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PM docs contract

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:32 AM in Pain Management
Hi all,

I am in the process of switching PM's. There was no contract with the first one. I think the new PM has one. I have some questions about them...

1) Can you ask for a copy of the contract prior to your appointment?
2) Did you get enough time to review the contract before you signed it or is it something you just sign with all the rest of the stuff?
3) Can you deny the contract? Will he still see you?
4) How legal is the contract if I am on a narcotic at the time?
5) Don't you feel like you have "big brother" on you?
6) What do you do if the contract has something, one part that you don't agree with for personal, religious, etc...reasons? Do you sign it anyway?

I just don't like the idea of having a legal docment hanging over my head. I am currently on the Fentanyl patch so, how could I abuse that? It's a matter of trust. I am trusting the PM to treat me correctly and they should trust me to follow through on our treatment plan.

I just don't feel I would have any respect for the PM.

Thank you in advance.



  • My guess is, here is the answers that I see...

    Yes - possibly not
    VERY - but just let your doctor know what it is and who prescribed it.
    Discuss any qualms you may have with your doctor.

    I don't like the legal document hanging over my head either, but if that's what it takes to have my pain treated, I am happy to comply.

    And, believe it or not, those patches CAN (and probably have) be abused... This world is made up of all kinds of people - intelligent people, idiots, intelligent idiots.... The majority suffer because of the sins of the few.

    The reason the doctors ask for the contract is simple - to cover backsides. Yours as well as theirs. They ask that they be the only doctor prescribing pain medication. If another doctor prescribes anything for you (such as a dentist or E/R personnel, etc) my advice is to call your PM doctor as soon as humanly possible so they are not hit with any surprises. If any medication appears in your urine test that has not been prescribed by your Pain Management doctor, he/she has every right to drop you as a patient. Unless they know about it.

    Whether we like it or not, big brother is out there, bigger and badder than ever before and his name is DEA. Especially with all these recent deaths that are attributed to overdoses of prescription pain medication.

  • I've been going to pain mgt for over a year, and I had to sign a contract stating various things including agreeing to random drug testing, and to not accept any pain meds from any other doctor. Also, I must notify anyone that treats me medically that I am a PM patient under contract. I must use only ONE pharmacy so they can check on me if necessary.

    I was presented the contract and I didn't have a lot of time to go over it. The nurse said please sign this, and I skimmed the form as fast as possible. I do have access to it on their website, so I know it very well and can avoid making mistakes.

    Here are other ways you can get in trouble and possibly dismissed
    -missing appointments
    -refusing drug testing
    -running out of meds before refill time, always losing scripts
    -being irresponsible with meds, skipping appts, procedures, etc
    _ refusing further testing, evaluation, therapies, or other recommendations from the doctor

    I know it's a lot to take in, and this is certainly not a complete list. Contracts do differ from one doctor to another. Some will not give you any pain medicine unless you submit to a urine screen on the spot at your initial appt, and you must provide them records and films that confirm your pain.

    My office would not see anyone without a referral from another doctor. Other clinics may have you come in at random times to do a pill count to make sure you are taking them as you're supposed too.

    All of this sounds very strict, and it has gotten this way because of the prevalence of drug abuse and diversion, and the DEA exerting pressure on pain doctors. This practice does however help establish trust because your doctor knows that you are following the rules, and therefore feels comfortable treating you.

    Too many people out there come in with bogus stories of pain, and doctors have to weed them out every day. My PM doctor knows my pain is real and trusts in what I say. In turn I get treated with respect and I know I will get the best treatment available. This only works when there is mutual trust and respect for one another, and I accept that I must follow all the rules in order to have this care available to me.
  • In Canada where I live i know of no contracts to sign but if you're caught with going to different Drs. for controlled medications it's called double Doctoring and it's a criminal offense. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • In the US, when a doctor runs your pharmacy sheet, it captures your prescriptions from every pharmacy in your area. They can even have the information from a previous state if you have just moved there, etc. So, that is a bunch of poop if you are in the US. I suspect kickbacks from the pharmacy he sends ALL his patients to.

    I am more than happy to provide any & all records, films, and history. The more the PM knows, the better they can treat you.

    Great, he feels fine treating me but what assurance do I have? Oh, the Hypocratic JOKE!

    This is all one-sided. I am the customer. I am paying him to treat me correctly.

    Thanks for your post.

  • Ah, Canada is the true "Land of the Free."

    Thanks for you post.

  • I just want to be treated fairly and unbiased
    We all want that-Drs are no exception.None of us like signing the contract (I don't think),it's like a clerk saying 'show me your purse' before you leave the store just because you could have stolen something.It can rob a persons dignity...

    ..but Drs are treated unfairly,targeted,and investigated by the DEA if they don't cover all of their bases when prescribing pain medications-simply because some people choose to abuse,or use diversion techniques with medications that are addictive and used recreationally.

    This is widely known,pretty much everybody and their grandmother knows about the dangers of prescription medication.WTH am I talking about this for again.........??

    Anyway,I understand the distaste insofar as the contract is concerned,but that's the way it seems to be.Like it or not,not really the point though..meds,no meds,meds,no meds.....give me the damn pen.... ;))
  • But the clerk cannot say that without any reason. They can't randomly pick out a person for no reason. Then they get into profiling, gender, race, etc.

    I would think that PM's could probably tell within a month or 2 if the patient is for real or not.

    I just feel so strongly that we should not have to be threatened and harassed for others actions. I know it is a losing battle but will never stop trying.

    Personal info - I am an Italian woman from New York = stubborn.

    LOL - I really would just like to take the pen too. My pain is still not controlled at all. Maybe if it were it would be worth it.

    Thanks for you post.

  • You stated: "That's bullying. To do "what it takes to have my pain treated"."

    I don't think of it that way at all. I was glad to have someone validate my pain - not tell me it is all in my head, and actually sit down, talk to me person to person and understand what it is I go through.

    Although I have agreed to jump through her hoops, I have never failed a pee test nor have I been asked to bring in my medication for a count.

    I do agree with your statement that anything could happen in transit with your medication, and I would have the same concerns.

    I don't mind going to the same pharmacy - they know me, I know them, they usually always have my medication, the wait time is minimal, I do not get the funny stares nor am I treated as an addict.

    I am giving up very little for my piece of mind. I mean, I've lost almost everything else (because of my back problems), I need to keep my mind right where it is. And as calm as possible.

    It's all just checks and balances. What it boils down to is what a person is willing to let go of in order to have what they need.

    I truly hope things work out for you and your daughter.

  • I don't recall a contract at my initial visit. This PM is the biggest joke. He will only treat you if he can do procedures or surgery on. He told me that after my next injection he will "ship me out" because I would be a medical management case only.

    It has been a long and horrifying experience with this PM.

  • I have been reading these posts all along.

    I'm sorry but at this point.

    What are you really asking about? If it is the pain contract with the NEW PM then you will really have to wait and see what is presented. You have enough facts to go on for now.

    If you are tired of the old PM and do not trust them then you will have to find someone new. In the end it will be up to YOU to decide who is the best AVAILABLE choice for you and whether or not to sign the contract if one is presented.

    I sincerely hope that the new PM is the right one for you.
  • I hope this new PM will be good.

    I just starting going to PM at the end of March 2009. So, my only experience is with him. Since I have had such a horrible experience with him, I guess I am sorta leary about the new one. Actually, just scared. I have been in constant pain since going to the PM.

    He has only tried me on Opana ER, Zanaflex, and Baclofen. He will not help to find the combination of medication that will treat me pain. He will not prescribe anything except the fentanyl 25 patch.

    He will only do procedures. When we run out of procedures (which will be my next one), he said he will "ship me off" since I would only be medical management.

    Thanks for the post.

  • There's a simple answer to the pain contract issue. If you don't want to sign one, find a physician that doesn't require one.

  • It is true that there are PM doctor who choose only to do injections or other invasive treatments. This PM kinda sounds like one of them but at least he's giving you Fentanyl patches. Your best bet is to be at an integrative clinic where they provide all sorts of treatment.

    I also felt weird about having to follow all those rules required by PM, but in time I felt comfortable and it doesn't bother me much. As long as I know what to do and what not to, everything is good.
  • It wouldn't hurt to tell your Dr you had a bronchial spasm and cough and was given hycodan if he asked for a drug screen. But I never bothered to tell my family Dr though as she is way across town and the walk in clinic was easier for me to go to with the terrible cough that I've had twice over 12 years and required the hycodan. It's very useful for suppressing cough. Take care of yourself and hope you feel better. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I'm going to piggy-back on this thread to keep from starting a new one.

    After reviewing the contract in the link that is stickied, I have a question. Are most (or all) of these contracts perpetual or do they have an ending date? I don't have a problem signing a contract that will help me with my pain, but I do have a problem signing a legal contract that holds me bound forever. I just can't see that it would be wise to bind myself to an endless legal contract when the treatment I receive may not be endless. Does that make sense?

    I know the presumption is that the contract is only valid while you are under that physicians care, but with a formal contract like this, presumptions aren't very useful. I certainly wouldn't want a doc I fired to be nosing though my pharmacy records stirring up trouble. And lets be honest here, for every wonderful doctor out there, there is another that is a control freak with a God-complex.

    Thoughts? Has this ever come up before?
  • I have been going to the same PM for 3 1/2 years. I went to him for a year before they realized I didnt have a contract signed. I read it and had no problem with ir because it assured me of getting good care from a Dr who is going to watch out for me.

    I have never had a pee test or my meds counted. But I never worry about it, because I take my meds as directed and so where does the problem lie if you are doing things right? I wasnt offended. Just knew there are checks and balances for everything we do.
  • I looked at the "stickied" example of a pain contract and honestly, it doesn't look anything like my pain contract.

    I have long suspected my doctor is more strict than most, but he also makes treatment expectations very, very clear - both what he expects from patients and what he offers in return. He also invites his patients to bring a family member, friend, or advocate to be involved in the contract review session, so that there's a support system involved if the patient chooses.

    The contract my doctor uses is very specific and contains very detailed information on just about every office protocol. The most recent contract I signed was about 10 pages long. Each page and several subsections had to be initialed, then the last page had to have my signature, his signature, a witness signature from his office, and there is an optional space for a second witness of the patient's choosing.

    My doctor requires a newly signed, updated contract annually. That's something he checks himself, at every visit, and if there's not a current contract on your chart his staff has to fix it before he'll continue the appointment.

  • I understand what you are saying/asking Dedalus,but whenever you discontinue with a Dr.,the contract with that Dr would be void at that time.

    Your concerns about a Dr nosing through your pharmacy records are just wasted worry-IMO-simply because any Dr with your name and info can do that if he/she feels inclined to do so,has the time and energy,and is that interested.

    I don't recall this particular subject,of Drs looking through pharm records,coming up before.I personally haven't thought about it myself...until now.I'm not concerned about it,but only because I have nothing to hide...but I would find it an invasion of my privacy.

    Privacy-ha ha,we don't really have much of that left unless we are in our homes with the blinds drawn and doors locked....
  • Robin said:
    Your concerns about a Dr nosing through your pharmacy records are just wasted worry-IMO-simply because any Dr with your name and info can do that if he/she feels inclined to do so,has the time and energy,and is that interested.
    My doctor pulls my information from the state prescription monitoring program at every visit. At the beginning of my appointment, they have me review the PMP activity sheet and sign a statement saying it's correct. Although that's outlined in my contract, I had to sign a separate consent for the state PMP to release the information.

    Personally, I don't mind a bit.

  • I hate to admit that I sometimes use marijuana for pain. I dont not go to pain mangt yet, but I assume that is where I will end up going. Does anyone have experience with going to a pain mangt doctor and smoking marijuana for pain also? What should I do? Should I tell him about it? Will they acept that? Do I wait and see if they drug test me first? Please any advice would help me.
  • Yes,and many patients sign forms at Dr visits,some with small print that may very well include this.Maybe not-just saying.

    I don't care about my pharmacy records being snooped in for the reasons that some people might..I simply mind that so many things that I thought were private or personal are really not,that so many of our rights are no more,but that's another subject.

    I do understand why Drs prescribing medications protect themselves.

    It was about a year or so ago when I recall a lot of complaints about the subject of 'jumping through hoops',and the numerous things that some had to do each month to recieve their prescription meds,ie;UA'a,pill counts,etc.,so I feel sure that some people were,and perhaps are still bothered by the routines that go along with the contracts.
  • I would assume that admitting you have used it in the past will not be a problem. However using it in the future while under a PMs care is no different than using any other drug that he did not prescribe. Well, maybe a little different as in many areas it is totally illegal.

    I'd suggest it would "probably" be safe to mention that you tried it for pain control and it worked. Let the PM take it from there.
  • ....and I'd mention it sooner rather than later, because once you have a dirty urine screen, you're going to have troubles.
  • Marijuana is illegal no matter what state someone resides in, under federal law.
    If I were Ashley, I would tell him that you have in the past and not touch it at all between now and your first visit. I can't remember how long thc stays in your system, but I do know that it is much longer than most other substances. You might want to look it up on the internet before making an appointment with a pain management doctor.
    Best of luck to you,
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