High Risk Patient

[larbec7]

I will try to make a long story short.  I have been going to pain management for several years and on the same medication.  My doctor is a personal friend and my spouse worked for him.  She was getting tired and stressed out from all the BS going on in the office and he was not willing to change his ways and allowed certain people to just play around 50% of there day on computer playing games, face book, myspace, stc...

Well, I told her to quit and she did about 7 months ago.  Ever since then he has given me one drug test after another and changed my medication amounts as well.  I became disabled about 18 months ago.  When I went to see him this week, I confronted him and was very blunt as to why he keeps messing with me.  He claims that I am considered a "high risk" and I should not be on the dosages I am on since I am disabled now and I do not have to function in a work environment.  He also claims that because I am tan and have muscle tone I must not be in the pain that he thinks I am in and in the same breath he says "you seem to be in more pain the past few months than I have ever seen you.  I'm sorry but WTF????  He also says that since we are friends I may want to consider seeing another PM doctor.  Everything he said to me I called him on it and told him he can't baffle me with his BS and what is the deal.  He just said, well, you are considered a "high risk" patient and should not be on as much of medication as you are on since you are disabled.  Is this not discrimination or what.  Let me tell you, I am only on 40mgs Oxycotin a day ...10 mgs every 6 hours, 3 Darvacet for break through pain and soma/zanaflex for spasms.

What are your thoughts?  have you ever been told or heard of being a high risk patient?  Just seems strange to me to be treating me for 7 years and now all of the sudden since my spouse quits to be doing this to me.

[Ella789]

Your Dr. sounds like an azz,  but I would think he still has the power to write whatever he wants in his or (your) report.  I think I would consider seeing another PM Dr. but then I think all the Dr. 's take up for one another too.   You should be able to get your medical history from him tho,  to see what he is writing abt. you.  It really is a sad situation but it seems that pm's do look at a person and decide if you rate their scale of "pain patient".   Always dress up and look nice if you do go to a new Dr. as they decide alot on how your appearance is.    
best wishes to you

Ella

[larbec7]

Thanks Ella, I do have a complete copy of my medical file.  He did question me why I asked for a copy and I told him.  I did not hold anything back from him last week and even told him point blank..."YOU can't baffle me with your BS"  I am trying to find another PM Dr as we speak.  I over heard a conversation as well the other day that HE was on some pretty heavy recreational drugs.  I am not sure if that is true but would explain his radical behavior

[Tuckamore]

Good to hear from you again larbec....but sorry to hear that you are dealing with all these issues with your PMP.

The writing is on the wall. For whatever reason this PMP no longer wants to treat you. I was in a similar situation with a PCP, my first as an adult. I thought he was next to God. I reside (grew up here) in a small community where everyone knows everyone. I had worked closely with him and his two MD friends that came from a large city to our town to begin a new practice. I was at another facility. He was never my "boss." So I missed all the signs that he no longer wanted to treat me following a very traumatic MVA that left me an extremely complicated patient with pain issues. He did a lot of damage to my reputation and believability through the things he charted in my medical record and the "referral" messages he either verbally said or wrote to outside specialists. He even sent me for a mental examination. What he didn't know was my best friend was employed as a RN Supervisor at that clinic. It was there that I learned through a therapist and psychiatrist that not only was I mentally healthy but that this PCP was harming me. On their recommendation I asked for ALL my medical records from every referral, including the mental health clinic. Luckily I had lots of trusted friends and he was still considered an outsider. (You know small towns.) After I read them I promptly fired my PCP but the damage was done. It took me years to live down and disprove his untruths as all other medical providers were not part of my small community.  

Don't let this happen to you. Move on quickly. I too missed the writing on the wall. I have never heard the term "high risk" patient in your situation. It's his term, for whatever reason.  He is behaving very unprofessionally in my opinion and you will be better off without him.

Good luck to you and please let us know how you are doing. It is my guess that your next PMP will be a better fit for you.

Take Care,
Tuck

[larbec7]

I appreciate your input and you hit the nail on the head.  I have found a Dr about 90 miles form here that is seeing a couple of friends of mine,  He requested I send him my last 5 month office notes and I really need to see my current PM Dr at least one more time due to my drug test.  I am not sure if my new Dr. will care or not (I am told he does not care but you never know)  The thing that really makes me upset is as long as my wife worked for him and I did him favors (I did his employee manual, SOP;s, computer work etc...) everything was honky dorey.  After my last visit with him last week and trust me I was rough on him and had nothing nice to say to him he asked me to fix something in his office.  As long as he gets his way he is fine.  Even the girls in his office hate him and he literally has a revolving door when it comes to employees.

Hopefully, I will be with a new Dr, in a couple of months.  I see the writing on the wall.  He even wanted to put me on Suboxone for my pain.  He indicated in my records that he wanted to try on that drug NOT for an addiction but because my pain levels were increasing.  I read the side effects of the drug and told him no way.

[larbec7]

Another thing that appears to be a set up.....we were talking about medical marijuana several months back maybe 9 months ago and that it was not legal in my state yet.  He said that it is a proven pain relief and suggested I try it.  I told him I did not have access to that and he suggested I speak to one of children that were in High School and I told him absolutely not would I do that...well, he said, he will talk to his son and he did and I tried it a few times and it did seem to work a little BUT....then he pulls my first drug test....some friend!!!!!!!!!

[Tuckamore]

What a QUACK! He may have been trying to set you up. And in the every day world, who will be beleived, a physician or you?

Suboxone is not prescribed for pain, at least not to my knowledge. Methadone would have been a better choice. In my opinion none of the meds you are taking are consider "high" dosages. Darvocet is not an effective medication for chronic pain. A prescription dose of ibuprofen is usually more effective than Darvocet.

[larbec7]

I think he has been trying to set me up since my wife left.  If I connect the dots, he tells me about marijuana, then cuts my dosages, then wants to put me on Suboxone that is prescribed for addiction issues even though he put in my charts it is NOT for addiction but for pain.  He would be the one to "change" anything in my medical records top cover his own sweet behind.....another reason I asked for a copy of my medical notes...some friend...

I can;t wait to see another dr, my town is probably larger than yours but there are only a hand full of PM Drs here....another reason I am going to a large city about 90 miles away.  The population there is well over a million

[Tuckamore]

Good choice larbec. I hope you will share with us how everything turns out. I will watch for your updates on the outcome of your appt with the new PMP. In my opinion your PMP was a bit vendictive and very unprofessional.

I see Atlanta listed on your profile page. I live in a very rural lake community. My home town is 10 miles way with a population of 7k, nearly tripled in the last 12 years. The next closest town, 45 minutes away is 15k. Our state capitol and closest large city of 275k is a good hour and a half drive from my home and the closest location that does offer only one actual PM Clinic. ....so I am very rural. Hence the reason that CP suffers are treated and followed by their PCP in my state.

We hope you'll continue to keep in touch.

[larbec7]

I will keep you all up to date.

[larbec7]

Well, he adjusted all my meds back where they were.  I am still looking for another Dr.  He is causing me more issues that really get to me.  My other Dr has me on permanent disability and my PM Dr always puts that I look muscular and well intact so now my disability company wants me to take a FEC test

[Tuckamore]

Thanks for the update Larbec.

I am glad that at least your PMP adjusted all your meds back to where they should be.

Physicians always "describe" how a patient looks to them ie, "healthy looking young female" or " this elderly gentleman appears frail and thin."  After reading thousands of physician H&P's or clinical visits I can assure you that a physician describes everyone as they view them.  

Ppl can be muscular and well intact and still have a disability. I think most medical professional know this, it can be especially true early on in a disability. In my opinion your disability company is grasping at straws and using any term they can find in his notes to use in an attempt to question your disability.

I hope your pain is in better control

[Wheels1990]

That doesn't even sound like a doctor, or a doctor anyone would want to go there.  I mean, like it or not, most disabled people *go* to a pain clinic and expect to have there pain controlled well enough so they can function.  Just because someone is disabled, doesn't mean they don't have to function.  Everybody has to function somehow in there life.  And some people have to function with pain every single day because doctors like *that* are all to common.

[opus88]

wow u have really had the gears!
medical MJ doesn't come from the streets it comes from a prescription....
My PMP told me medical mj does help with back pain yes however it has to be in a brownie and a person would need to eat alot of these brownies to get enough pain control so than there would be the weight issue...I don't know if he is right on this or not, just what I was told.
besides if he supplied you with this through his son....there is really something wrong with this guy!!!....what else is he getting 'through his son?'
now you will have further problems because of what he has and could write in you're disability report...make sure you're PCP is aware of all you have posted and is ready to stand behind you whether you look 'tan and healthy' or not.
good luck

[larbec7]

My PCP and I had a long talk last week and we are together and he is on board (or at least he acted and said he was)  I also heard my PMP is doing meth or some type of injections in the arms...he is skinny as a rail but like I said I had heard this....although from a reliable source

I am just so tired of these Dr.s that "act" like they know if you are in pain or not and they tell you..."you look like you hurt"  : you look fine today"  urg.....I know how I feel, not him

Now my disability company wants me to go for a FEC...I think because the doc that has me out on disability says I am loosing strength and can hardly lift anything...and my PMP says "I look fit and tan and muscular"  I am not sure what the FEC is and also...do I give in my best at 100% or if it hurts back down and tell the doc doing the FEC "I simply can not do this or do thet"???

[larbec7]

I went to a new PM doctor last week.  he took me off my Soma and told me that Soma is what killed Michal Jackson and Anna Nicole.  I argued with him a little but did not want to push it because he said he would not give me Soma and if I wanted it to go find another PM doc.  He claims Soma magnifies all pain medicine and it can cause me not to wake up.  INMO that may be true if you abuse it.  I have been on Soma since 1998 and HELLO...I am still here.  I do not abuse anything.  The sad thing is Soma does help me ALOT.

Anyway, he took me off my OXYIR 10mg 4x aday and put me on Percocet 10/325 4x a day.  Well, I can't tell where I am getting anymore relief than I had before.  From what I have been toild OXYIR and Percocet is the same substance????

I called his office 4 days after I stated taking the Percocets and spoke to the nurse and told her I was not getting anymore relief and she told me it took a couple of weeks for the Percocet to get into my system.....I wanted to say BS but I did not.  IMHO when you take a pain pill it should work right then and there ....  am I wrong???  I go back to him for an update next week.

I will see what he says when I tell him I am not getting any relief.

[Ghilly]

Yes, Oxy IR and Percocet are the same drug, but Percocet have tylenol in them.  The Tylenol acts as a catalyst for the oxycodone in the Percocet, kind of like the caffeine in aspirin does.  I don't know why he'd take you off one and put you on the other, since too much Tylenol is very damaging to the liver, and pure oxycodone is a much safer choice for someone who is on pain medication long term.  That makes no sense to me.  It would have made more sense to just have you take a couple of Tylenol twice a day rather than having you take 325mg four times a day.  While that's still well under what is considered the toxic level of Tylenol, it's just kind of stupid when Tylenol is so readily available.  I'd be interested to know his reasoning.

Ghilly

[larbec7]

I wish he would just give me something that will ease up my pain.  I have been a pain level of a 7 to 10 for over a year.  When I was taking 20mg of htdos 4x and 4 to 6 soma a day for two years prior I was pain free all day and slept like a baby

I may just have to ask him flat out to prescribe the hydros again BUT he wont do the soma and the zanaflex puts me out

[concerned621]

I'm not so sure I agree with everyone about the writing on the wall and just get out of there. He has documented in your MEDICAL FILE you are HIGH RISK.  What did you do to make him say, think, or write that in your file.  Unless you are leaving something out it doesn't appear to me you are high risk.  Being tan and tone is him making a judgement of you based on your appearance, that is discrimination.  On a side note: be careful of that, disability could view that the same way.  Back to him.  Does he own the practice? If not find out who does. Ask to meet with that person, the office manage and their human resource manager.  If you can talk with an attorney and/or bring someone professionally dressed who is good in a business setting to this meeting.  You dress professionally as well.  Have notes about what occurred. It will show them you documented what happened.  Prior to this meeting sign a request to have your medical file sent to the attorney if you get one or to you personally.  review all of his notes.  The sporadic changes in medications makes no sense, that wouldn't help you as a high risk patient so what was his plan, why was he doing that. If he did not want to treat you any more he should have said so and not treated you so poorly.  Your wife worked there and left for good reason. Don't just drop this. If you ever do return to work companies check you medical for insurance, also for life insurance this also could be a big problem.  So good luck and don't let someone do this to you.

[AmazonGirl]

Actually getting a prescription for Soma is getting more harder everyday, lots of doctors will not prescribe it for any reason, so what that doctor did is not unheard of. I guess when mixing soma with prescription pain meds like hydrocodone and oxycodone gives the person a heroin like high...atleast thats what I've heard and been told by many doctors and nurses.

Also taking Percocet has a very short half life so their is no waiting a week to get it's full effect like you would with long acting pain meds. So this doctor is lying to you cause either they dont want to deal with it or have some other weird issue with it.

Also last but no least, just because their's so much misunderstanding out their about Suboxone...it's main ingredient, Buprenorphine, has been used in other countries (Europe mainly) for many years for moderate to severe pain and they're also doing trials right now in the states for Buprenorphine to be in a patch form that will FDA approved just for chronic pain. And also lots of doctors are starting to prescribe Suboxone/Subutex for chronic pain....I take Suboxone after trying every other pain med out their and it's the only thing I've found to help with my pain, and I have pain from cancer and other problems. But because Buprenorphine has a peak level befre taking mroe is useless and blocking other pain meds is the reason for it being used for opioid dependence, but it is a VERY stong narcotic, 50 times stronger then morphine.

But as most of us with chronic pain know, finding a good doctor is like a needle in a hay stack sometimes. Just remember that you hired that doctor, and if they treat you bad, then fire them.

[larbec7]

I did not leave anything out and he owns the practice.  I went to see two other PM docs and they both said he was treating me incorrectly.

Just curious, how is it discrimination by him putting things in my chart about my appearance?

[larbec7]

I am feeling this new doctor out and I KNOW them telling me it takes 2 weeks for a med to take effect is a liar.  I am going to start  a new post on my meds because I tried something and want to get some feedback from others if I should tell my new doc or not.

Because I have so many diff meds I decided to try some things on my own to see what works well for me.  I took a percocet 10/325 along with 10mgs of OXYIR and I got pain relief for about 3 hours.  I normally take darvacet for break through pain which is useless to me, it never did any good so I did not even attempt to take any of that. For my break through pain, I took another 10mgs of OXYIR.  My question is, should I tell my doctor what I tried> OR will he think I am a bad person?  

Basically I am taking 4 10/325 Percocets a day and 8 to 12 OXYIR a day and it is working.  I am not having any issues, no side effects, I am sleeping well at night now where b4 I was lucky to get 4 hrs a night.  I can think clearly, no constipation etc...

What are your thoughts?

[kolo13]

Hey, I just read through this and if you don't mind me putting my two cents in...
I was talking on the phone to a friend in health care while I was reading and I asked "What does this mean - high risk patient?" Well it could mean anything; high risk for what? So I told him more of your story and mentioned the medical marijuana thing and where it was obtained and he said, "Oh now it's clear, he's a high risk for the doctor. he could put him out of business."

[Tuckamore]

You are probably correct that the high risk is for the physician. A physician that sets up his patient with illegally obtained marijuana does not have the patients best interest at heart, through his son no less. And than he drug tests.

There are a lot of reg flags with this physician!! I think he is the high risk!

[larbec7]

And he gave me the marijuana