufacture devices (at $150,000.00 a pop) to be used as oral opiate alternatives and dose reducers come into play here?” On the opposite side, I don’t understand why these opiate producers like Mylan, etc. aren’t screaming their heads off because of the drop in prescriptions! It has had to hit their bottom line. I suppose they are afraid of the DEA also.

  5. Steve just wanted to say THANK YOU FROM THE BOTTOM OF MY HURTING HEART!!!

  6. How do the companies that manufacture devices ( at $150,000.00 a pop ) to be used as oral opiate alternatives and dose reducers come into play here? Just wanted to throw that out there.

  7. […] Go on the offensive with health care providers […]

  8. I have agreat pm doctor (finally) but I sure wish I had had this “discussion” to use awhile back. Thanks for the great info!!

  9. I liked your posting here Steve. It put a smile on my face and ya know? It’s so true. If the other meds can’t be reduced, then why should a pain patients medicine for pain control be reduced? So the patient can’t do anything but lay in bed for the rest of their lives? This actually is happening right this minute. This whole mess is over board. What ever happened to just getting rid of pill mills, (btw was supposd to have been doctor offices that patients walked out with pills in hand, those were the real pill mills) that wasn’t enough… Screw up everyone’s lives who suffers with pain..

  10. I like the tennis match analogy. Dealing with healthcare professionals can be really tricky if you have the wrong attitude. This is really good to keep in mind for myself and anyone I know that ends up on pain medications for a while.

  11. PainCare2014….LOVE THIS!!!!!!!

  12. This quote from the DEA should read,

    The U.S. Drug Enforcement Administration is trying to limit and ration access to opioid painkillers by placing fear in all Pain Specialist and Pharmacist, if you prescribe or fill opiates you will get unwelcome visits by a DEA agent or two and pharmacy audits according to a DEA spokesman who says “we will stand in the way” of a pain patient getting a legitimate prescription for pain medication filled by putting the jobs of doctors and pharmacist at high risk.

    “We’re not doctors but pretend to be . We’re regulators and enforcers of the failed War on Drugs. If something is prescribed for a legitimate medical purpose, we’re certainly will make all pain sufferers more miserable and are going to get in the way of pain sufferers to make their lives more unbearable,” said all DEA agents.

  13. William I really believe in your world of pharmacy….Chronic pain is junk science to you and tolerance to narcotics after long term use necessitating increasing doses is also junk science. You must have missed class the day they talked about the difference between TRUE addiction and the body’s eventual tolerance and dependence on the narcotic dose. Seriously, I’d rather fill 9 good control scripts and 1 bad one..if the doc tells me he prescribing it for legit medical purpose, who am I to demand he bring me the chart, get real…let laws of Darwin figure it out. WAR ON DRUGS, PROHIBITION ON DRUGS HAS might wish to read the History behind the Harrison Act of 1914……had nothing to do really with protecting the public from the bad nasty drugs…it was racial prejudices. BTW as a RPh I usually discuss with my PCP and my husbands doctor about what therapy is going to be prescribed, havent been fired from a practice yet, matter of fact thet appreciate the dialogue.

  14. Then they say “you’re fired!”
    What then???

    • If they start discussing reducing your dose.. that is just the first step of many more discussion about further reductions… if you are a chronic pain pt… there are only two options.. you eliminate the cause of your pain.. or you take opiates to manage your pain.. If there is no clear reason – or treatable reason for your pain.. then your options drops to one.. We don’t cure hypertension, diabetes, high cholesterol, hypothyroidism … we help pts manage those conditions … generally with medications…if a prescriber is only interested in how many mgs of a opiate that you are taking.. and has no interest in helping you optimize your pain management and optimizing your quality of life.. then it is time to find a new doctor… or let you current doctor to whittle away at your quality of life..

      • what if u tell ur dr. ur in pain all the time and u know someone who gets pain killers from the same dr. and ur dr. tells u she cant prescribe u anything for the pain but she continues prescribing to other patients especially to this person that u know and u know this person aint in that much pain and u tell them u have this or that the other persons like ooh i have that too which my dr dont know i know this person i just dont understand why someone who is really in pain suffers while the person who really aint in pain gets prescribed can u help me understand this please

        blue dolphin

    • Candice what do you want to be in life ? Are you proud of yourself ?

  15. That’s a very nice fantasy conversation you had with yourself, Steve. How should PT respond when HCP says “No, I do not believe what you have is pain. What you have is addiction. What you experience when you reduce your dose is called withdrawal, not pain. Would you like to enter a rehab facility where your addiction can be treated in an appropriate manner?”

    PT may be confusing pain with withdrawal. After all, withdrawal hurts. Now that there is new focus on reducing unnecessary narcotic use, its up to HCP to determine what condition PT has and prescribe the appropriate course of treatment. Is it appropriate to treat addiction with opiates? Maybe, sometimes. But that isn’t PT’s decision, its HCP’s.

    I’m not making any absolute statements here. Each case has to be evaluated individually on its own facts. But PT cannot go to HCP with demands. That’s a good way to get your ass fired from a practice. PT has to trust HCP and follow orders or find a different HCP.

    • William you are entirely correct.. the pt has two options.. find a new HCP or go to a rehab center.. and then when it is documented that the pt is a legit chronic pain pt.. the pt can sue the HCP for at least pt abuse, malpractice, reckless negligence and defamation – because the pt’s medical record now has that the pt has been treated for addiction…

      • Exactly. This is why patients who are too f***ed up to treat, can’t find a doctor.

        This is very noticeable in veterans.

        The combat-wounded soldier who re-ups for another tour of duty, will get all necessary assistance from Army physicians, to remain on duty. Can’t sleep? Lunestra. Can’t think? Prozac. Can’t walk good? Muscle relaxant.

        Okay, maybe more than necessary.

        Nobody in the Medical Command will advise a good soldier to quit while still alive and somewhat healthy.

        Separate from service and good luck getting pain care.

        You might have a Bronze Star and two Purple Hearts, and a full ounce of steel fragments lodged anterior to your spine, courtesy of some fool who built them into an IED. In the Army, that made you a bad*ss. In civilian life, most PCPs won’t want you for a patient. If they don’t treat you, you will sue them out of practice. If they treat you, DEA will shove them out of practice. If they can’t find room in the schedule for an appointment with you unless you wait 4 months, you might go somewhere else.

        If you re-enlist, you get all the meds you need, to keep fighting until dead.

        Barney Ross Isn’t your CinC.

  16. Give a copy of the same to the pharmacist who INSISTS/DEMANDS TO the doctor that decreasing the pain medication is required or else the prescription doesnt get filled..{also called extortion in my volcabulary} .and ask the pharmacist where he/she got her MD degree and ask to see their state issued medical license that they are a doctor. Has anyone had any success filing a complaint with the state AGs and the state Pharmacy boards of pharmacists practicing medicine without a license???

    • Success or not we should all be filling out complaints when we have one. why? They may not do much about one persons problem but when they hear the same complaint over and over again they are force to eventually look into it. By saying my letters or my calls does not matter is the same thinking that keep American home when it comes to voting. What they dont realize that if people do not participate then the system does not work well. In this case the state can sound dumb because all they reply to are usually written complaints. I have a very hard time imagining that every chronic pain patient wrote just one letter a week to there state governor or Representative that we could stop this injustices. But people just do not want to make the effort and would rather whine and complain on facebook then act,

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