how many of u get drug tests at ur pm clinic? i realised a lot of you are talking about it, but in the whole time ive been going to my clinic ive never been tested now im worried that my dr is not doing his full job. do all pm clinics test are they mandated to or is it an option?
if you are in any actual pain management facilities, they also are very much governed by DEA rules very heavily(this part is 'usually the 'why' in why we even have to sign contracts). and almost ALL do have you sign a contract which simply stipulates their rights and also yours, and kind of go into just 'expectations" overall so their just is NO doubt about who's responsibilities are up to who.
depending upon just how long ypou have been at this particular clinic, they may not have gotten around to it yet. this occured hwn i started with mine when somone dropped the ball? i signed mine like well into my 6th month there i think? the contracts are also just good protection for the PM clinics to help to not end up being audited by the DEA at some point which if ANY patients screws up big time and the DEA becomes involved, could shut down that particular PM clinic to ALL patients until whatever issues hopefully get rectified to the DEAs satisfaction.
the contracts just tell and govern alot and assure everyone is ALWAYS on that very same page with the needed info too.
have you ever had ANY UAs done on you at this clinic, or bringing in meds for pill counts? it IS up to any 'good' PM clinic to put into place anything they can to assure that number one, diversion' is not taking place, which IS what the DEA really is MOST concerned about, that every script IS a 'legit/needed" one and used per directions ALWAYS(this part really IS where the UAs come in to see that all is being taken accordingly per directions given that would show up in that UA, and that nothing else is in any patients system they were not rxed). and good record keeping that covers the PMs butts and also yours.
but as i said above, depending upon just how long you have been going there, they may have forgetten to have you sign one too. but i would most definitely ask your NP or PA at your very next visit if they actually even do this very needed part of PM. as i said, it keeps that clinic from getting into any trouble and also spells out all of your rights and responsibilities in writing so there just IS no, "well nobody told me THAT', if something "inappropriate/just not 'right'' takes place with someones meds. and i do have to say that just knowing i am and will be getting suprise UAs and knowing what my contract states really does help me to stay totally and completely compliant. since if you do not, you ARE outta there. so it does help with keeping a better handle on the possibility of addiction rearing its ugly head too. i KNOW if i take even ONE lil pill than i am allotted for THAT particular day, it CAN and eventually will come back to haunt me in some shape or form.
when it comes to taking what we just have to take with this level of narcotic therepy, anything that can help us to not only take away the edge of ugly pain we have to deal with, but also help us to stay totally compliant really IS needed. and that contract and suprise UAs and bringing in meds for pill counts too, well ya can't go wrong there in everyone just knowing whats expected as total compliance.
i just WOULD find out from your PM exactly what the deal is there. if they don't require all that i mentioned above, they are running a pretty darn risky PM clinic. you just do NOT want to be a victim of 'their' inability to simply best 'police themselves' for themselves(to just stay running at all) and their patients. hope this helped,marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
ive been there 6 months never signed any contract and 1 or 2 of those months when i called in to make an apt he was booked up so they just had me come in a pick up a script and not to worry about being seen which i find kinda fishy i prefer being seen and TALKING to my dr but now hearing all this about contracts and ua and none of that being done and my dr never asked me to bring in my meds to have them count it now im worried this dr dont know wat hes doing and im not sure wat to do
IF you are being treated for Pain Mangement by a doctor or in a clinic you should be on a contract and you should be regularly be dropping urine for drug testing. I go to a private Dr. have for the last 13 years, I'm on a contract just like when I went to the big PM clinic, and drug test every 2 or 3 months. That doc giving you a script without being scene is a major RED FLAG...they don't do that, not the good ones. Honestly, it sounds like you should check into a new PM doc.
I go to a actual pm clinic, they cover all the bases. contracts, UA's and We bring every script for pill counts at every apt. These things are mandated by our sate medical board in order to safely prescribe and treat pain without repercusions from the dea.
Take care, Dave
I go to a Pain Management Practice in NC. It was over a year before I took my first UA and I had sigend a contract. now I get tested every few months, sometimes twice in a row to "catch me off guard LOL ". But that practice had just been opened a short time back when i started going and now they have signs every where telling patients to bring meds to every visit. I do go every two months for my meds as I have proved myself worthy so I get a post dated script for the 2nd month.
i usually only have one UA done per year, but it is ALWAYS up to them to decide what visit they are going to do this at. and while i have never been 'asked' to bring in my meds and have been there since early 2004, most of my visits are scheduled the day before i am due to run out,so seeing someone in the throws of WD if i had decided to take more than i should have, would be pretty darn obvious to them. so i think that is why i have not yet had to bring in my pills per their request yet. but i DID voluntarily bring my MSIR in when we had a very insane result with one UA with only my MS. i just decided to bring them in for counts for the next few visits so they knew nothing was "up' there. and i was UAed again too and those turned out perfect.
but i most certainly would ask whoever it is you see on a regular basis about the 'whys' of no contract. they just 'could have' forgotten. but YOU need everything well covered and documented, and so do they.
my PM clinic is currently running with two less "people'(NP and PA) to even see patients so what they did was take the more longer there/more 'stable on their meds" type patients like myself and we are now once again(they used to do this a couple years ago, and then stopped) allowed to see my PA one month, then the next one, my Rxes are automatically sent to my pharm after i call them and request for that 2nd month. so i am 'seen' now every other month. but the more often you just ARE even seen, really helps with your compliance, and they also have to be covering their own butts here too.
while some of those rules come from the PMs themselves, other more strict rulings actually come from the DEA and what YOUR state actually recommends, as dave mentioned too. some rules that actually govern most PM clinics are actually a more mandatory type thing. those rules are the ones i would check into. if this clinic is not doing contracts, i seriously would reconsider even going there. the likelyhood of any given patient just doing something really "stupid' with their meds would simply be a much higher risk with NO set guidelines to follow like with an actual contract spelling out everything expected. which just 'could' also bring down the state or worse, the DEA down on them at some point too. this would possibly shut down your pain clinic and not even allow YOU, the not involved patient, to NOT be able to even get YOUR rxes either. ALOT of good record keeping too is a real big thing for the DEA.
what i would do here, besides actually asking about the contract thing, is to request all of your records from this particular PM(from beginning til current), just to really see for yourself, how well they are just 'getting your pain issues/understanding' along with how well documented everything just is in YOUR particular file as well. while there just would be some things that you would NOT get, you should get enough to read thru to simply just 'know/get a good idea' how well they are documenting every single one of your visits and what dosages of the specific meds you are currently on too. there just should be like at least the 'summary" of your visits on like one full page per visit, pertaining to what your pain issues just were, what was actually talked about during THAT particular visit, and then any possible changes made to your pain care plan too. it all should be there for EVERY visit. and NOT just like a tiny little paragraph or even just a sentence or two. these are called the 'clinic visit notes' that ARE mandatory for ANY visit with ANY actual doc you simply see, like even your primary too? but the PMs really just have to be much more in depth when it comes to documentation for esp writing scripts for class II narcotics that most of us have to usually take. i DO think getting and just reading thru your own file would give you the best overall idea of how well they are simply doing YOUR needed documentation. all you have to do is call their medical records dept and they will send out a form for you to sign/send back to release the records to you.
between just seeing your own records and just asking them right out about what 'they" actually "require' from their patients as in that contract, mandatory UAs and pill counts(those 3 things are pretty standard in ANY 'good' PM clinic) really would give you the best idea here if you should stay IF they DO have that all covered, or try and find another PM who DOES better follow what are actual laws in PM in most cases too. as others have also told you here, if your PM is just not at all following what are actual "rules of practice" for any PM clinic per state and DEA rulings, it really can set up ALL patients for ending up without a PM when things hit the fan at THAT particular clinic. all it takes is one patient who feels totally 'free to do' whatever with their rxed from there meds, and/or really sloppy paperwork to bring in ALOT of really powerful people into any PM clinic. they just have that 'right" at anytime if something just 'prompts' an audit. this could shut down the WHOLE clinic depending, while they go thru every single patients records to just check on that "supposed to be there" documentation, among other things they look for.
unfortunetly there just are alot of what are called 'pill mills' out there where anyone can obtain meds even without any real check up/evaluation from the Rxing doc to even try and understand/know what any given patients pain actually is stemming from, or any real 'rules/regs' you have to follow and you can walk out of there with even more than one rx for some pretty strong narcotics. it is these types of so called PM clinics that give all of the good ones, and "us" simply as chronic pain patients a bad name. you just want to protect yourself here doing what YOU still can FOR yourself. just DO start checking into the things mentioned in all of the good answers to your post. YOU, as a patient anywhere actually just should not have to ever 'worry" about anything having to do with something like rxing from any doc. they DO know what the 'rules' are, whether or not they 'choose' to follow them or not is all up to how much real risk they are willing to take and how much they actually give a darn about their patients suffering too. good luck with this, marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
im on percocet 5/325... im getting really worried now. i was going to ask my dr all about this when i went in to see him this month but once again im told to just come pick up the script... this is stupid ive been with this dr for 7 months now and seen him twice... this does not seem like how a clinic is supposed to be run especially run like this... idk wat to do. it took me a year to find this dr im afraid itll take me even longer to find a new one and i REALLY dont wanna go back to living in THAT kinda pain again anyone got any kinda great advice??? im completely lost now!!
Dont worry -- Ive been going to my PM for 4 years now and havent ever had a UA although he knows Im in a critical Career and subject to Randoms at work -- Since ive been in PM Ive been switching between Perc 10's and Norco -- Then Methadone for 3 mos and I couldnt take the side effects so we decided to f=go back to Norcos for a year -- then I was wearin BUTRANS for 8 mos with perc 5s for breakthrough pain -- Now Im back on Norcos and perc 5's for breakthrough -- NEVER HAD A UA or Drug Count -- Hes a great doctor the UA's are not mandatory and are at the Docs discretion -- Your contract is the leverage for discretion and permission for the Doc to do any and all things on the contract it is not MANDATORY In any State in this country Period end of story
In Pain Mangement Contracts are mandatory....they don't just make them up for the heck of it. They are required to keep you and your doctor in compliance with state, federal and DEA laws regarding narcotic medication use, end of story. If your PM doc doesn't follow the rules, then how do you expect him/her to make you? The simple fact here is your PM doc/clinic is not doing their job...they give you scripts for narcotic meds without even seeing you, how do they know you even still need them. They've seen you twice in seven months, that's ludicrous...that's how pill mills and junkie shops work. You're not on a contract so there's nothing to keep you from going to multiple docs to get as many scripts for narcotics as you want, once again major red flag. You get no testing done, nothing to keep you honest or compliant. Do ya see the problem here? I know it's hard to change docs, trust me I've been in pain management since I was 17, I'm now 42....but you really want to be with a doctor or clinic that plays by the rules and is accountable and keeps their patients accountable, because when you show up for your appointment one day and there's a big sign on the door that says, "Shut down by the Department of Drug Enforcement for Mismanagement of Narcotic Medication and Illegal Dispention" it's really gonna suck. You can find horror stories from people all over this board who have been through that very thing...and they don't hand out scripts to get you through....you are stuck with no doc, no pills, and nothing but detox, withdrawals and a whole bunch of pain until you find another doc. But, your the only one who can make that decision, everyone has to decide whats the right thing.
ty for your responses sorry it took so long to reply i actually couldnt find my thread and i just happened to look in my email and there was an email for a link to it. im gonna start looking around and calling diff pm clinics to find one that is better. its kinda sad that this guy is this bad because he is so convenient ive never ever had a dr so close and easy to get to but i need a dr that is good to protect myself not only of being sol one month because the dea shut them down and if he is a pill mill something tells me that he would be willing to give me whatever i want just to get the money and thats no kinda good dr at all. thank you all for ur advice and input and wish me luck!
Best of luck, and I'm sorry your doc turned out to be suck a schmuck! I know it sucks when you think you've found one and they turn out to not be the right one. Stick around HB, we're glad to talk if you have questions.
i was kinda curious about that one too? danme, just what do you THINK is actually IN that contract? that is where is actually spells out what IS expected of you in PM with UAs pill counts and what their rules just are so no lines get crossed by the parients. and everyone is always on the same page.
tm23. while you are not yet just that 100% certain about what is going on at your PM, i would not make any sudden/rash moves just yet. obtain your records first so you can simply read thru them to see how they are doing their actual job for you with good documentation. that will show you and tell you alot. the main goal at any 'good' PM too is to actually be trying to reduce your pain by actively using many different methods depending upon YOUR own pain levels and generators. if you have not actually BEEN seen, i am curious as all get out just to hear how they are 'justifying' your Rxes, ya know what i mean? they ONLY way to fully eval ANY pain patient is to be seeing and talking to them. depending upon what little or how much they have written in your records will seriously show if they are making things up to PUT into your records or just documenting your rxes. and since this just IS a record of you/your medical documents at all and will follow you, you NEED to see this stuff BEFORE cutting any ties so you CAN make some complaints to the appropriate authorities if ANYTHING in them is falsified or just plain wrong too. you ALWAYS have to be your own advocate here and check into things that could simply affect you at some point too.
did you see the actual doc when you had your initial appt for the full eval/consult? just what is/are your main pain generators? knowing that really would help in just seeing if your pain IS 'just' being treated using the best method or if there was/is a better more effective way to help you using other modalities and maybe even longer acting meds 'instead of' placing someone on what just is a much higher risk for addiction with the short acting meds(the SAs are abused MANY times more often what LA ones are). it is the just handing you scripts every month with NO actual involvement or good documentation in an ongoing way of your pain levels and 'needs" here that kind of IS the key to really know what is going on with this particular clinic. they are just supposed to be asking you how your pain levels are with the meds they are rxing,then documenting continuing need for. its simply a big part of the overall process.
what really kind of freaks me out the most is the fact that you are only a 'new' patient and not on older more established patient that 'they just know after time, they can trust after you have been getting at LEASTongoing UAs to simply 'prove to them" that you are lower risk and even CAN be given ongoing scripts without even being seen like EVERY month? i was seen like every two weeks when i started at my clinic in early 04.
if i were you hon, i would try and actually get in to SEE your doc or whoever YOUR NP or PA at this clinic is and ask some hard questions. in most PMs you do not "usually' see your actual doc every single month unless you are an extreme case, or needing procedures/injections. most of us usually see either an NP or PA who is working "under' that docs name. this is how things usually just go depending. you 'should' have an assigned 'person" to you as well who you would see every time you NEED to be seen. you just really NEED to get some stuff stated to you and ask why no contract was needed when you have spoken to other patients in PM who HAVE to. and also what 'their' requirements are as far as UAs and any other more standard measures that ARE in almost every single PM just put into place(that is how i would ask this, and not say by LAW that contract is supposed to be? or they may think you 'might be' a problem for them). did they even give you what has to by law be given to any ptient as in a booklet called 'the patients bill of rights" at your initial or any appt? every SINGLE time i go to my clinic, i am asked if i 'need one' and if i decline only because i already have one, i have to initial a form stating i declined it. i don't think this is 'only' in MY state, i believe this is a federal, just like the HIPPA form you also have to sign?
if they have NOT even done THIS much for you, i would seriously get your records asap, skip seeing that doc and move on asap to another 'actual' PM clinic. this just would indicate a seriously BAD pill mill clinic. and all odds are if this just IS, it wont be around too much longer depending upon how long this crap has been going on there.
once you actually have ALL of the facts and your records i would call and ask for immediately BEFORE you get seen(if you even get that far) just so YOU just have them before you get seen and ask questions. this way they wont be able to "change' anything or add anything TO them. just so you know, if at anytime someone has to 'fix' or change ANY actual medical document it HAS TO by LAW also be stated that 'this was changed because" and with a signature right there and date too of who changed them and why. getting YOURS now, incase anything should "pop up' that you KNOW is not right in your records down the line, you just HAVE the "original set".
you just need to have your ducks in a row here before cutting ties with these people and be actively looking for a really 'good' PM to work with you in helping to keep your pain down in ALL of the right ways(you just do not want any gaps in YOUR ongoing pain coverage). even tho you may have to go a bit farther, it IS soo worth it for you to simply 'be" in a good PM clinic for ALOT of really good reasons. i just DO have a very strong feeling here, if this clinic you are at right now is actually doing this(esp with NEW patients?) and not requireing ANYTHING that simply not only is helping YOU from becomming a potential addict/staying totally compliant and using everything that has been mentioned. and ESP in the case of someone just getting scripts to divert/sell on the streets(VERY easy for anyone to do the way this clinic is set up), the DEA more than likely ALREADY has this clinic on their radar. not only would that leave you hanging with no real way to help your pain when they DO get shut down, but there would be a TON of other patients as well who now ALSO need to find a brand new PM as well. and that could end up keeping YOU from even finding ANY PM that is not bursting at the seams with ALLLL the other clinics 'old" patients once they get shut down.
you would simply be wayy ahead of the game here by bailing NOW, not after the aftermath. the average clinic seriously has like at LEAST a thousand or so(probably much more) patients who are seen by a combo of the docs, NPs and PAs all handling their own caseloads every day of the week. and i am willing to bet given how they are just 'doing things' with just handing out scripts to even brand new patients with not requireing to be seen, thay ARE already WAYY over any 'required limit' amount of patients. they simply HAVE way too many patients than they CAN 'appropriately' even care for. i would actually call and get the records started by just asking for their medical records dept, and just tell them i need my records for my own personal files i keep at home(i do this with EVERY doc i have to see). they will send out a paper to fill out(a 'release of information form"), you just do that and send it back to them. then in about usually a week or so, they will be in your mailbox. once you have those, THEN i would immediately start calling other clinics and asking them if they are taking new patients or get the needed referral from your doc. once this clinic goes, at least YOU will be able to still have your pain better managed. if they just are NOT requireing the 'basics" here at this clinic, things WILL catch up with them, probably MUCH sooner vs later, so you need to get out asap. but DO obtain those records first, since i would doubt very much once the DEA just does their job here, you may not even be able to GET your own records or it will be a huge mess to 'try' and get anything from the DEA at that point.
i would definitely speak with your doc about this whole situation and get that referral for a new one soon. and when calling the new ones, if they ask why you are leaving your current, i would simply tell them you do not feel 'right' in how this place was doing things at all. no contracts or any 'standards' were being met. i am sure if the clinic has been around for even a while, many other clinics are fully aware of how "this one' is being run. word does get around with this type of crap when it gives the good PMs a bad name. ultimately the decision is yours hon. but this just sounds sooo incredibly not right, its sick. i would talk with your primary and get things moving very soon. were you actually 'referred to' this clinic by a doc or did you just make an appt or what? good luck tw. and DO please keep us posted. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
i was kinda curious about that one too? danme, just what do you THINK is actually IN that contract? that is where is actually spells out what IS expected of you in PM with UAs pill counts and what their rules just are so no lines get crossed by the parients. and everyone is always on the same page.
tm23. while you are not yet just that 100% certain about what is going on at your PM, i would not make any sudden/rash moves just yet. obtain your records first so you can simply read thru them to see how they are doing their actual job for you with good documentation. that will show you and tell you alot. the main goal at any 'good' PM too is to actually be trying to reduce your pain by actively using many different methods depending upon YOUR own pain levels and generators. if you have not actually BEEN seen, i am curious as all get out just to hear how they are 'justifying' your Rxes, ya know what i mean? they ONLY way to fully eval ANY pain patient is to be seeing and talking to them. depending upon what little or how much they have written in your records will seriously show if they are making things up to PUT into your records or just documenting your rxes. and since this just IS a record of you/your medical documents at all and will follow you, you NEED to see this stuff BEFORE cutting any ties so you CAN make some complaints to the appropriate authorities if ANYTHING in them is falsified or just plain wrong too. you ALWAYS have to be your own advocate here and check into things that could simply affect you at some point too.
did you see the actual doc when you had your initial appt for the full eval/consult? just what is/are your main pain generators? knowing that really would help in just seeing if your pain IS 'just' being treated using the best method or if there was/is a better more effective way to help you using other modalities and maybe even longer acting meds 'instead of' placing someone on what just is a much higher risk for addiction with the short acting meds(the SAs are abused MANY times more often what LA ones are). it is the just handing you scripts every month with NO actual involvement or good documentation in an ongoing way of your pain levels and 'needs" here that kind of IS the key to really know what is going on with this particular clinic. they are just supposed to be asking you how your pain levels are with the meds they are rxing,then documenting continuing need for. its simply a big part of the overall process.
what really kind of freaks me out the most is the fact that you are only a 'new' patient and not on older more established patient that 'they just know after time, they can trust after you have been getting at LEASTongoing UAs to simply 'prove to them" that you are lower risk and even CAN be given ongoing scripts without even being seen like EVERY month? i was seen like every two weeks when i started at my clinic in early 04.
if i were you hon, i would try and actually get in to SEE your doc or whoever YOUR NP or PA at this clinic is and ask some hard questions. in most PMs you do not "usually' see your actual doc every single month unless you are an extreme case, or needing procedures/injections. most of us usually see either an NP or PA who is working "under' that docs name. this is how things usually just go depending. you 'should' have an assigned 'person" to you as well who you would see every time you NEED to be seen. you just really NEED to get some stuff stated to you and ask why no contract was needed when you have spoken to other patients in PM who HAVE to. and also what 'their' requirements are as far as UAs and any other more standard measures that ARE in almost every single PM just put into place(that is how i would ask this, and not say by LAW that contract is supposed to be? or they may think you 'might be' a problem for them). did they even give you what has to by law be given to any ptient as in a booklet called 'the patients bill of rights" at your initial or any appt? every SINGLE time i go to my clinic, i am asked if i 'need one' and if i decline only because i already have one, i have to initial a form stating i declined it. i don't think this is 'only' in MY state, i believe this is a federal, just like the HIPPA form you also have to sign?
if they have NOT even done THIS much for you, i would seriously get your records asap, skip seeing that doc and move on asap to another 'actual' PM clinic. this just would indicate a seriously BAD pill mill clinic. and all odds are if this just IS, it wont be around too much longer depending upon how long this crap has been going on there.
once you actually have ALL of the facts and your records i would call and ask for immediately BEFORE you get seen(if you even get that far) just so YOU just have them before you get seen and ask questions. this way they wont be able to "change' anything or add anything TO them. just so you know, if at anytime someone has to 'fix' or change ANY actual medical document it HAS TO by LAW also be stated that 'this was changed because" and with a signature right there and date too of who changed them and why. getting YOURS now, incase anything should "pop up' that you KNOW is not right in your records down the line, you just HAVE the "original set".
you just need to have your ducks in a row here before cutting ties with these people and be actively looking for a really 'good' PM to work with you in helping to keep your pain down in ALL of the right ways(you just do not want any gaps in YOUR ongoing pain coverage). even tho you may have to go a bit farther, it IS soo worth it for you to simply 'be" in a good PM clinic for ALOT of really good reasons. i just DO have a very strong feeling here, if this clinic you are at right now is actually doing this(esp with NEW patients?) and not requireing ANYTHING that simply not only is helping YOU from becomming a potential addict/staying totally compliant and using everything that has been mentioned. and ESP in the case of someone just getting scripts to divert/sell on the streets(VERY easy for anyone to do the way this clinic is set up), the DEA more than likely ALREADY has this clinic on their radar. not only would that leave you hanging with no real way to help your pain when they DO get shut down, but there would be a TON of other patients as well who now ALSO need to find a brand new PM as well. and that could end up keeping YOU from even finding ANY PM that is not bursting at the seams with ALLLL the other clinics 'old" patients once they get shut down.
you would simply be wayy ahead of the game here by bailing NOW, not after the aftermath. the average clinic seriously has like at LEAST a thousand or so(probably much more) patients who are seen by a combo of the docs, NPs and PAs all handling their own caseloads every day of the week. and i am willing to bet given how they are just 'doing things' with just handing out scripts to even brand new patients with not requireing to be seen, thay ARE already WAYY over any 'required limit' amount of patients. they simply HAVE way too many patients than they CAN 'appropriately' even care for. i would actually call and get the records started by just asking for their medical records dept, and just tell them i need my records for my own personal files i keep at home(i do this with EVERY doc i have to see). they will send out a paper to fill out(a 'release of information form"), you just do that and send it back to them. then in about usually a week or so, they will be in your mailbox. once you have those, THEN i would immediately start calling other clinics and asking them if they are taking new patients or get the needed referral from your doc. once this clinic goes, at least YOU will be able to still have your pain better managed. if they just are NOT requireing the 'basics" here at this clinic, things WILL catch up with them, probably MUCH sooner vs later, so you need to get out asap. but DO obtain those records first, since i would doubt very much once the DEA just does their job here, you may not even be able to GET your own records or it will be a huge mess to 'try' and get anything from the DEA at that point.
i would definitely speak with your doc about this whole situation and get that referral for a new one soon. and when calling the new ones, if they ask why you are leaving your current, i would simply tell them you do not feel 'right' in how this place was doing things at all. no contracts or any 'standards' were being met. i am sure if the clinic has been around for even a while, many other clinics are fully aware of how "this one' is being run. word does get around with this type of crap when it gives the good PMs a bad name. ultimately the decision is yours hon. but this just sounds sooo incredibly not right, its sick. i would talk with your primary and get things moving very soon. were you actually 'referred to' this clinic by a doc or did you just make an appt or what? good luck tw. and DO please keep us posted. marcia
ty for all of ur advice. i have 4 bulging discs in my back, tendonitis in my hands, and an unspecified knee problem that has yet to be diagnosed. ive had my bulging discs since my kids were very young... cant remember how old they were now as im quite upset because of an argument with my sister in law and its making it hard for me to think. the tendonitis ive had for roughly a year and the knee pain is much more recent more like 9 months thats pretty much what pushed me over the edge and finally made me go to my pcp for help with pain control as with the back and knee i could barely walk or move i was in so much pain.
this clinic is fairly new. i was referred by my pcp. they referred me to this one because the pain clinic rents their office 2 mornings a week. there is only my dr and his nurse in the office and the 2 times i was seen i was seen by the dr. i did call and asked what you suggested about the contract and the nurse seemed very surprised and said that i should of gotten the contract to sign when i got all the other papers to sign at the initial appointment. she got my file and realized that i hadnt signed one and said that she would make a note to have me sign one at my next appointment which was scheduled without my knowledge so i guess it was a good thing that i called. she also explained what the contract says in it and it did mention the drug tests and she explained that she doubted i would get one very often as my pcp gave me such a high recomendation to the pm dr and explained that the dr feels like i can be trusted because of this if that makes any sense. also when the script just needs picked up my dad picks it up for me as its easier for him to get out and it gives him an excuse to come see my kids. im not really sure what to make of all of this now. before i was aboslutely sure that this clinic was a pill mill but now im not sure what do you think since im sure you have more experience that i do in this kinda stuff ya know wat i mean??
This clinic may not be a pillmill so to speak, but they sure as heck are not running like they should....you don't just "forget" to have your patients sign their PM contract. And there is still the major fact that in 7 visits you've seen a Dr. only 2, and they're giving you pills....that just doesn't happen in a legitimate, well run Pain Management clinic....it really does not sound like these guys no what the hell they're doing.....
hey kat, the very same thing DID happen to me with what they were 'supposed to do' which was not only signing my contract, but also my 'entering PM UA too. and my clinic IS a pretty strict one that i feel totally comfotable at that 'they' are doing,and have been doing all the right things in trying to manage all of my many pain areas. sometimes things DO slip thru the cracks. alot DOES really depend upon what the patients true pain just is and how badly they are in dire need of just getting everything moving to try andget pain down. i was a total freakin mess when i started at mine. but i was being SEEN every two weeks too. so they 'can' forget.
but in this particular case TW, they really "should be' trying other modalities to just help with ALLL your multiple pain generators there too, not just handing out rxes, ya know? like trying ESIs(steriod injections) to see if they can help with those discs and the radiculopathic type of pain it generates. or using additional other types of meds such as the anti siezure group, really DOES tend to 'hit' radicu/spinal pain much more effectively than using "only' just narcotics alone, as in a 'combo' of?
it just sounds like you are being seen in the type of docs office that is called a 'sattilite(sp?) clinic' where many different types of surgeons and other specialists simply see patients at clinics once or twice a week so the patient does not have to go as far and they are treating patients who live in areas that are kind of 'undertreated' too. this is NOT at all unusual, but in PM, its just 'odd' in HOW they are NOT fully evaling and trying everything to help each area of your multiple pain sites, and that is worrisome in and of itself. while this clinic, since you stated it is only one doc and one nurse, i am really wondering if they even 'offer' those needed types of the injections or many other actual 'procedures' needed/used by certain patients at only a sattilite type of clinic? they DO require alot more nurses to assist docs when they even 'do' the procedures just becasue they ARE needed, not to mention the actual procedure rooms(kinda set up like you would see in an OR) room and equipment. or maybe, since this just is set up the way it is, if anyone DID require like the ESIs they send them to the 'base' clinic this doc actually works out of?? could be it, but i most cerrtainly WOULD when you see the doc, start asking questions about what they 'offer to try and help bring certain 'types' of pain down. now THAT you just do have a right to know, what do they offer their chronic pain patients, and i WOULD ask.
i would also find out the actual name of this 'bigger clinic' this doc works out of too,just so YOU know as much about this overall 'clinic' as possible.
i still would obtain the actual records tho, just to see how well everything about you and your pain is being "seen" by the eval doc too(the overall treating docs "impressions' always have to be in the clinic notes).just where in your spinal levels are those bulged discs located? are they in the upper like within the c spine or lower like lumbar? when was the LAST actual MRI or whatever "scan or even plain x ray" 'found' those bulging discs done on you? if this was NOT done within the past year or so, you do need a 'comparritive' one done NOW to just see what may or may not actually be impacted there at THIS point. if this is within the lumbar, it just 'could" also be generating your unexplained knee pain like my annular tear and stenosis at the L 4-5 is doing in my L knee on the inner side? or you could also have some type of mechanical issue or wear and tear type of injuries too. i too have BIG crap in my other knee from not only RSD but other more structural damage too, and this was also after two seperate knee surgeries to fix the first round of crap. since i cannot "feel' the inner structures of my RSD side knee due to another stupid syndrome from SCI, anything seems to keep happening there in an ongoing way. but your problem knee NEEDS to be better looked at FOR an actual diagnosis too. since 'most" PMs really do not do alot of real 'diagnosing" of spinal issues but usually treat people who have already been diagnosed that come to them after that for pain treatment, just seeing an actual ortho for a full eval on the whole spinal really would be ideal as far as finding out if there is also ANY types of problems within your c spine that just could be generating what is actually more radiculopathic type of pain and not actual 'tendonitis". how did they Dx the hands as even having tendonitis?
i have hed to see many different surgeons and had many scans done to find MY real underlying generators that THEN just get told to my PMs PA so they can better treat what cannot be fixed by surgery, or help with the pain TIL surgerys are done too. so seeing other specialists is NOT at all uncommon. you just, with any contract and being in PM cannot accept ANY types of actual narcotics from ANY other docs at any time unless it is some type of a post op situation, and then your PM also has to be in on this as well. but you just DO need much more of a clear and solid dx of what are your pain generators and how bad they are with a full top to bottom type of MRI that either your primary can order(usually alot easier done this way), or he can also refer you to an ortho who could do this as well. but you just do need to know what and the whys of your pain are 'really' stemming from and then what can possibly be done to fix/treat or just do pain management for.
in almost every case of esp multi disc bulging depending upon severity, they DO usually progress over time, and thats why the MRI really is needed(your primary should have sent you for an MRI as soon as you presented with that back and esp knee pain before sending you to PM. you NEED this now). and just because you even HAVE any issues with your hands, seeing that c spine along with the lumbar(or wherever your bulges are at if not there) too really IS also needed. while you 'could' have tendonitis, it usually will go away for at least a while at "some' point, but can come back too. but this usually also responds pretty well to just about any type of NSAID as well since tendonitis is only inflammation of the hand/finger tendons in YOUR case(anything with the suffix of 'itis' just means 'inflammation of' whatever the word/body area is in front of it). but spinal CAN mimic what you could be feeling in your hands too if you happen to also have bulging or some other "types' of what are many different types of possible disc/spinal issues too in that lower end of the c spine( c 6 thru T1 governs the hand and finger movement and sensory). what is it that you are even feeling in your hands besides pain? any other 'symptoms" there or real pain in your neck area?
for now, i would just obtain the records and seriously start checking into this pain clinic a bit more to find out where their 'base of operations' actually is even located and anything you esp NEED to know with the contract in a face to face way. it just really still does sound like all this doc actually even does is 'just' write scripts to patients instead of REALLY trying to 'treat' the patient as a whole, esp with multiple pain generators with one as yet to even be identified? there just are sooo many better ways of trying to treat someones pain than 'just" using narcotics that also need to be tried with what you just have there as yours.
i guess your just going to have to try and use your best judgement and instincts there until you can find out ALLL of the other things that any CP patient being treated at any pain clinic should just know about, like what 'other modalities' does this clinic just offer? it still sounds like this little two person 'clinic' just may have wayy too many patients to even 'do' the more commonly used types of pain care treatments that usually work more effectively for what YOU have and just where you have it. or to just be SEEN at the very LEAST every other month. i hope this is indeed a better managed type of clinic than has been presented so far hon. but DO get those records to just SEE for yourself how well their actual documentation just is. if they do a pretty sloppy job, then there WILL be problems at some point down the line. this IS the DEAs area with 'justifying the need" for narcotics to even BE rxed,esp the way this doc is doing it. just ALWAYS be aware of anything that does not 'seem right' and note what that is like in a notebook or something, then describe it and date it(start with the NO contract and no 'baseline UA. and anything else from there). it just 'could"be handy for you at some point. you yourself just do not need any problems for you caused by a really sloppy clinic. i hope this all works out. you just DO deserve more from ANY PM clinic and need some good diagnosising too right now. marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
