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Pain Mgmt. Clinic: Am I an Abuser or Dealer?

krazybobkkrazybob Posts: 53
edited 08/15/2015 - 12:09 AM in Lower Back Pain
Long. I'm sorry, I am a detail guy.

Last December 2014 my back finally gave out after years of managing it with medication. Oxycodone. The PCP that provided it knew that I was living in a cancer hospital with my daughter and that there was no money for a MRI or getting into treatment (covered by insurance.) Fast forward to now, when my private insurance hit $800./mo. and instead of telling me options I telephoned the insurance company and went through signing up for a new plan. To do this they required that I first terminate my current plan. I did as instructed. Wrong Answer! When all was said and done the computer decided that I qualified for California Medical - free insurance. I don't want Medical, free or otherwise. I was told I had no choice.

Finding treatment became difficult but I finally managed to find a Pain Mgmt. Clinic at a regional medical center of prominence. As a teaching hospital I first see a Fellow and s/he advises me this way or that. The main doctor then comes in for a recap. But each time I see a new Fellow I get a different course of treatment.

Lately I have been doing a lot of acupuncture and swimming every day. It appears that although the swimming has got me up and moving apparently I have aggravated a prior neck issue that I had surgery to correct 5 years ago with a Discectomy. I needed to reschedule an appointment last minute and was told that the next available was September 9th. I replied that I would be out of medication by then, do you have anything sooner. I was told that I needed to speak with a nurse and she had me race in today - I made it work to my detriment. My issue was not a medication refill but scheduling. My daughter,a cancer patient, was up all night vomiting and today I could not find a suitable babysitter. Once doesn't just pass of a seriously ill child to just anyone. I did find a retired nurse,a neighbor of mine.

Today I saw a young Fellow with the face of Doogie Houser. Young like Doogie [edit] ! He went on and on an on about my tingling in my fingers and my neck surgery and this and that and this and that until I finally stopped him. I said "Respectfully doctor, I don't understand why every time I come here and see a new doctor I get a different course of treatment." "Well, what do you mean" asked the doctor. "Well, today you are asking about my neck but I am here for my lower back. Before I was given a cortisone shot. Then I was offered nerve burning. Now you are asking me if I am interested in a Spondilator or something like that." This [edit] him off clearly and he retorted that the numbness and tingling in my hands was caused by a neck injury. It would have been nice if he had tied that up in the beginning. All I know is that I haven't been able to feel my feet for quite some time and now my hands are numb. To me it is related; to him it is something new. We can agree on that once presented like that.

I then see the main doctor and all is well. I was very happy to announce a decrease in my medications because of swimming. The doctor asked if I wanted to go down on the medication and I agreed without hesitation. I also asked about a chance of the cortisone injection but under sedation. He said no, it didn't work. Doogie Houser disagreed! I was to return in one monthly. While waiting I was called back into a treatment room now with the main doctor and the student and accused of either being a drug abuser or dealer. I don't know which. I was peppered with questions on how I could be out of my medication so soon (I was not and never said that I was). Why did you tell the nurse that you had to be seen today? I didn't! You got your refill on the third and you are almost out? No, I said that I am getting low. "You just said you have only three left?" "No! I said that I only have three in today's cup." I dispense my meds daily just like my daughter in plastic medication cups that are labeled with the time. It went on like this until I was told that I would be removed from the program. I begged tearfully not to be, that I wanted treatment, not drugs! I maintain this position. I was seated again in the waiting room. While waiting I approached the counter and asked to speak with the nurse about the scheduling confusion and did not get to. But Doogie Houser reappeared.

In the waiting room with other patients and staff I was asked if I was still using a Fentanyl patch. I answered in the affirmative. I was asked in front of others if I would mind showing the doctor. With no real option to refuse I removed my shirt and exposed my patch. HIPPA VIOLATION!!!! I had offered in private to submit to a UA and was denied by the main Doctor. "What would that prove?" That I am not using more medication than prescribed. I took my glasses off and asked the doctor to look at my eyes. "And what does that prove?" That I am not high. In retrospect it appears that I was not being accused of using too much, but of selling my medication. My acupuncturist told me that he was concerned with me not getting active or I'd end up in a wheel chair one day. I mentioned this to Doogie Houser in the waiting area and he replied, "That isn't likely. In fact, I don't think there is anything that wrong with you now."

My MRI, CT's and X-Rays say otherwise. HIPPA violations once again. Although I made a statement I did not reveal a medical diagnosis in public. The young doctor did. He also made a libelous and slanderous statement but I have no intention of muddying the waters.

Lastly, I telephoned the pharmacy and spoke with a really nice woman that has been filling my meds and those of my daughter for a couple of years. She knows me to be a man of character, honest, and caring of my daughter. At no time have I concerned her with filling my narcotics, an important point. She is required BY LAW to refuse to fill any medication that she feels is being abused. She explained to me that the way the main Doctor was writing the prescription is confusing., He writes that I am to take one every 6 hours for pain as needed but with a goal of 3 tablets a day. Every 6 hours is four tablets. The quantity is 90 because the doctor has written on the actual prescription not to exceed three times daily regardless of instructing me to take one every 6 hours. The math doesn't work. The prescription is for 23 days, not a month! I have enough to last until next month but only because swimming has caused me to decrease on my own. I thought that would be excellent news!

I don't know how to proceed. If I mention the HIPPA violations the doctor may boot me out of fear of a law suit or something. If I protest too much about being accused of being either an abuser or a dealer that too may be a red flag. BUT I AM NEITHER!!! I take my meds as prescribed and only as prescribed except that I am taking less and voluntarily agreed to a formal decrease. I maintained that I did not know why my on hand quantity was low and I tried to explain that the fill date was not the date that I picked it up. That suggested to the doctor even more of a problem. He did everything he could to trip me up and succeeded in confusing me. I don't know dates! I get telephone call reminders of appointments for both daughter and I, or my cell phone beeps and reminds me. I don't look at dates and actually thought we were further into August than we are.

I know that there are many that game the system and abuse it. I am not one of them. How can I proceed and still stay in a hard to find pain management program? I've done nothing wrong but have clearly been wronged. Instead of an appointment next month the main doctor made it for 2 months, denying me TREATMENT. Lesson learned: don't tell Doogie Houser you disagree with his medical assessment without his boss there also.

Humbly Yours,



  • sandi123ssandi123 Posts: 456
    edited 08/15/2015 - 4:46 AM
    Sorry the appointment went south the way it did, but perhaps I can offer some input that might help clear some things up.
    You go to a major teaching hospital, and residents and interns do "rotations" through each department/specialty as part of their training. They work under a licensed physician in that specialty during their rotation. Each doctor/resident is going to have their own ideas or recommendations regarding treatment. They may or may not be something that you or even the head doctor may agree with, but their job is to base recommendations based on your examination. A spinal cord stimulator is one option offered to treat neuropathic pain and most of us dealing with that type of pain will have it brought up at some point. It is an option that may not have been brought up before.
    As far as the meds and the appointment goes, it sounds as though the way it was recieved by whomever answered the phone believed that the reason you requested the earlier date was because you stated you would be out of meds by September 9th, and it doesn't sound like you clarified that it was a scheduling conflict, rather than a med issue.
    It also doesn't sound from what you stated that you clarified that was the reason for requesting an appt earlier than the 9th when speaking to the doctors.
    Perhaps, it would have cleared up any misunderstandings if you had clearly stated what occurred when you called to schedule the appt.
    I would suggest that you bring your bottles with you to appointments and if there is any confusion you simply show them you have all of your meds with you.
    I am not saying that this is all on your end, it appears that there were some serious gaps and misunderstandings during the visits with your doctors.
    Given the illness of your child, it is likely that you may have to rearrange appts again, so a frank discussion with the head of the clinic might be in order, explaining the circumstances and making sure that if you do have to reschedule that they understand the reason clearly would help .
    One last suggestion, I always put the refill andpick up date of my meds, along with the date that I actually start a new bottle of meds in my phone. That way if there are ever any questions, I have all of the dates right at the tips of my fingers.

  • krazybobkkrazybob Posts: 53
    edited 08/15/2015 - 3:48 PM
    Hi Sandy and thank you for taking the time to reply. You are correct in many ways. Having lived at a training hospital for 9 years with my daughter I sure understand interns doing evaluations. But in my case the doctor had seen me before and keyed on the fact that I was having a numbness now in my fingers. He rambled on and on about your neck this, your neck that until I finally stopped him. I ticked him off when I asked why every time I come in I get a different answer. I *challenged* his learned experience. He could have been polite but instead made derogatory comments to the head doctor. This young pup also extended his belief that there was nothing wrong with me. Like an immature child he appears to have sought to get even because he had no clinical reason to believe that I am faking anything. As I mentioned my MRI's, CT's and X-Ray's say otherwise.

    My daughter celebrated 5 years in remission s few weeks ago! But she does have appointments that are always scheduled on now well established days. Tuesday, doctor #1. Wednesday, doctor #2,, etc. They are popped into my phone and this is partly why I don't recall DATES. I go by DAYS.

    I WAS clear as to why I was rescheduling but it doesn't seem to have either been clear to the doctor, or the nurse suspected that it was just a ruse to get in sooner. Fraud is rampant and I get that. But I was clear that my daughter had been ill all night and that I could not get just anyone to watch her - a brain cancer patient. She is high maintenance with injections and oral meds and a parent that is an experienced medic. I've been drawing her labs for years and basically functioning as her live-in nurse. Scheduling has not been an issue. But as I have learned pain mgmt. patients are crafty and have excuses. The doctor was likely expecting some kind of scam. Based on a Fellow that did not like being challenged - which is my right to advocate for myself - and the nurse who did not communicate effectively I ended up the one on the receiving end. The questions were being thrown at me so fast that I couldn't get a coherent sentence out.

    I need to send the doctor a letter explaining this;. I am concerned that I am not getting treatment I realize that meds are part of treatment but so procedures designed to mitigate the pain and referrals to others that may be able to remove the source of the pain.
  • It does sound as though the receptionist or whomever answered your call failed to relate the reason for the change in appt . Unfortunately, that happens all too often, failure to listen to what's being said.
    I can see where the intern /resident would be concerned with the new numbness, and wanted to focus on that, but that doesn't excuse his being unprofessional.
    I hope you can get it straightened out and everything back on track as far as your treatment goes.
    Managing a major illness of a child is hard enough, and my prayers for ongoing good checkups and follow ups for her. God bless her.

  • Sandi, I am afraid to say anything at all. But the doctor has moved my next appointment to October and cut my does form 4 times daily to twice daily. I am being punished for the arrogance and anger of the Fellow. As I described new symptoms that I thought related too the numbness in my feet I thought that they were related. Had the doctor told me in the beginning the numbness was due to a neck issue I would not have stated so forcefully that each time I come in I get a different plan of action from the student doctor. I have aright to advocate fir myself!!! But I angered him. The smug look on his face told it all. I challenged him as a doctor when the truth may lay in the middle. I am there for treatment that of course includes meds. But while there I asked about revisiting the cortisone injections and I was serious.

    I have since spoken with the pharmacy and learned that the doctor wrote the script incorrectly. I have even photograph of the bottle because the main doctor demanded to know why I think I am running out. I AM running out based on math - 23 days and not a month instead of a 30 day supply Q6. I told the doctor that the bottle looked low and it DOES. That's because it IS LOW.

    Why has there been a black cloud following me for the last 20 years?

    I must add that I am seriously depressed now. This has brought me to a place of fear and tears. I am fearful that if I speak up to clear the air I risk ticking off the doctor even more. If I don't I am forced to exist in unmanaged pain based on a mis8understanding. I slept all day today and I am now cutting pills in half to save what I have. This too will force me down but I have not choice. I can only hope that what I have been told about pain meds actually causing pain is accurate.

    How do I write a letter to the doctor? I am factual, detail oriented guy. I believe that people cannot make a proper decision with only partial information. But too much will make me look guilty now that I've had a weekend to line up my "story."

  • SavageSavage United StatesPosts: 5,427
    edited 08/18/2015 - 12:00 AM
    You mentioned about ...pain meds can actually causing pain.
    I've not experienced with that re my spinal and current chronic pain issues.

    But when younger, I suffered with migraines regularly. I had prescription for meds that not only became ineffective over the years, but were causing rebound headaches. One time I needed hospitalization to stop the cycle.
    And then I had to stop that medication.

    For the chronic pain, my PM doctor keeps my scheduled meds changing every year or two to maintain their effectiveness.
    Sometimes when med no longer controlling the pain, one may think they need increase in dosage, instead of change of med.

    I'm sorry, I may have missed it. Were you released as a patient from that doctors' office?

    Although I can understand letter to doctor that you want added to your chart to clarify your situation....whether you were released or not....if you had difficulty with doctor, or fellow or resident, understanding you when you were person to person,
    my experience is that anything in writing can lead to even more misunderstanding.

    In writing, the tone, etc....is not there. One of the reasons all these emotive symbols so popular with emails and texts.

    Personally, I would wait for appointment and see if brought up again.
    Having been in teaching hospitals myself, I would listen to the fellow, resident, student, whoever..as they examined me and spoke out loud to me what they were thinking.
    Then wait to see main physician and let him make the decisions and if I still have any questions, I direct to him.

    Main doctor is there to..lack of better way to say..he's there to catch them with wrong opinion and or diagnosis and or treatment..in order to continue teaching. The main doctor isn't just going to go along with incorrect information reported in from their residents.

    Im so sorry for you child's illness. I would think that to be all consuming to your thoughts and energy.
    This is foremost on your mind and may be another reason to at least delay before putting anything in writing, at least at this time.

    I wish your daughter the very best...and to you and your family, also
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • I am up at this early hour because the pain is so intense that sleep isn't going to happen. I don't know what I did in a previous life to bring this upon me. The doctor recommended more exercise - swimming was an outstanding choice! Only to aggravate a prior issue. How this turned into me using too many or selling my "extras" that don't exist I am at a loss.

    When I first became a patient I had meds on hand from a prior doctor. I was on a more frequent dose so the quantity that I had each month was higher. But wanting less to be sufficient I worked hard at not taking the meds as often as prescribed. I was then moved to a program and the dose remained the same at first while I was being encouraged to decrease on my own. I did just that. The following prescription the doctor reduced the frequency by one tablet a day but he wrote the prescription still at 4 a day. That's what was on the bottle and that's what I took. I didn't realize that the quantity was insufficient for a month because I still had some left over, plus I was taking fewer here and there. Now that those are gone I am down to just what has been prescribed - and now I know that it is only a 23 day supply. I didn't know before because I was just reading the bottle and not out of meds.

    The doctor told me that I needed to find another program and I tearfully begged him not to, that I was there for treatment. I said I would do a UA and he wanted to know what good that would do. It would show that I was taking the meds and the level in my system should indicate how much. Its just math to them. He let me stay but further dropped the frequency to twice a day and made my next appointment for 2 months from now. I think he wants me to suffer without meds to prove that I am out of meds and need them. Why else would he do that? I realize that abuse is rampant but I have been a model patient. I have taken only what has been prescribed and actually less. That's why I had a small reserve.

    Yes, my daughter takes much of my time. She will be having a MRI this week followed by another 3-day stay that I need to be with her for. I have not written a letter for the reasons you mention. They become a record of the confusion in an unintended way, and lack emotion. But I cannot go without my meds! Just because Doogie Houser got ticked off tat I caught him being less than clear I am going through this. The contempt on his face was clear and his words in the waiting area, "I don't think there's much wrong with you to begin with..." are just as clear. The main doctor will take his word over mine. That's wrong. He's a student. The doctor peppered me with confusing question one right after the other in an attempt to confuse me and when he confused me he declared that he had proof. Proof of what? That he confused me? If you want the truth you let the suspect talk freely and THAT will bury them. Not a coerced confession when you don't even know what you are being accused of. or saying as you are interrupted in the middle of an answer to answer another question.
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