I am new here and would like to know what kind of experiences other people, who are on medication, have with their doctor and the medical community in general.
First a little background: I am 58 years old, and have multiple issues with my spine which have plagued me my entire life. I have stenosis in my lower back with degenerative disc disease from the neck down. X-rays show very little disc remaining, with bone spurs protruding all down my back. I have been in pain my entire life but it gets worse as I age. I began seeing my current doctor about 6 years ago, and after seeing more specialists and tests, they all agreed that nothing could be done except try to alleviate the pain. My PCP began prescribing Oxycontin which does seem to help. Anyway, I’ve been on the stuff now for the last five or so years.
This is the first and only doctor who has been prescribing pain meds so I don’t have any other experience to compare with my current situation. I was insulted by the urine tests at first, but I realized that he must do this to protect himself because the DEA basically has doctors scared to death of being arrested. So I do the urine thing and don't complain. However, I do know that he is allowed some discretion with prescriptions. He tells me that he trusts me and that he has no question about my integrity. For five + years, I have done everything that was asked, never had a problem with my urine tests or prescriptions. I don’t drink or take any other drugs. But at this point, he still insists on monthly office visits to write my prescription. Nothing has changed for the last five years (save for periodic reviews). The sole purpose of my monthly visits is for him to pull out his pad and write a prescription, and he writes the same prescription, for the same dosage, month after month. Now I know that he is legally allowed to write up to 90 days in advance, but I don’t know if any doctors actually do that.
So what I want to know is: Is my PCP being unreasonable by insisting on monthly visits given our long established relationship? Or is it standard and customary practice amongst doctors to require monthly visits for everyone on narcotics without exception? He tells me that he treats everyone the same, but I feel like I ought to be treated as an individual and not as a segment. If he trusts me, then why can’t he relax a little and cut back on the office visits to 60 or 90 days apart? I feel like it is an unreasonable burden to set aside an entire day each month just to sit in front of him while he writes the prescription.
No? Yes? Is it this way with all doctors?
Thanks for listening and thanks in advance for any thoughts on the subject.
Last edited by gmack; 01-12-2011 at 11:07 AM.
Hello and welcome to the boards. I'm pretty new to pain management, so probably not the best one to answer your question, but for my first 3 visits, I had to be seen every month, but at the last appt, she scheduled my next one for 3 months out. I guess it just depends on the Dr. She's certainly not the trusting, easygoing type; I think it's more along the lines of she's over-booked and too busy to see everyone once a month. Be happy you have a good relationship with your dr, even if he does drag you in once a month. A lot of us dont have that and it's crummy.
I can only get 30 days at a time, but I can ask for a renewal online or by phone. I then have to drive to the office to pick up the prescription and carry it to the pharmacy as it cannot be phoned or faxed in.
This was the case with my previous spine doc too. But I don't know how common this is.
Hello gmack and welcome to the HealthBoards!! In the case of Oxycontin, a schedule II drug, there are no refills allowed. So, yes technically you have to see your doc every month. However there are exceptions like what the two posters below described. My pain med doc sees me and then gives me post-dated prescriptions (much like mombomb described) for 2-3 months, and then I have to see him again. But I have to make that appt. before I leave the office. Now, if it were something like Vicodin,Lortab, or Norco (hydrocodone and tylenol), which are all schedule 3's, these are usually allowed refills without seeing a doctor in most states (in the U.S.). Hope that helps...janiee
Thanks for the input... Yes, I understand the DEA regulations regarding prescriptions. But my doc will not even write post dated prescriptions. He requires a "full fledged" (for lack of a better term) office visit every month. This means every month waiting at least one but sometimes as long as two hours to see him, sitting with him privately while writes the prescription, then back to the desk to pay for a regular office visit. This has been going on for five years. I just feel like it is pointless and unreasonable. Not to mention he collects $185 for this every month. Nothing changes. We've explored all other options, titrated to an effective dose, and the prescription never changes.
p.s. I would gladly stop by to pick up a new prescription. I just don't understand why he makes me spend all morning for an office visit.
Last edited by gmack; 01-05-2011 at 05:27 AM.
Reason: post script
Your questions very reasonable and i will try to share with you how things working out with me.
I am under Pain Mgmt Dr for 5 years by now. I was told by my PCP who is excellent DR, that I must be seeing by PM DR, b/c PCP's dont get same training like PM (Anesthesiologists) do. All good PM Drs are anesthesiologists, they know pain medication in and out b/c they assist during surgeries as well.
PM Doctors have special training not only regarding treatments, but also opioids. This is why so important to be under their care if your problems are chronic. Seems to me that you live in great amount of pain and that your problems are permanent unfortunately.
When I just met my PM Dr in NYC, for the first 3 month he saw me ones a month. Urine tests was done at my first app and then during first 3 month. They had to make sure I take my meds in Rx doses and don't do any "funny" business.
After my first 3 month, I see him every 3 month now. I call his office (to his assistants) every month for new prescriptions. I get 30 day supply only.
Hard copy usually sent to me in 3 days and then I go to refill them at my local Pharmacy I go every month to. When I go to see him every 3 month, he checks with me my health issues, orders tests if he feels I need, sends me to see another specialist if he feels I need it, gives me my prescriptions and we done until next 3 month.
His assistant told me that by law, I must see him every 3 month. Once I ended up at the local Hospital and Dr there Rx to me another pain meds by IV. I was so nervous about it, knowing that by law, I cant have anybody else to Rx opioids to me, but my PM, so I asked Dr at the Hospital to call him and confirm it with him.
When I came for my app later, he told me that I dont have to worry about it so much, b/c they have contracts with every Hospital in a country and also because he trust me completely. He said that working for many years with CP patients who on narco meds, taught him to recognize troubled people and I am not the one he has to worry about.
So in all 5 years, I had my urine test only 3 times in the beginning and never since.
I am sure if you talk to your PCP about coming every 3 month, not every month and to ask if you can call to the office about prescription being send to your house, he will be able to give you an answer.
Is any reason why you under his care, but not under PM? Just out of curiosity...
I got impression that you take Oxy as BT medication, not as LA, right? I dont want to play a Dr here, but just have to say that Oxy usually prescribed like one of the LA medications (long acting) to keep blood plasma leveled, this prevents pain from spiking. And BT (break through) medications which we take as needed when pain gets higher, usually Percocet and others. But if you on Oxy only, you are lucky to be able to function on it for so many years and that you did not get body tolerance to your medication, after which medicine stops working.
I asked you about PM versus PCP for a reason. See, PM know their stuff. Like my PM always tells me that each of his patients have individual "cocktail" of medication, b/c what good for one, not good for others. They have knowledge of meds, they have good experience especially if you lucky to get PM with back ground in Anesthesiology. And like my PCP said, they dont get trained in this field...
Best of luck to you, I hope I answered some of your questions.
The Following User Says Thank You to Moldova For This Useful Post: gmack (01-05-2011)
Thank you Moldova for the thoughtful reply. The reason I am seeing my PCP for pain is because there were no pain mgmt doctors or clinics in the area. Several clinics have since opened in my state (only one within driving distance) but pain management is relatively new around here. In fact, I just learned a few days ago of the one clinic within driving distance. I did call this clinic today and had a telephone consultation to learn about their practices. They too require a full appointment every month when prescribing narcotics. So perhaps it is a local or regional practice. I may go to see them just to see if they have any new ideas about how to treat my pain, but they may end up wanting to continue the same regimen I am on now.
I have seen many specialists who deal with chronic pain but none of them manage chronic pain patients on an on-going basis. So the PCP was my only option.
Hi and welcome to the boards. I have been under the care of a pain management doctor for more than 5 years. The doctor I see is very good at what he does. He is one of about 9 doctors in the practice which includes pain management, rheumatology, sports medicine and rehab. It is the rule of the practice that all pain management patients who are on Schedule II drugs (and some schedule III's) see the pain management doctor every month. I am on very high doses of narcotics and although I know my doctor trusts me, I have never complained about having to see him every month. If that is what's required of me in order to have my severe pain managed, then I'm willing to to that. When I see him monthly we just touch base about how my pain has been the previous month and if there are any new symptoms. I can only think of 2 or 3 times in my relationship with this doctor that he has given me a post-dated prescription and that was because I was going to be out of town. So, I don't know what to tell you as far as your particular doctor. Even though it can be a huge inconvenience and take up lots of time, I still think it is worth it. Hope you can find a doctor who has guidelines that meet your lifestyle. Feel better!
The Following User Says Thank You to BrittleBones For This Useful Post: gmack (01-06-2011)
Thanks Brittle. As I said, this is the first doctor I have seen who prescribes medication for my pain so I have no idea if his policies are standard practice or not. On the surface, it just seems pretty unreasonable to require full monthly office visits just to get a prescription, when nothing ever changes. I knew things were different when schedule II drugs were involved but it still seemed excessive. I guess being in constant pain is a special kind of medical condition and those of us who suffer cannot expect the same consideration as other "safer" illnesses. It is a shame that people with legitimate and real pain must, in addition to our physical suffering, bear the legal burden caused by a few corrupt individuals. I don't blame my doctor. I've been researching my state laws and if I were a physician, I probably would not even risk prescribing narcotics.
Hello gmack. It's pretty standard to have the monthly appointments. When I was in between pain management doctors, the pcp wanted to see me every 2-3 weeks to discuss medications. He wasn't comfortable prescribing narcotics for a long period of time at the clinic he was in practice.
The first pain clinic I was going to, I was required to have monthly appointments and I was on very little medications(4 5mg percocets a day). He was more into giving spinal injections then prescribing medications. It's awful being under treated for pain.
I'm at a different pain clinic and we are required to be seen once every two months and they post date prescriptions. I'm on a much stronger dose of medications.
I'm pretty sure this is your doctors standard procedure.
Last edited by Nicole74; 01-06-2011 at 05:40 AM.
The Following User Says Thank You to Nicole74 For This Useful Post: gmack (01-06-2011)
please be careful with spinal steroidal shots. Many Doctors like to do it, b/c it pays good money to them. But you can have no more then 3 a year, do you know that?
I guess then you have no choice but go with a flow... If this is what they want and require, you can't change that. Opioids puts a lot of responsibility on prescribing Doctor, so they want to make sure their patients well taken care of. I am sure your Dr doesn't do it b/c he doesn't trust you; believe me, they know their stuff and can recognize trouble.
I use my PM Dr in NYC, it not easy for me to be on a road. So I am so happy that I can see him every 3 month, not every month, otherwise it would be very hard to do.
Moldova: I know that alot of people think that if their doc is not a PM then they are not as "good" at pain management, but that is a false statement. I've been in Pain management for 11 1/2 yrs. now, part of the time under the care of a Pain Management and for the past 10 yrs under the care of my PCP, the whole time on heavy narcotics, Oxycontin, Oxycodone, Fentanyl, Percocet, and MSContin. I've had 13 surgeries in both knees in the last 12 yrs. I'll take the care and treatment of my PCP over the Pain Management docs anytime. My PCP is a very thoughtful, knowledgeble, caring, intelligent doctor who looks out for my best interest, listens to me and what I think/prefer, respects what research I do on meds on my own, and changes meds when I ask, if it's a tangible thing to do at the time. In the 10 yrs that I've been in her care she has never once, asked me to do a "pee" test, accused me, suspected me or questioned me about my med use, nor has she asked me for pill counts, she trusts me 100%. The unique thing about this relationship is that I also have BiPolar Disorder with a history of suicide by oxycontin overdose. She or any other doctor could not touch me and my chronic pain with a 10 foot pole and have just reason to do so, but she chooses to trust me instead.
Gmack: I see my doc once a month, every month, always have, always will, that's the way she does it. But it's not an in and out visit, she takes the time to sit and talk with me, goes over things makes sure all is well, sees if I want/need to change anything, etc. she is an awesome doc. As the others say, you can only get 1 months supply of Sched. II meds at a time, and most docs do not give out postdated scripts. So it's not unusual for a doc to see you once a month. Unfortunately you seem to be in one of the "cookie cutter" type practices, so it might be prudent to request more time of your doc if he's going to insist you see him so often, or request a quarterly schedule.
I think the general consensus is that you 'gotta do what you gotta do' if you want to be treated.
I feel that I'm very fortunate (..much like Kat) to have a PCP who is caring, knowledgeable, and willing to treat me. I have no contract, no drug tests, no insulting questions are asked or assumptions made, no humiliation etc....
I'm also aware of my end of the bargain, to be accurate, honest, and forthcoming. My memory stinks so I keep a daily log (tracker) of my pain, diet, and med consumption so that we can work together to find the right treatments.
Do you pay all that $180 per visit, or is most of it refunded by insurance?
If its all out of pocket, it might be worth doscussing wether the doctor will consider moving to alternate month appointments, just writing you a script that you go in and pick up. The worst that can happen is that s/he will say no, they arnt comfortable with that arrangement, and things will stay the same. if you dont ask, you'll never know
The desire to take medicines is what seperates man from the lower animals - William Ostler
Moldova, that is untrue. I've had 12 spine injections in 1.5 years. 2 of those were diagnostic for nerve burning without steroids. I keep my list with me and the dates to show new doctors, so I'm asked to do any more shots. Also, I'm very sensitive to the steroids and have reactions each time.