jbot
08-19-2004, 11:19 PM
Hello every one this is my 1st time post.I have been reading boards for a few months and have learned alot of info. I have been going to a PM dr since March. Out of all the time I have gone to her I have only seen her 2 times and her assistant the other 5 times. i`m not sure if they all billing my insurance for a dr. visit when I am seeing the assistant. i feel that i`m not getting the PM that i should be getting.I also have to do a drug test every time I go.(Like if i was going to do hard drugs i`d go through all this) Anyway i`d like to change PM dr and wonder what I need to do. I sign the contract and don`t know if i need to notify them of my intent or just not make another appt. I really feel they control all my medical life even to taking a aspirin.I don`t know if anyone else feels like this but thats just me.There are many things I don`t know and don`t have time to ask when i`m rushed in and out like a herd of cattle. One of my main concerns was if I end up in ER due to car accident or some other emergency. Will the minute i tell the ER drs what pain meds i`m on will they with hold any other pain med that I might need at the time because of being afraid of what i`m on already.I know this might sound confusing but it was just a thought. Its like pulling teeth to get any help with pain because i don`t 'look" like I have pain. Oh well any reply will be appreciated. I will write more later on my condition but part is fibro and disc problems and OA.............
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Kissa
08-19-2004, 11:48 PM
What is it exactly are you looking for in terms of a PM or rather what do you feel you'd like to change by finding a new PM? I think starting there will help some in deciding what to do for the right reasons.
You can probably be very sure your insurance is being billed for the time you spend with her assistant. They may also be billing your insurance for your drug screens. You can find that out by calling the insurance company and asking.
All PM's make you sign a contract and have the right to do a urine screen. Most PM's do not or do this on a really random basis, it is actually pretty important because it may potentially weed out those abusing medications. Unfortunately for those who have CP this seems a bit unfair, but it is a sacrifice we sometimes have to make.
PM's do control a large portion of your medication care. Some PM's make exceptions when it comes to ER's, I know mine does. If something happens and I end up in the ER and I need to get medication I can however I have 7 days to report this to the PM or else our contract is terminated. Some folks have indicated that some ER's will undermedicate you because they feel you are on strong enough meds, others have stated ER's offer the meds but the patient turns them down. The best advice in this situation is flat out ask your doctor what would happen or how the situation should be handled.
As far as being hearded in and hearded out, that is very normal and I think a great majority of PM's do this for a few reasons. The primary reason is it is a small speciality, the doctors are very few but the demand is great so many doctors double book or have an assistant help.
You do have the right to not be seen by the assistant and request you specifically see the doctor, I am not sure however how the doctor will react to this. I will not see my GP's assistant, she is wrong nearly every time I or my husband has had to deal with her so I am not willing to take that risk again.
If you have real concerns you have to be assertive and made them heard however don't over burden the doctor with 50 questions, try to ask a few of the most important ones first then over time ask others if you feel you still need to. This is true of all doctors. Some patients go to see a doctor lets say with a cold and while in the office they suddenly remember they strained their back, been having sinus issues and can't sleep much.. things like that, adding more illnesses to their grocery list unexpectedly. This is not fair to the doctor nor the patients waiting out side. I hope that made sense.
As far as finding a new one I honestly don't know how that would work. I would surmise that you should give notice to your current PM after making your appointment with new one, but remember it could be months before you can get into a new one which could be a sticky situation. You should be honest with the office and tell them exactly why you are looking for a new doctor. You can also tell the new PM when calling them the situation, you feel your level of care is not being met and you'd like to find a new doctor.
The real question is going to be if you go to a new doctor and they don't fit all your needs or try a completely different approach and you are not happy there then what will you do? If you skip from one PM to the next several times, yes this can be seen as a potential problem by the new doctors you are going to see. Because PM treatment is such a delicate situation with the abuse of medications doctors will screen their patients to be sure they aren't shopping. I am not saying you I am saying they can percieve that.
You could decide to not tell the new doctor about the old but this presents a really big problem. If you are on strong medications, lets say Oxy or MS C and you go to a new PM requesting this medication the likelyhood of them throwing you out would be great. How would you explain to them that this is the only medication that works for you? If on the other hand you don't tell the meds and they put you on something else much weaker you run a huge risk of withdrawals and severe pain. Being dishonest as you see is not a wise idea in this situation.
I guess what it boils down to is does your medication work? Is your only inconvienance being drug tested? You have to really ask yourself what are the valid reasons for wanting to change. Have you made an effort to speak specifically with the PM and voiced your concerns? I believe you should at least give this a try.
If your doctor is giving you a decent level of pain relief is that something you are willing to risk in the long run by changing doctors? These are the things I would think long and hard about before looking for a new doctor.
If your level of treatment of pain is nil and the doctor treats you bad, then yes, by all means you should seek out a new doctor.
Good luck to you
Barbie
You can probably be very sure your insurance is being billed for the time you spend with her assistant. They may also be billing your insurance for your drug screens. You can find that out by calling the insurance company and asking.
All PM's make you sign a contract and have the right to do a urine screen. Most PM's do not or do this on a really random basis, it is actually pretty important because it may potentially weed out those abusing medications. Unfortunately for those who have CP this seems a bit unfair, but it is a sacrifice we sometimes have to make.
PM's do control a large portion of your medication care. Some PM's make exceptions when it comes to ER's, I know mine does. If something happens and I end up in the ER and I need to get medication I can however I have 7 days to report this to the PM or else our contract is terminated. Some folks have indicated that some ER's will undermedicate you because they feel you are on strong enough meds, others have stated ER's offer the meds but the patient turns them down. The best advice in this situation is flat out ask your doctor what would happen or how the situation should be handled.
As far as being hearded in and hearded out, that is very normal and I think a great majority of PM's do this for a few reasons. The primary reason is it is a small speciality, the doctors are very few but the demand is great so many doctors double book or have an assistant help.
You do have the right to not be seen by the assistant and request you specifically see the doctor, I am not sure however how the doctor will react to this. I will not see my GP's assistant, she is wrong nearly every time I or my husband has had to deal with her so I am not willing to take that risk again.
If you have real concerns you have to be assertive and made them heard however don't over burden the doctor with 50 questions, try to ask a few of the most important ones first then over time ask others if you feel you still need to. This is true of all doctors. Some patients go to see a doctor lets say with a cold and while in the office they suddenly remember they strained their back, been having sinus issues and can't sleep much.. things like that, adding more illnesses to their grocery list unexpectedly. This is not fair to the doctor nor the patients waiting out side. I hope that made sense.
As far as finding a new one I honestly don't know how that would work. I would surmise that you should give notice to your current PM after making your appointment with new one, but remember it could be months before you can get into a new one which could be a sticky situation. You should be honest with the office and tell them exactly why you are looking for a new doctor. You can also tell the new PM when calling them the situation, you feel your level of care is not being met and you'd like to find a new doctor.
The real question is going to be if you go to a new doctor and they don't fit all your needs or try a completely different approach and you are not happy there then what will you do? If you skip from one PM to the next several times, yes this can be seen as a potential problem by the new doctors you are going to see. Because PM treatment is such a delicate situation with the abuse of medications doctors will screen their patients to be sure they aren't shopping. I am not saying you I am saying they can percieve that.
You could decide to not tell the new doctor about the old but this presents a really big problem. If you are on strong medications, lets say Oxy or MS C and you go to a new PM requesting this medication the likelyhood of them throwing you out would be great. How would you explain to them that this is the only medication that works for you? If on the other hand you don't tell the meds and they put you on something else much weaker you run a huge risk of withdrawals and severe pain. Being dishonest as you see is not a wise idea in this situation.
I guess what it boils down to is does your medication work? Is your only inconvienance being drug tested? You have to really ask yourself what are the valid reasons for wanting to change. Have you made an effort to speak specifically with the PM and voiced your concerns? I believe you should at least give this a try.
If your doctor is giving you a decent level of pain relief is that something you are willing to risk in the long run by changing doctors? These are the things I would think long and hard about before looking for a new doctor.
If your level of treatment of pain is nil and the doctor treats you bad, then yes, by all means you should seek out a new doctor.
Good luck to you
Barbie
vamp36
08-20-2004, 12:17 AM
I understand the point of being "rushed" during a doctor appointment. I had many questions for my GI doctor when I first got sick. But at every appointment, I never got the chance to ask them. I finally scheduled the next appointmet with the receptionist to allow some extra time for this issue. It worked for me. I'm not in PM so I don't know anything on how their clinics operate. My GI doctor prescribes all my pain meds and my other meds for me.
tyler7
08-20-2004, 01:18 AM
After reading through some of this stuff, I though I'd just mention this point real quick - Though in my history of seeing PM docs I was never made to do a drug screening by way of urine testing, it's always sorta been my understanding based on a lot of personal experiences I've read that they do the urine test not as much to see if you're abusing your meds (taking too many, etc), but actually moreso to make sure you are in fact taking the meds at all. This would be to combat someone who is faking pain to continually get meds, but then they go and sell them on the street, since as we know with these strong narcotics, most of them have a very high illegal street value.
jbot
08-20-2004, 01:29 AM
Thank you both for your answers.Irelly would like to go back to my GP and let him take care if everything,I can tell him what she is giving me and he can write a script for it.All i`m on is Fentabdyl 24 mg patch and loritab that my GP wrote me and the PD just wrote it also. I`m not taking anything to be at the stage of being addicitve to it now.I also take a antidepressant that can cause your b/p going up. I`m on b/p meds now.When I go to the PC they don`t even check my b/p.With them having people in very bad pain and people with b/p problems. It would look like they could foa simple blood pressure test.What it the meds make it go up and you don`t know it because no one takes a test. Some people don`t go to other drs or they quit their GPs unless some emergency comes up. So it couls be 6 mos before they found out they had high blood pressure.I firmly believe that every medicine a person is on every one of their dr`s should know exactly what it is why its being giving to you and the milligram.You should also tell what the meds are being taken for.Seizure meds are givin for pain also.So if u tell the dr u or on seizure meds they will automatly think you had seizures.All I want is my pain index to get to a steady 6 and off the steady 8-9. I have never been put on a pain pill such as peveoct oxcy (sp) so i don`t know how they might help. Well again thanks for the help some times with the pain i get more confused and can think less for myself. Some times 2 heads are better the one. In this case we all need as many heads as we can get..thanks.........jbot
tyler7
08-20-2004, 02:28 AM
JBOT - now that you've just provided this little update here, there are things you should be aware of, which you're obviously not at this point. Mind you, I don't say that in a condescending or inflammaory way, not at all, you simply may just be "relatively" new to world of continuous pain mgmt.
First of all you say that you're not currently on anything that's to the stage of being possibly addicting. I'm of course not trying to suggest that you may be addicted to your meds (in fact it's only a VERY SMALL percentage of people on opiate meds for chronic pain that become addicted, especially when taken exactly as directed - this is something the media have blown WAY out of proportion). But the fact is, as you say, you're on the Duragesic Patch (Fentynal) and Lortab for BT pain. While true, you're on the weakest strength of Duragesic (patches range from 25-100mgs), Fentynal is STILL, to the best of my knowledge, the strongest form of synthetic opiate pain killler in the world. And I"m guessing you're on Lortab 10mg, which should be good for BT pain. So you're definitely on some pretty strong meds, while of course it depends on the level of your pain and how long you've been dealing with this, as far as how that strength directly affects you. But make no mistake, while you may have no personal issue with addiction to the meds, you're on right now some extremely addictive drugs.
Also, at the end you mention that you've never been put on any type of pain pill, so you wouldn't know how/if that may help. Well, as I just pointed out above, you're taking Lortabs for your BT pain, and that is pain medication pill, comprised of hydrocodone (the narcotic) & tylenol. Unless you were referring to specifically a long-acting pill, such as OxyContin, but since you referenced Percocet in that sentence (which is made of the same active narcotic ingredient as OxyContin, which is oxycodone, but Percocet - a brand name - is an short acting, quick release drug), I assumed you were acknowledging the distinction. Ok, good luck in the future :)
First of all you say that you're not currently on anything that's to the stage of being possibly addicting. I'm of course not trying to suggest that you may be addicted to your meds (in fact it's only a VERY SMALL percentage of people on opiate meds for chronic pain that become addicted, especially when taken exactly as directed - this is something the media have blown WAY out of proportion). But the fact is, as you say, you're on the Duragesic Patch (Fentynal) and Lortab for BT pain. While true, you're on the weakest strength of Duragesic (patches range from 25-100mgs), Fentynal is STILL, to the best of my knowledge, the strongest form of synthetic opiate pain killler in the world. And I"m guessing you're on Lortab 10mg, which should be good for BT pain. So you're definitely on some pretty strong meds, while of course it depends on the level of your pain and how long you've been dealing with this, as far as how that strength directly affects you. But make no mistake, while you may have no personal issue with addiction to the meds, you're on right now some extremely addictive drugs.
Also, at the end you mention that you've never been put on any type of pain pill, so you wouldn't know how/if that may help. Well, as I just pointed out above, you're taking Lortabs for your BT pain, and that is pain medication pill, comprised of hydrocodone (the narcotic) & tylenol. Unless you were referring to specifically a long-acting pill, such as OxyContin, but since you referenced Percocet in that sentence (which is made of the same active narcotic ingredient as OxyContin, which is oxycodone, but Percocet - a brand name - is an short acting, quick release drug), I assumed you were acknowledging the distinction. Ok, good luck in the future :)
jbot
08-20-2004, 09:43 PM
Hi Tyler yes you are right i`m new to pain management but have had constant pain since i was 15. Until now I have just "dealt' with it best way I could. i was put on loritab a few years ago by my GP. Since I worry about withdrawel I make sure that I stay off them for several weeks at a time. So far no problems except the pain gets worse.Since the PM dr put me on the fentanydl 25mg patch I go an extra few says without one to keep this in check also.My loritab is 1 every 12 hrs for BT pain. Even on this small amount I have been off for the last 8 days. I also told the dr that I did this sometimes. Of coarse she told me I need to keep it in my system to get pain relief.Ii just can`t take it with out a break. The few times i did take it exactly as I should I didn`t get below an 8 on the pain chart so figure why take the chance of having withdrawels. I have been reading on here how some ppl have to count their pills and make sure they don`t come up even 1 short before the next refill. It seems like the fear of that is as bad as the fear of pain.I know there is part of me fighting the medicine because its hard to have to be total dependentent on one person who can make you feel like the devil himself or can make you feel like a normal human. In the past 40 yrs of dealing with pain and dealing with dr`s makes me wonder how i have lived this long and still be sane. Any time a CP patient mentions pain they start shifting their feet and I know the subject is going to get changed to something else.Also know i`m in for more "test' to rule out things even though i had the test before. Most of the time i leave with a fist full of antidepressants, cortizone, and antiiseisure meds and told to come back in a month and see how these work.Well thanks for letting me vent. I do hope that each one of you can find a good pain level and when you do by all means try to keep the good dr that gave it to you.I`m still searching so i use alot of prayer. God speed to you all with my hope of a pain free tomorrow for all of is :) jbot
Kissa
08-20-2004, 10:17 PM
You are lucky, I guess you could say that, to be on the medications you are, for some it seems to take years before they are on the medications that you are. Count those blessings!
I understand that your desire is to have more compassionate and trustworthy care, I think we can all attest to wanting that. Sadly most PM's are not in the category.
And a good point was brought up about the tests that I had forgotten, it is possible to be checking for serum levels and how the kidneys are doing. Many doctors never test at all. I do think that they should check your bp each visit and check your kidneys etc every few months. I get mine done but that is only because my GP and Rheumy does it because of other health probs and not the PM meds.
Again I do believe much of this goes back to the fact that they are over booked, there needs to be more doctors in this speciality, it is fairly new. Unlike say a Rhuematologist who are a dime a dozen and easy to find. If you arent happy with your current Rhuemy then find another, it only takes a few minutes. Trying to find a new good Pm could take weeks, months and even years. Some have waiting lists for months in advance. It's difficult to find one. I got very lucky with mine, while he is over booked I was able to get in within 2 weeks of calling.
As far as your GP medding you, he *might* do it, it is going to depend on how he feels about prescribing the level or type of narcotics you require, even at low doses they rank pretty high in the scale. He may not want to risk his practice to do this. Certain prescriptions will set off flags and the doctor could be investigated and risk being fined or losing his liscense. Again, he might do it but I would think the only way one would do it would be if they knew you really well and you'd been a patient a long time. Some states require very heavy documentation to get the medication you are getting while others are a little more lax. With the new upcoming or pending changes in law this may all change and be easier on us all to get the help we so need.
Regarding Addiction, the chances of it happening are very very slim. You have a good attitude about it but I am concerned you may be hurting yourself more than you are helping. It seems you go a week without meds or BT or at least that's how I read it. Going without meds that long is too painful. If you have a concern, and I believe you do and it's valid, you might want to reduce that timeframe to a day or two at the most. You are only causing yourself undue suffering. You could even take a day off once a week. Some suggest a day or two every month.
The way I look at it is if you can get a comfortable level of pain control daily then it is quite well worth the risk of possible addiction. You seem to have a good head on your shoulders and I wouldn't worry so much.
I know if you search around this forum Shoreline had responded to something similiar and offered very good advice regarding the subject, similiar to that of which I just stated.
Best of luck to you!
I understand that your desire is to have more compassionate and trustworthy care, I think we can all attest to wanting that. Sadly most PM's are not in the category.
And a good point was brought up about the tests that I had forgotten, it is possible to be checking for serum levels and how the kidneys are doing. Many doctors never test at all. I do think that they should check your bp each visit and check your kidneys etc every few months. I get mine done but that is only because my GP and Rheumy does it because of other health probs and not the PM meds.
Again I do believe much of this goes back to the fact that they are over booked, there needs to be more doctors in this speciality, it is fairly new. Unlike say a Rhuematologist who are a dime a dozen and easy to find. If you arent happy with your current Rhuemy then find another, it only takes a few minutes. Trying to find a new good Pm could take weeks, months and even years. Some have waiting lists for months in advance. It's difficult to find one. I got very lucky with mine, while he is over booked I was able to get in within 2 weeks of calling.
As far as your GP medding you, he *might* do it, it is going to depend on how he feels about prescribing the level or type of narcotics you require, even at low doses they rank pretty high in the scale. He may not want to risk his practice to do this. Certain prescriptions will set off flags and the doctor could be investigated and risk being fined or losing his liscense. Again, he might do it but I would think the only way one would do it would be if they knew you really well and you'd been a patient a long time. Some states require very heavy documentation to get the medication you are getting while others are a little more lax. With the new upcoming or pending changes in law this may all change and be easier on us all to get the help we so need.
Regarding Addiction, the chances of it happening are very very slim. You have a good attitude about it but I am concerned you may be hurting yourself more than you are helping. It seems you go a week without meds or BT or at least that's how I read it. Going without meds that long is too painful. If you have a concern, and I believe you do and it's valid, you might want to reduce that timeframe to a day or two at the most. You are only causing yourself undue suffering. You could even take a day off once a week. Some suggest a day or two every month.
The way I look at it is if you can get a comfortable level of pain control daily then it is quite well worth the risk of possible addiction. You seem to have a good head on your shoulders and I wouldn't worry so much.
I know if you search around this forum Shoreline had responded to something similiar and offered very good advice regarding the subject, similiar to that of which I just stated.
Best of luck to you!
jbot
08-21-2004, 08:00 PM
Kissa
Thank you. You d make a good point and maybe I will try a day or two a month being off.I have to worry more then most ppl because my dad was a alcoholic and dies at age 62. He stop drinking 1 month before he died and went into DT`s.At that time we didn`t know as much as we do now and how to treat it.Maybe if i would have known then what i know now his death could have been prevented by seeking medical attention faster.He to had pain that dr`s couldn`t control because they didn`t have the drugs for arthritis that they have now.About all he had was darvocet until he desided to go the alchol route.I never want to see that again as long as i live nor would i want my kids or grandkids to have to see me like that, i guess that is why i watch it so close.I just really worry what if i get on to many meds and something happens to the dr and for what ever reason i couldn`t get anymore for a few weeks or months.I just want to know that i wouldn`t go into any serious withdrawels. I guess thats just my little way of knowing i still have a little control over my life.
Thanks for saying i have a good head on my shoulders sometime i wonder if i have a head at all,lol.
I have not seen a post from SHORELINE in awhile.Is he ok?
He really is a walking book of info. Well thanks again for you time and post to me.Take care..............jbot
Thank you. You d make a good point and maybe I will try a day or two a month being off.I have to worry more then most ppl because my dad was a alcoholic and dies at age 62. He stop drinking 1 month before he died and went into DT`s.At that time we didn`t know as much as we do now and how to treat it.Maybe if i would have known then what i know now his death could have been prevented by seeking medical attention faster.He to had pain that dr`s couldn`t control because they didn`t have the drugs for arthritis that they have now.About all he had was darvocet until he desided to go the alchol route.I never want to see that again as long as i live nor would i want my kids or grandkids to have to see me like that, i guess that is why i watch it so close.I just really worry what if i get on to many meds and something happens to the dr and for what ever reason i couldn`t get anymore for a few weeks or months.I just want to know that i wouldn`t go into any serious withdrawels. I guess thats just my little way of knowing i still have a little control over my life.
Thanks for saying i have a good head on my shoulders sometime i wonder if i have a head at all,lol.
I have not seen a post from SHORELINE in awhile.Is he ok?
He really is a walking book of info. Well thanks again for you time and post to me.Take care..............jbot
Kissa
08-21-2004, 08:36 PM
Shore's been was on the last few days I'm sure he will post when he gets a chance. He's probably overloaded with posts he might want to answer.
I can understand your fear of addiction and you are wise to pay attention to it instead of saying "it won't happen to me". But again as we many times discussed, people with chronic pain rarely get addicted to pain medication in the terms of needing it to get high or needing to find more via beg borrow or steal. You can however be dependant on it, which is honestly different. It means your body is requiring the medications and yes you can have withdrawals.
As long as you pay attention to your body and what it tells you when it comes to meds you should be fine. If you find you somehow take more than normal then you need to talk to your doctor about it. It could be a result of the meds no longer working or something similar. It in no way means you have become addicted.
I can understand your fear of addiction and you are wise to pay attention to it instead of saying "it won't happen to me". But again as we many times discussed, people with chronic pain rarely get addicted to pain medication in the terms of needing it to get high or needing to find more via beg borrow or steal. You can however be dependant on it, which is honestly different. It means your body is requiring the medications and yes you can have withdrawals.
As long as you pay attention to your body and what it tells you when it comes to meds you should be fine. If you find you somehow take more than normal then you need to talk to your doctor about it. It could be a result of the meds no longer working or something similar. It in no way means you have become addicted.