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Changing Pain Management Provider

I would like to preface this post by stating very clearly that I do not want what I'm saying to snowball into a "doctor bashing" thread!  As we all (should) know, it is against forum guidelines to "doctor bash", and understandably so.  I have been tossing the idea of this post around in my head for a few days just to make sure I worded my reasons for why I want to change providers in the least disparaging way to my current pain management clinic.
So, here goes.
After my surgical experience, I learned a whole lot more about pain medications. Not everything, naturally, but enough to know that my current pain management team just hasn't been getting it right in my case.  At the hospital, one of the staff doctors came in to discuss my pain management medication plan with me.  Kudos to her--not only was she professional, she also had the ability to explain in a clear and understandable manner how pain medications work.  After seeing what I'd been prescribed in addition to learning the type of work I do, she asked how on earth I was getting through a day at work.  Yes, the 2 10mg oxycodone (and the thought of bills to pay) helped me function enough to get through the work day, but I wouldn't be walking upright by the time I got home.  I admitted to this hospital doctor that I could show her an exact schedule of when I had to take a third (but not specifically prescribed) oxycodone--my college schedule.  Sitting (especially in night classes for 2.5 hrs +) caused my pain level to skyrocket. 

I knew I was taking a huge chance of being red-flagged by this physician by admitting that I was not taking a narcotic "as prescribed".  Without overtly knocking my pain management team, she said she thought the long-acting OxyContin may be a better choice for someone in my situation.  Anything I've read when I've accessed my charts from this entire procedure and follow ups just states I'm progressing well, and I've seen nothing anywhere about my "misuse of medications".  So far, the medication regimen this doctor prescribed has been working well.  In that alone, I know I am extremely blessed.  I see the anguish in some of your posts surrounding pain management issues, and I just feel plain bad for anyone who has to endure so much to sometimes receive so little (in whatever sense "little" has for you). 

I am one of the multiple members on here who have issues in two (or more) regions of my spine, and though my lumbar recovery is going swimmingly, I'll likely still need pain management services for my cervical spine problems.  Honestly, I neither feel adequately cared for nor do even feel KNOWN by my current pain management group.  I have experienced my lowest pain ranges in a long time in my cervical AND lumbar areas, and that's post-op.  In a way, I feel like the doctor who took care of me in the hospital in terms of medications listened in a way that my current pain management providers are not.  At times I feel invisible, at other times, under an unnecessary microscope (both of which are demeaning in their own ways).  The hospital has a policy that the patient is released after a certain time because they deal solely with post-operative pain management, and I get that.  
I've only been to this one pain management clinic, yet I'm concerned with the concept of "doctor-hopping".  There are such a wide range of perceptions about this issue.  Some places are highly sensitive about people changing physicians--particularly in situations like pain management where narcotics are often part of the equation.   If those of you who have had a similar experience to this would please share their knowledge with me, I would be very grateful!  Did the process of change go smoothly? 
Thank you for taking the time to read this, and for anything you might have to offer!
Kimmy72, Spine-health Moderator
Firm believer in PMA!
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Comments

  • Bruce EitmanBruce Eitman Akron, OH, USAPosts: 1,510

    Kimmy

    I have to be honest, it took 2 1/2 years before anyone introduced the concept of a pain management doctor to me.  When I met with the PMD, he didn't think there was anything that could be done fore me and referee me back to the surgeon.  So I don't know much about pain management, but I wish that I did...

    But, I do know that if we don't act as our own medical advocates, then nobody will do it for us.  So, by all means get a second opinion.  If it turns out to be a good opinion, then switch.

    Use your GP to get another referral. Your GP will be the common thread between your doctors, so they should be comfortable that you aren't just out to get drugs.

    When I needed an MRI to speed up getting into my surgeon's office, I called multiple doctors to get the prescription and ended up with two.  Same for muscle relaxer.  Both were extreme circumstances, but when one doctor us under-performing look for one that will help.  In both cases it was the specialists office that didn't call me back, but my GP was very helpful.

    Bruce

    Read my story at Bruce - My Story
    ACDF C4-C5-C6-C7, and getting better every day
    It has been a process of healing, learning, exercising, and resting - and figuring out when to do which.

  • hvillshhvills Suzhou, ChinaPosts: 971

    Kimmy...

    I 100% agree with Bruce... if you are not happy with your current pain doctor by all means get a new one. 

     What surgery did you have?  When?      

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
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  • RNinPainRRNinPain Philadelphia Posts: 1
    Hi Kimmy72,
    I do have experience changing PM, but let me start by saying that many patients switch practices for all types of reasons. This should not be considered a "red flag" just because it's pain management. Especially since you say you have only been to one PM clinic. Insurance changes made me have to switch providers one time. The other time was because I felt the Dr. and I had gone as far as he could take me and it was time to move on. (You can use whichever excuse you want when asked why you want to switch dr's but I recommend not sounding resentful to your current PM for any reason).  
    I did not have much of a problem except how long it can take for a "New Patient" appointment at a PM office. I mean, it can take weeks to months. They will not accept you as a patient at most offices if you have already been treated at another PM office UNLESS you have your medical records sent to them. This should not be a problem. Even for patients who have been "fired" or kicked out of their PM, the office still must forward a copy of your medical records when you request them too. Most PMs will require you to sign a contract and will fire you if you do not adhere to it.  Make sure you look around to find the right PM for your needs. Read reviews on the PM and their office staff!  Ask your PCP for a recommendation, or friends/family for theirs. I actually got my current PMs info from my previous PM! 
    Treat the first visit as if you are interviewing the doctor, have questions written down ahead of time, asking the doctor what treatments his office offers and get an idea of what to expect from your future visits and plan of care. Write down all your symptoms, tests, and treatments that you have tried and what happened when you tried each treatment, therapy or medication. Also, keeping a daily pain journal is very helpful in finding the right treatment for you, so it would be great to bring that with you too.  New patient appointments are scheduled for more time than regular appointments so use all that time to your advantage!  The daily journal or organized treatment history with outcomes will show the doc what didn't work and what did and what the hospitalist recommended without it coming off as you trying to dictate your own care. 
    It can be difficult to find a good doctor (any kind of doctor can be hard to find!), that is not just intelligent but also has a good "bedside manner". 
    I put off switching docs before because of the hassle it seems to be. I should not have waited so long. Switching to my current PM is the best thing I ever did. Once you settle into a new office you will be relieved too.  
    Good luck!
  • Thanks to you both for taking the time to read and respond.  The examples of my being undertreated are many with my pain management clinic, and it is time for a change.  I was just nervous about how this would look to the medical community involved in my care, but yes, I do need to be my own advocate. AND I don't need to take crap.  It was difficult enough to get through an HOUR sometimes without the added "injury" of having poor medical support.  The straw that broke the camel's back for me was this:  I called and left a message about a month after my last cervical injection to let them know that my neck pain had come back full force (which was disappointing, as I'd had pretty decent results from the first one), so I was wondering how to proceed.  I come home to a rather snippy message from one of the nurses.  "Well, we see you're having surgery in January, so there's really nothing much we can do for you.  Call back for an appointment."  :s   Ummmm...yes, surgery on my LUMBAR spine.  I felt like calling back and telling that particular nurse to at least give my file an obligatory skim before calling and leaving idiotic messages.  LIke I said above, my neck has felt fine and dandy since I've been on this new round of medications!  Call for an appointment?  I DON'T THINK SO.
    I had an L4-S1 fusion in the beginning of January, and I feel like I've been making great progress.  I do NOT want to backslide into pain management hell.  The one last unfortunate piece of this puzzle is that my PCP and PM doctor are thisclose, so I'm going to have to be very careful when I ask to be referred somewhere else.  I also hope my PCP is capitated to more than just the PM clinic where he sent me.  Insurance--the other fun part of this circus!
    Thanks again, and I apologize for the lengthy posts.  Just frustrated, and don't want or need my patient reputation tarnished as a result of a team of pain "specialists" who don't even know WHO I AM.
    Kimmy72, Spine-health Moderator
    Firm believer in PMA!
  • Motor1MMotor1 Pittsburgh, PaPosts: 606
    I also have changed PM doctors. I was seeing my first one for almost a year. He did try several injections & also prescribed me pain meds. My issue with him was he really didn't want any feedback from me when he started me on meds. He didn't care about the side effects they had on me. It actually took a phone call from my physical therapist saying that the tremors I was having from my meds, were hindering my therapy sessions. 
    I am currently with my new pain doctor and he actually asks me every month if I'm doing ok on my meds & asks about any side effects I'm having. And when I was having side effects, he didn't have a problem either changing the dosage  or just changing the med. 
    I explained to him at my first appointment  that the reason I changed doctors is I felt that my last doctor wasn't listening to me. 

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  • Thanks, Motor1!!  I, too, was seeing my PM group for about a year.  You took a page from my book on the pain management route--injections, medications (and the side effects part, too!), etc. 
    I am really glad to hear you now have a PM doctor who, by the sounds of it, gives a hoot about you and really listens!  That must be such a great feeling, as well as a relief.  Thankfully, your physical therapist stepped in, too. 
    Did you ever have to deal with the first PM doctor in any way after you switched? 
    I appreciate you sharing your success story! 
    Kimmy72, Spine-health Moderator
    Firm believer in PMA!

  • rninpain said:

    hi kimmy72,
    i do have experience changing pm, but let me start by saying that many patients switch practices for all types of reasons. this should not be considered a "red flag" just because it's pain management. especially since you say you have only been to one pm clinic. insurance changes made me have to switch providers one time. the other time was because i felt the dr. and i had gone as far as he could take me and it was time to move on. (you can use whichever excuse you want when asked why you want to switch dr's but i recommend not sounding resentful to your current pm for any reason).  
    i did not have much of a problem except how long it can take for a "new patient" appointment at a pm office. i mean, it can take weeks to months. they will not accept you as a patient at most offices if you have already been treated at another pm office unless you have your medical records sent to them. this should not be a problem. even for patients who have been "fired" or kicked out of their pm, the office still must forward a copy of your medical records when you request them too. most pms will require you to sign a contract and will fire you if you do not adhere to it.  make sure you look around to find the right pm for your needs. read reviews on the pm and their office staff!  ask your pcp for a recommendation, or friends/family for theirs. i actually got my current pms info from my previous pm! 
    treat the first visit as if you are interviewing the doctor, have questions written down ahead of time, asking the doctor what treatments his office offers and get an idea of what to expect from your future visits and plan of care. write down all your symptoms, tests, and treatments that you have tried and what happened when you tried each treatment, therapy or medication. also, keeping a daily pain journal is very helpful in finding the right treatment for you, so it would be great to bring that with you too.  new patient appointments are scheduled for more time than regular appointments so use all that time to your advantage!  the daily journal or organized treatment history with outcomes will show the doc what didn't work and what did and what the hospitalist recommended without it coming off as you trying to dictate your own care. 
    it can be difficult to find a good doctor (any kind of doctor can be hard to find!), that is not just intelligent but also has a good "bedside manner". 
    i put off switching docs before because of the hassle it seems to be. i should not have waited so long. switching to my current pm is the best thing i ever did. once you settle into a new office you will be relieved too.  
    good luck!

    i missed your post earlier!! thank you !!  your last pm recommending your next pm?!  that's priceless!
    i have been keeping detailed logs of my pain levels, medication schedule, but i cannot tell you how much i appreciate the advice of charting my previous treatments/outcomes.
    you also touched on a point that had concerned me, but i had completely forgotten about--not being perceived as a "know-it-all" about my situation.  i agree with you that records and preparation are going to be my greatest allies when i'm looking for my new pain management providers. 
    again, thank you for sharing your knowledge with me on this one--as my dad would've said, now i have "more arrows in my quiver".  take care!
    Kimmy72, Spine-health Moderator
    Firm believer in PMA!
  • Motor1MMotor1 Pittsburgh, PaPosts: 606
    Kimmy, 
    The only hard part I had about changing PM docs was getting my old doctor to forward my records to my new doctor. They kept insisting that they faxed them, but when I called the new doctor, they didn't have them. They wouldn't let me schedule my next appointment until they had my records. This took a couple days to resolve. Their offices are just across the street from each other. I even asked them if I could come pick them up & I could walk them to the new doctor. Of course, they said no, but somehow that day, the records were faxed to my new doctor. 
  • Hey Motor1--yes, I could see where that might be a potential issue, as in the former PM providers getting their knickers in a twist because  you're no longer using them.  After all, there's really no mistaking why you need your records forwarded to a new place!  You're firing the old one!!  Rather than ask you what they could do to make the situation better, improve their service, etc., they decide to make things even more inconvenient for you by screwing around with your records.  Across the street, too.  Now there's a nice touch.
    I''m definitely getting the ball rolling on the switch this week.  I've got at least a month before I'm released from post-op short-term pain management, so I'm just going to act "as if" I'm going to have a problem with record transfers, PCP referral, etc. 
    As always, thanks everyone!  Your insights are invaluable!
    Kimmy72, Spine-health Moderator
    Firm believer in PMA!
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