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    Old 07-16-2009, 08:34 AM   #1
    Brosiah
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    Why are PM doctors intimidating??

    Hello-

    I have been reading the boards about PM doctors and how people are usually nervous about the first appointment. I am going to my first appointment on Wednesday and when they made the appointment they said not to be late or they will cancel my appointment ( I wasn't planning on being late so I dont know why they said that). I thought that was kind of rude, but I'm starting to think that PM doctors are that way. Whats up with that? Why are people nervous at the first appointment and why are the doctors so harsh and intimidating to people. I am not a drug addict and I dont expected to be treated like one...but is this what I have in store for me?? I will be very offended if they are rude to me for no reason. Obviously my X rays and MRIs should speak for themselves...I have obvious reasons for needing pain meds. Whats their problem ??( I get that people abuse meds but arent the majority of people in real legitimate pain??)

    Just FYI- My surgeon wants me to see PM doctor because my surgery is the 27th and he doesnt prescribe medication any stronger than what I am already on. He wants to PM doctor to presribe my after-surgery medication.

     
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    Old 07-16-2009, 09:13 AM   #2
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    Re: Why are PM doctors intimidating??

    This is a great question and I think your attitude towards it is the right one. I'm going to answer your question in two parts....

    Part I: The Docs: I think a lot of the PM docs are standoffish at first because a certain percentage of people that come through their doors are abusers and just looking for meds. They've seen all the tricks and probably been burned a few times. In my case, it took my PM Doc quite a while to warm up and when he did, he became a different Dr. (in my eyes). Much of the change, however, was due to me, which I'll explain in the next part.

    In my clinic, for example, they UA every patient at the first visit, and one of the Docs won't prescribe any meds until the results come back. You have to be referred from another Doc, preferably a specialist and depending on your condition and why you're there, often dictates the attitude. For example, if you're referred by a GP for some type of phantom pain, then the PMs can be standoffish and have a bit of a chip on their shoulder. PMs want to see documentation and would rather treat more impt cases (not that this case isn't impt, but you know what I'm trying to say). Many GPs just shuffle people off to PM because they don't want to deal with whatever is the problem when in reality, they could handle it. Cases like this invariably frustrate PMs.

    Conversely, if the patient is referred by a specialist of some type, say post surgery that didn't go well or some type of pain that has been deemed permanent, than the patient enters the PM clinic under a whole different set of circumstances. Because they were referred by a specialist, there is immediate credibility and secondly, given the nature of the referral, they most often always involve xrays, scans, and etc., which fully document things. Docs like to agree with other Docs as there is strength in numbers.

    Part II: The patient: Patients are often worked up and nervous because inherently, they know if the back of their minds that the PM Docs virtually control their entire lives...Via the meds. What if I don't get meds? What if he changes me? What if he stops them? And so on. I have to believe that when patients get worked up, then it transfers negative energy to the Docs....Has to in some regards.

    My situation changed drastically with my Doc when I finally came to the realization that the Doc was there to help me and that I wasn't doing anything wrong and got over the stigma of being on pain meds. As a CPer, one has to be their own advocate at times. Hindsight is always 20/20, but looking back at some of my appointments, my care today would be much different if I hadn't been my own advocate at certain times and instead, sat quietly in the corner like the good little patient.

    By no means am I suggesting any type of rebellion, but sometimes one has to stand up for what's right and be treated with compassion...For example, with dose increases, changes and etc. Many continue to needlessly suffer because they are fearful of speaking up. They think that if they speak up, they may be cut off or reduced. However, the opposite is probably true....In many cases, I think Docs can be more concerned with those who are perfectly satisfied with their meds and don't ever have tough periods, get worse, or whatever. Most people's problems / health evolve over time....It doesn't stay the same for 10 years. But, on the other hand, if a patient is on a relatively low dose and it's working, Docs won't rock the boat for the obvious reasons.

    Hopefully this answers your question...Probably much more in depth than what you wanted, but I felt like it was important to go over the two variables as they are dependent upon each other.

    As a quick side note, I would suggest you maybe read the post of different types of PM Docs...This can often dictate one's care. The thread is titled "Re: Chronic pain - Frustration"...Last post was 6/30/09. My post was # 3 in the thread.

    Best of luck at your upcoming appointment.

    Regards,

    Ex

     
    Old 07-16-2009, 05:40 PM   #3
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    Re: Why are PM doctors intimidating??

    I think that was a very informative post, Ex. IMO you can't ever give enough information with questions such as these.

    Brosiah, try not to form an opinion based on what you have read and the fact that you were told not to be late. The person that schedules the appointments tells everybody the same thing. Usually, the PM doctors have tight schedule and they just want you to know up front. Most specialists are the same way. I have seen some interesting confrontations at my rheumatologist's office. I was very nervous when I went to see my PM for the first time and I had to work at getting an appointment in the first place. My anxiety was the only negative thing about the appointment. My PM was extremely nice and just listened to my story and what I had been through. She was so comforting, I felt as if I had just seen my therapist rather than a PM.

    As Ex said, you have to be your own advocate so you will get proper care. Just make sure you tell your doctor everything that he/she needs to know, be honest and tell them how your life has been affected. Good luck, I hope your visit goes well! Remember...Positive thoughts;0)
    weezi

     
    Old 07-16-2009, 07:02 PM   #4
    icehouse3z
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    Re: Why are PM doctors intimidating??

    i agree i think in the back of the patients heads they realize their life is in the doctors hands, especially when it comes to meds, but if you stick to your doctors orders you wont have any issues. ive been in good standing with mine for awhile, hes great and wana keep it that way

     
    Old 07-17-2009, 09:25 AM   #5
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    Re: Why are PM doctors intimidating??

    My PM is attached to the back clinic that did my surgery. It was a smooth transition for me as my surgeon was the one who finally passed me over to the pm after a year. my file was already in the system and he was well aware that I was in need of pain meds and why.

    He is a wonderful caring doctor. what's funny is that he isn't in favor of surgery as the the ultimate answer. So we have occasional chuckles about the surgeon and my back. I personally couldn't ask for a beter person to care for my pain concern.

    One thing, I wouldn't go into the doctor with a chip on your shoulder to start with. That will raise their hackles. If you start off with all your records and an open and honest attitude that should be the best way to start, Good luck!

     
    Old 07-17-2009, 11:30 PM   #6
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    Re: Why are PM doctors intimidating??

    I agree completely with what Ex has to say. You need to be your own advocate but that doesn't mean 'chip on your shoulder' that means confident - imagine that you have a blood pressure condition that needs to be brought down to a certain level and you're discussing the best ways of doing that.

    I was undertreated for a long time - simply because no one ever offered me anything else and I didn't understand what PM was all about. I was just handed tramadol, then when I needed thoracic surgery I was given Oxycontin. It was only after my surgery that my surgeon told me what to expect and that I would be dealing with acute pain on a daily basis and that I'd need PM (which I'd only had through a gp before that). My PM is a wonderful man and appreciates it when I comment on my care. I spoke to him on the phone yesterday and he said something that I consider very important - I've had 3 extremely bad days and my gp and PM had to become involved because I refused to go to hospital - he said that he appreciated me ringing him and telling him that I was in acute pain because otherwise he doesn't know and therefore can't treat me. How true is that - if you don't tell them, they won't know. Many drs will not offer increases in meds or changes unless a patient requests it - and if they make a suggestion that you're not happy with, htey won't know if you don't tell them. This is what I mean by being your own advocate. It's always worked well for me since I've employed it.

    The only thing that I worry about it the off chance of being sent to a PM that either doesn't really care or is just not a nice person. There isn't much you can do here except find a new PM - I did this and I don't regret it for an instant - I still see my old PM for RFD so I tried not to make waves when I was leaving. It's always best to try not to burn your bridges if possible.

    Good luck with your appointment. You know who you are and what you need and I'm sure that will come across to your dr. Remember that they're there to make your life easier, by treating your pain. That's it.

     
    Old 07-18-2009, 01:03 AM   #7
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    Re: Why are PM doctors intimidating??

    Most of wha tother's wrote is very true, BUT....I saw a PM doctor once that was the biggest jerk towards everyone that comes thru the door. I have a friend that was accedentally shot in the back and is parallyzed from the waist down, but he gets these severe burning pains in his legs. They will hurt so much that he ends up vomiting and shaking, and he IS in real pain, but this PM doctor's answer was just anti-deppresants. Of course the doc that refered my friend got upset and decided to take over his pain issues himself. This same PM doctor has done several other things that I could go on forever about, as he is one of the very few PM docs we have in my area, so anyone that has needed an PM doctor has gone to him atleast once, and all of them have ended up having to look for another doctor that would do pain but wasnt a PM doctor, he's that terrible, even my best friend, who's 74 year old mother got treated bad by him while she was in the hospital recovering from a triple bypass and several infections, and came close to death several times, and they asked him to oversee her pain issues and he treated her terrible.

    So yea, sometimes one does need to be worried about seeing a PM doctor. But with this guy it's just that he's the only one that excepts medicaid and medicare, but if you have very nice insurance, there is a group of doctors here that will take you, but most people I know in chronic pain are on disability and dont have those fancy insurances. But I'm not trying to worry you, but sometimes these PM doctor have the attitude that everyone that comes thru the door IS an addict, and I think they love being able to intimiate us. I have to go out of town to see a doctor for my pain, and I'm glad I do cause he's the greatest doctor ever.

    -degus

     
    Old 07-18-2009, 07:46 AM   #8
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    Re: Why are PM doctors intimidating??

    I have a wonderful DO/PM doc that specializes for a group of Orthopaedists here.

    I went to him when I blew a disc at L5-S1 and it was causing all sorts of pain, but my surgeon was wary of doing surgery on me since I'm allergic to so many medications they use to reduce swelling after surgery and thought maybe I could live with the disc as it was under an old surgery the same surgeon had done 10 years ago.
    At first my PM was very frustrated that he couldn't do any nerve blocks or injections of any sort on me as I'm allergic to all steroids to the point they will kill me. But he did give me Norco for the pain and explained that the less I weighed the better, as it would take pressure off the spine and got me a tens unit for pain as well.
    I took to heart what he said back then and started losing weight and doing my own stretching exercises I'd learned after my back surgery to help loosen up the area. He was so impressed 3 months later that I had taken to heart what he'd told me to do, losing weight, and that I did the stretching every day that he sat down and actually asked me if I needed more pain relief to make sure I could function normally, which I did and we got my pain down to a 4-5 daily with the Norco.
    He's worked with me when it was discovered that I have degenerative disc disease and now arthritis along my spine to make sure i understand my physical limitations and we did wonderful together for 2 years with me seeing his PA inbetween my visits with him for my meds. I also take Neurontin and Roboxin for my back as well as the Norco.

    A few months ago I knew something was horribly wrong as my arm kept going numb and was so painful when I woke up in the morning I about was crazy with it. I didn't hesitate to call him. They did an xray that actually showed the blown disc and he right away ordered an MRI on the Neck and since I've been nothing but honest with him in the past 2 years, he put me on Oxycontin and allowed me to stay at the same level of Norco for the pain. He suggested in front of another doctor that they could do a quick diagnostic block to make sure I was telling the truth about the pain and I was all for it if it helped them know what was going on. They decided not to do it after all and trusted me.
    Two weeks later when I went in to discuss options after the MRI and mentioned I was still taking 6 norco a day and thought that the Oxy would make it so I didn't have to do that, he didn't argue with me at all, just upped the Oxy to 20mg 2X a day and still allowed that I could have 6 Norco.

    My point is this....I am my own advocate telling him when I am still in pain and I have been very open to anything he wants to try on me and take to heart his advice on what I can do to make myself more comfortable, like losing 40lbs. I still plop on the floor every morning before my shower and stretch out and I still use biofeedback to convince my body that the pain isn't that bad and I still walk around and go to work etc. My doctor is amazed and says I'm a model patient. I've heard him being tough with other patients though while waiting my turn at appts. He isn't always so nice to people if they resist his ideas and just want the drugs.
    So, be open to your PM. Try what they want you to do. Don't jump to drug treatment or get in your head that is the only way. It does put the Dr on the defense when you do that.
    I always listen to what he has to say before I chime in with my own ideas as well. I always nod and sit as if I am open to anything he has to say and truly believe Dr's read body language of patients. They instinctively can tell by this if you are there to get the help you need or if you are there to get the help you think you need. Two very different things in my book.
    Just my 2 cents.

     
    Old 07-18-2009, 09:38 AM   #9
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    Re: Why are PM doctors intimidating??

    Quote:
    Originally Posted by Executor View Post
    Part II: The patient: Patients are often worked up and nervous because inherently, they know if the back of their minds that the PM Docs virtually control their entire lives...Via the meds. What if I don't get meds? What if he changes me? What if he stops them? And so on. I have to believe that when patients get worked up, then it transfers negative energy to the Docs....Has to in some regards.
    I was more nervous before I saw my PM doc than any other doc app't I've ever had because of the reasons listed above and others. I had a minor anxiety attack while in the waiting room. (If he wouldn't have been running so late this may not have happened. I have mental health issues also.) So you're not alone.

    I tend to joke around when I'm stressed but in an introverted straight faced kind of way. Don't do this. Pain meds are a serious thing and you don't want the doc to think you're taking it lightly or having fun with the meds, which isn't my intention at all.

    I also agree with what Ex said about being your own advocate but not being too demanding all the time. Pick your spots when you think you need something different than what might be given. I would try to pick your spots later also. Let the doc be in charge as much as possible in the beginning. While we need to be our own advocate, I put myself under the doc's care and need to respect his authority. If you don't like the doc, then by all means change if you can instead of having a power struggle.

     
    Old 07-19-2009, 02:48 AM   #10
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    Re: Why are PM doctors intimidating??

    Thanks everyone for posting! I truly appreciate the responce. I wont have a chip on my shoulder but I guess I am a little sensitive lately about doctors and their staff. With all the issues I have had with pain lately I just hate this feeling that I am not in control of what happens to me. That I am at the mercy of other people makes me very anxious. I have had a few problems with my surgeons nurse being very un kind and down right hatefull to me. (In case anyone is wondering: I very tactfully confronted her and just tried to let her know I wasnt trying to get one over on her and that I didnt appreciate being treated as though I am and she really mellowed out and has been quite nice to work with ever since).
    I will walk into this appointment with my head up and well prepared and with an open mind and hopefully all with turn out for the best.

     
    Old 07-19-2009, 04:31 AM   #11
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    Re: Why are PM doctors intimidating??

    Remember Dr.s are people too. I have been going to the same clinic since 19
    2000. To me it's not like a doc visit it's like seeing an old
    Friend for awhile. We talk about our crazy families & life in general. He is the greatest doc ever & so are all in the office. A lot of it depends on your additide when you go in, be yourself and explain it like your talking to your best friend. Pretty soon you might just be.
    I take:
    Dilaudid
    Opana ER
    Xanax
    Valium
    Zanaflex
    Flector patches
    And armrix
    I have a life again I can enjoy most days. Sure some days aren't
    Great but at least I have a LIFE again to enjoy.

     
    Old 07-19-2009, 09:20 AM   #12
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    Re: Why are PM doctors intimidating??

    Quote:
    Originally Posted by Brosiah View Post
    T
    With all the issues I have had with pain lately I just hate this feeling that I am not in control of what happens to me. That I am at the mercy of other people makes me very anxious. I have had a few problems with my surgeons nurse being very un kind and down right hatefull to me. (In case anyone is wondering: I very tactfully confronted her and just tried to let her know I wasnt trying to get one over on her and that I didnt appreciate being treated as though I am and she really mellowed out and has been quite nice to work with ever since).
    Ironically, sometimes an "incident" can open a door to a new and improved relationship. I had something similar with my PM years ago, and while it certainly wasn't any fun, it was the stage to a whole new relationship. As a result, things are much different. This is part of the "advocate" concept I was talking about.

    I've read all your posts and I think you've got the right attitude and will do fine. When a person is in pain, they respond different at appointments than those who are not.

    Best of luck and please let us know how it goes.

    Regards,

    Ex

     
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