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What you want you doctors to know-part 2 -Chronic pain patients bill of rights
OK so I took some of the input I got here, and I read through many posts and some of the archives, and I met with several doctors and administrators, including the medical director and the wellness director and the CEO of one of our community health care systems. They are interested in working with me to improve their systems for dealing with chronic pain patients. With no other group of patients do we see this hostility between doctors and their patients. I've caught some of it already. Some of the doctors went off on me with their horror stories and think I am being naive about the depth of the problem and some on this site have suggested that I don't understand what chronic pain patients go through. I have been a chronic pain patient for thirty years and my wife is the above mentioned CEO. I have seen and experienced a lot of what chronic pain patients go through. And I am trying to help here. We have a system in crisis and what's happening here is coming to where you live too if it's not already there. The largest PM clinic in our state has closed to new patients and the organization that provides health care to the homeless lost their ability to prescribe narcotics. This has caused a chain reaction where a lot of doctors and the other large community health organization have also had to close their doors to new patients. This has caused the remaining providers to be under a lot of pressure and they need to find a better way of dealing with this or shut their doors too. This is causing a lot of suffering. This week my wife was trying to help a lady who had been on pain meds for years. She was angry with her doctor and went to find a new one. Well, needless to say she found that was impossible and last I heard she had gone to the ER where they gave her a referral to the state rehab clinic - the one with the endless waiting list. It is situations like these that cause me to want to help. I know that the problem might be too big for me to help at all. I might just get flamed out here and have a bunch of doctors let loose on me with their frustrations. But I do have access to this one system ( more than a dozen clinics ) and the people I am dealing with are compassionate and want to help, and we already have interest from the largest provider system in the state who want to be informed if we come up with something better than their current narc contract. So what we have in mind is a chronic pain patients bill of rights. Please, can anyone help with concrete suggestions for what we would include in this that could address the most serious concerns? I have doctors who are on board with this idea and would like to see more consistency among doctors in how they treat their patients. They are willing to set up re-training programs to give all their providers a better education on the problems faced by chronic pain patients. Some are a little resistant to this however and they all insist that it will have to be accompanied by better understanding on the part of patients about what their responsibilities are going to have to be to help deal with the epidemic of problems that accompany narcotic prescribing. What are patients willing to do to help with this? How can we be more effective in educating the patients? And the problems are huge. There is an enormous black market in pain medications everywhere in the country. I am looking at a DEA report on the retail price of pain meds on the street for the month of August for California. $10 - $120 per pill for Oxycontin, $10 - $75 for Fentanyl patches, and so on through every pain pill I've ever heard of.. Every one of these pills came from someone who told their doctor they were in pain. Now that wholesale doctor shopping has been curtailed through pharmacy reports distributed to every provider we actually have gangs that recruit senior citizens with legitimate diagnoses to go in with MRI's and cat scans and a script to follow to maximize the amount of meds given. But every study I've seen indicates that the criminals provide a small percentage of the illegal pills. Most of them come from people with a legitimate reason for pain who are selling a portion of their pills, often to be able to afford their other medications. When a doctor asks you for a drug test it is usually an across-the-board attempt imposed from above them to find out who is NOT taking their meds. Doctors are under intense scrutiny from the medical establishment and law enforcement to be able to justify every narcotic prescription. I have noticed on this site that some patients do not understand the laws and regulations that their doctor is operating under. I've seen patients accuse their doctors of trying to pad their bill by making them come in for an appointment every month. Are they aware that the laws have changed to require patients who are receiving narcotics to come in to pick up paper scrips in person each month? No more call-ins and no refills are permitted. And while some doctors would allow their patients to come pick those up at the front desk, their insurance companies began to demand that an exam be done for each scrip. Doctors are required to make attempts to find other ways to control pain. When they are called before the pharmacy board they need evidence that they tried other methods besides narcotic maintenance to control pain, and while I realize that it is a giant hassle to feel like you are being asked to try experiments on your body when you know that the pills work, to accuse the doctors of just trying to sell you expensive treatments to make more money is in most cases going to be unfair. In fact an unwillingness to try other approaches is on the list of signs of addiction that the doctors are supposed to look for. This is one of the issues we might deal with in the patients bill of rights. Ironically, one of the most vocal groups pressuring doctors to stop prescribing for chronic pain are ex-pain patients. All you have to do is go over to the substance abuse forum to see that many people accuse their doctors of causing them to become addicted, "If only they had told me that these were addictive I never would have taken them", is something I've seen many times and in fact I've seen many people express on that forum that doctors are irresponsibly prescribing narcotics willy-nilly (again just for the money) and need to be prevented from prescribing them at all. These are the patients, by the way, who win lawsuits against their doctors and make it much more difficult for any of them to prescribe for pain. Anyway, I could go on but I think you get the idea. I have good friends who are compassionate, caring doctors who are frequently fighting for the rights of their patients against this array of forces and yet they often get accused, unfairly, of all these things I see people accusing their doctors of on these forums. But if we can come up with a way to do this better it can be implemented in this system, affecting hundreds, maybe thousands, of patients, and perhaps even have influence beyond that. If any of you understand what I am trying to do and could contribute specific coherent ideas I would appreciate it very much. Thank you.
I really don't care about your qualifications as I would say the same things to anyone asking about improving chronic pain treatments and access to aggressive pain medications.
1) A narcotics contract should never be required unless there is evidence that the patient has abused or diverted the medications. Evidence isn't a a urine test, but a pattern of refills LONG before the medication should run out (the attempt to PICK UP the medication occurs before the patient's supply falls to 4 days).
2) Doctors should not be allowed to send patients to physical therapy BEFORE getting MRI's or Xrays on file.
3) Pain patients should see the same doctor on each visit. Clinics should not keep changing you doctor at each visit.
4) Doctors should be prohibited from having patients repeat previous treatments. Once you have tried physical therapy for your chronic pain, you shouldn't be required to try it again.
5) Follow up visits should be limited to once every 4 months, if not longer. Unless the nature of your pain changes or you need a higher dose of a current medication, there's no reason to spend what little money you have on unproductive office visits
6) New doctors should be prohibited from changing a current medication or treatment plan if the chronic pain has been present for at least 2 years.
7) Once addiction possibilities have been discussed, they are not addressed again unless a new medication is introduced.
8) Doctors may not drop patients or deny them medications as a consequence of LEGITIMATE medical marijuana use.
9) Standard of care practices should place the patient's quality of life issues BEFORE the doctor's needs.
Hope that helps!
1) A narcotics contract should never be required unless there is evidence that the patient has abused or diverted the medications. Evidence isn't a a urine test, but a pattern of refills LONG before the medication should run out (the attempt to PICK UP the medication occurs before the patient's supply falls to 4 days).
2) Doctors should not be allowed to send patients to physical therapy BEFORE getting MRI's or Xrays on file.
3) Pain patients should see the same doctor on each visit. Clinics should not keep changing you doctor at each visit.
4) Doctors should be prohibited from having patients repeat previous treatments. Once you have tried physical therapy for your chronic pain, you shouldn't be required to try it again.
5) Follow up visits should be limited to once every 4 months, if not longer. Unless the nature of your pain changes or you need a higher dose of a current medication, there's no reason to spend what little money you have on unproductive office visits
6) New doctors should be prohibited from changing a current medication or treatment plan if the chronic pain has been present for at least 2 years.
7) Once addiction possibilities have been discussed, they are not addressed again unless a new medication is introduced.
8) Doctors may not drop patients or deny them medications as a consequence of LEGITIMATE medical marijuana use.
9) Standard of care practices should place the patient's quality of life issues BEFORE the doctor's needs.
Hope that helps!
Hi I was diagnosed with RSD in 06 but this started in2000 went thru years of its in your head you are chasing drugs every line. It didnt matter that I would have my Lt hand,arm neck Lt side of face all swollen, But what really got me was when my husband rushed me to the hospital because I had been curled up in pain no sleep for days when got to hospital BP was 296 over 190 they thought it might be cancer but didnt want to do anything to mask the symptoms I got fed up wanted to go home but didnt make it when I tried to leave I passed out on the ER floor from the pain still no treatment Now I find out if they had somehow any way treated me in the beginning it woulllld not have stopped it but would have slowed down the spread. Now the RSD is in both legs , back LT arm, starting to go into Rt arm in neck and face which makes the needles they stick in the front of my throat to get to my spine hard to do and risky. But I still get the "WE dont want to give you pain meds because in a year your family is going to sue us because you are addicted" give me a break, Not treating me has stolen my life, my children are always worried about me and I hate that they shouldnt have to and ALL I see is doctors more worried about their insurance than the patient. I am willing to sign a release just to get treatment, and before anyone says about other treatment I have even been checked for tens inplant, But they cant I have large aracnoid cyst on spine and they say degenative dics sooooo have asked about patches if you have other ideas I will ask about them too it is either depression meds that dont work or needles that have had 12 in 6 months did nothing or made it worse, but last appointment more needles or nothing. SO when IS patient care and quality of life considered!!!!
Kolo:
I did not think you sounded like a jerk either....As Tuck stated, we do not have actually do have Pain Management Clinics (very few) and usually our Primary Doctors are our Pain Management. I have a Primary that also does all the prescribing. This is the reason why we have such a great relationship. My Doctor see's me for everything.
Like I said, I did sign a Pain Contract but it's just a legality that need to be in my records. My Doctor has 100% trust in me and has NEVER asked me for a urine sample or even hinted at it. I am very truthful with him...even if I run short that particular month...I tell him. He seems to understand but also reminds me that I must try and stay on track with the prescription which in most cases I do.
I feel very lucky that I live in Wisconsin. The State is very family oriented and runs at a slower pace than most states. Our speed limit is generally still 55 MPH which in comparison is much slower than the rest of the country.
I go to the clinic and usually every Doctor or nurse working that day knows me and it's "Hi, how are you" all the way down the hall.
The University Hospital & Clinics is about the only Pain Clinic that I know of within a couple hundred miles of the capitol city.
I hope this gives you insight on why I question things.....It's not you...it's just being cautious.
Thanks,
Molly
I did not think you sounded like a jerk either....As Tuck stated, we do not have actually do have Pain Management Clinics (very few) and usually our Primary Doctors are our Pain Management. I have a Primary that also does all the prescribing. This is the reason why we have such a great relationship. My Doctor see's me for everything.
Like I said, I did sign a Pain Contract but it's just a legality that need to be in my records. My Doctor has 100% trust in me and has NEVER asked me for a urine sample or even hinted at it. I am very truthful with him...even if I run short that particular month...I tell him. He seems to understand but also reminds me that I must try and stay on track with the prescription which in most cases I do.
I feel very lucky that I live in Wisconsin. The State is very family oriented and runs at a slower pace than most states. Our speed limit is generally still 55 MPH which in comparison is much slower than the rest of the country.
I go to the clinic and usually every Doctor or nurse working that day knows me and it's "Hi, how are you" all the way down the hall.
The University Hospital & Clinics is about the only Pain Clinic that I know of within a couple hundred miles of the capitol city.
I hope this gives you insight on why I question things.....It's not you...it's just being cautious.
Thanks,
Molly
Kolo,
You didn't sound like a jerk!!! I like Mollyrae was trying to figure out where you were coming from. Sorry if I was ever less than kind.
You have my support. In my state we do not have the typical PMP or PM Clinics with contracts that are found in other states. I don't know if I can locate any information in prototypes for you but I will search.
You didn't sound like a jerk!!! I like Mollyrae was trying to figure out where you were coming from. Sorry if I was ever less than kind.
You have my support. In my state we do not have the typical PMP or PM Clinics with contracts that are found in other states. I don't know if I can locate any information in prototypes for you but I will search.
Hello Kolo13, deeply interested and should share story with all, abbreviating as much as is tolerable.
Very sick individual I am and have been. Pain meds of Patches and methadone. Family doc of 30 yers treated this once well musceled hay farmer, dairyman and factory worker.
Doc's practice ended and sent to 'Clinic', the new kind of clinic, where DEA, (clearly a fully out of control, to well federally protected, over taxpayer supported agency, an agency funded in large part through confisication of citizen assetts, regardless of trial) managed federal legislation which changed doctors into DEA agents.
The real issue, after lawsuits against doctors and clinics employing "contracts", (none of which are worth the paper they are wastefully written on) will be how doctor's insurers will react when the first jury rewards are passed down for patients.
The legal community is highly tuned, purpousely waiting ( as they should) untill millions of patients are irreversably damaged by such 'contracts', so that there will be work for many lawyers, for years to come. And this will happen.
One such case has begun in WA State, where patients are filing huge, massive damage suits against those most deserving to be sued. The typical "12, 15, and up to 30 member doctor boards" you hear about nationwide. It's important to remember, these doctor boards are staffed by doctors who do not work any longer. It's much eaisier to sit a board for ridiculous sums and salaries, than to go to work at your practice.
Likewise, there are countless suits being prepared for filing next year, where doctors employing 'contracts' in their clinics (usually tax payer supported clinics) will be gleefully sued for "Contractualy Coersion", also known as contract fraud. These doctors will be paying sums ordered by juries never before imagined.
Just briefly, very briefly, here's why.
A patient has lost a doctor who previously delivered pain medications of strong content to him/her. Mentioned suits will only be filed in cases where medication could cause withdrawl that could be reasonably expected to threaten life if stopped suddenly. Clearly, the patient is challenged to quickly find another provider unless the prior doctor made arrangements.
Death, or very, very, very serious suffering could commence without at least a taper down effort for the patient. True, the patient would suffer terrible pain, long after withdraw, but would still live. However, in this instance, (patient is tapered) to be legally actionable, his suffering began before he dealt with a doctor, little claim could be made.
In the truely beautiful response of the Constitution of this particular nation, certain aspects of that Constitution cannot be ignored, but often are, yes, even by a Congress and President sworn to uphold it. It happens all the time, Congress passes unconstitutional laws and the highest and most Supreme Court, tells that particular group of ego filled non constitutional trained lawmakers, you were much the stupid group that year, your law is now thrown out as meaningless.
Certain federal policing agencies tell certain gullible groups and associations of doctors, here's how your going to do it under our new law. (Note agencies call it "their law", since it benefits their agency in every financial manner possible, jobs ,position and on and on)
But,,, there's a smart lawyer who sees ahead of all others, as all income producing lawsuits in fact begin.
This one is glaring and simple but has no need to change federal laws at all. It's the "Contract", used in every Clinic nationwide and the State Boards of doctors who are liable, down to their sportcoats and should be, because they seek to side with a political party telling them they have great power. They don't.
Contract law is miles thick and fills libraries, we all know that.
First universal, nationwide legal agreement about them?
There MUST BE MEETING OF MINDS, to enter into any contract, which can be verbal, written but is binding if there was a "MEETING OF MINDS".
First major mistake of medical community? Calling it a 'contract' in the first instance. They will suffer massive financial loss and should ofcourse.
Second universal understanding of contract law?
No contract is ever, I mean EVER, considered a contract, if it was agreed to under coercion. Meaning one party (the doctor) using power, force and intimidation to get compliance. In other words, much like bribery and plently of doctors who decided not to defend their professions and become DEA agents, know what they have done.
They have before them a sick and in pain, suffering person, not yet a patient. They KNOW the person must have certain medicines or that person will suffer greatly, perhaps die. In most cases, that person expects to die without the medication and that to now get it elsewhere is impossible, since any reasonable effort on the person's part will leave a gap of time to great to leap. There is no time.
Who stands between that person's immense suffering is a Clinic doctor with a piece of paper that says, "Contract".
Does the 'Doctor' know the challenge that person, who wants to be a patient faces? Yes.
Does Doc recognize onset of withdraw? Yes.
Doc see fear on person? Yes
Does Doc see that it's clearly too late for this person? Yes.
Does Doc have nice prepared 'Contract' for person to sign and agree to his terms to be 'saved'. Yes.
Does Doc have advantage in this new contract? Yes.
Doc in position of power? Yes.
Doc want compliance with his and any other's form of compliance, even a Government's desire for compliance (Smell the Constitution rotting right there a bit? Don't worry it won't.). Yes.
Doc using intimidation? Most certainly yes, he's saying sign this agreement, and I will save you from potential ER visit , or death, or pain.
And worst of all for Doc's financial health and his insurer's health, it comes across loud and clear as little 20 year old Amy sits in front of the small town jury where big Clinic doctor is forced to go and Amy is crying and she says to the jury,
"The doctor said if I didn't sign it he wouldn't treat me!" and the tears flow ( they should) and the jury is bitterly angry ( they should be) and the verdict is,,,,,
CONTRACT FRAUD VIA COERCION ( and it is)
and the $$$$$$ just flows to law firms and thier patient/clients nationwide as the collective of our nation's laws transfers tens and hundreds of millions from insurance company executives ( previously worried about lawsuits from those overdose cases when they bribed congress to write the new unconstitional laws that just fell on their faces and the DEA's)
(footnote, the DEA will no doubt be reduced in size, once the magnificence of the error is discovered by congress, being bribed by many other industries)
So, people here can begin a Federal legislative or State solution or send a few bucks to firms already underway in this, quick PC search will get you there, or just spread the word at law blogs. Frankly it's a no brainer, only some stupid lawyer from a doctor's insurer would even argue the facts a minute, till the Judge, even pre bribed, would be faced with undisputed, Black's law as well as entrenched American law re: contracts.
Those pain contracts are nothing, they have no legal standing and those who were forced to sign them are victims of fraud, period. Here's a high five to Class Actions!
Very sick individual I am and have been. Pain meds of Patches and methadone. Family doc of 30 yers treated this once well musceled hay farmer, dairyman and factory worker.
Doc's practice ended and sent to 'Clinic', the new kind of clinic, where DEA, (clearly a fully out of control, to well federally protected, over taxpayer supported agency, an agency funded in large part through confisication of citizen assetts, regardless of trial) managed federal legislation which changed doctors into DEA agents.
The real issue, after lawsuits against doctors and clinics employing "contracts", (none of which are worth the paper they are wastefully written on) will be how doctor's insurers will react when the first jury rewards are passed down for patients.
The legal community is highly tuned, purpousely waiting ( as they should) untill millions of patients are irreversably damaged by such 'contracts', so that there will be work for many lawyers, for years to come. And this will happen.
One such case has begun in WA State, where patients are filing huge, massive damage suits against those most deserving to be sued. The typical "12, 15, and up to 30 member doctor boards" you hear about nationwide. It's important to remember, these doctor boards are staffed by doctors who do not work any longer. It's much eaisier to sit a board for ridiculous sums and salaries, than to go to work at your practice.
Likewise, there are countless suits being prepared for filing next year, where doctors employing 'contracts' in their clinics (usually tax payer supported clinics) will be gleefully sued for "Contractualy Coersion", also known as contract fraud. These doctors will be paying sums ordered by juries never before imagined.
Just briefly, very briefly, here's why.
A patient has lost a doctor who previously delivered pain medications of strong content to him/her. Mentioned suits will only be filed in cases where medication could cause withdrawl that could be reasonably expected to threaten life if stopped suddenly. Clearly, the patient is challenged to quickly find another provider unless the prior doctor made arrangements.
Death, or very, very, very serious suffering could commence without at least a taper down effort for the patient. True, the patient would suffer terrible pain, long after withdraw, but would still live. However, in this instance, (patient is tapered) to be legally actionable, his suffering began before he dealt with a doctor, little claim could be made.
In the truely beautiful response of the Constitution of this particular nation, certain aspects of that Constitution cannot be ignored, but often are, yes, even by a Congress and President sworn to uphold it. It happens all the time, Congress passes unconstitutional laws and the highest and most Supreme Court, tells that particular group of ego filled non constitutional trained lawmakers, you were much the stupid group that year, your law is now thrown out as meaningless.
Certain federal policing agencies tell certain gullible groups and associations of doctors, here's how your going to do it under our new law. (Note agencies call it "their law", since it benefits their agency in every financial manner possible, jobs ,position and on and on)
But,,, there's a smart lawyer who sees ahead of all others, as all income producing lawsuits in fact begin.
This one is glaring and simple but has no need to change federal laws at all. It's the "Contract", used in every Clinic nationwide and the State Boards of doctors who are liable, down to their sportcoats and should be, because they seek to side with a political party telling them they have great power. They don't.
Contract law is miles thick and fills libraries, we all know that.
First universal, nationwide legal agreement about them?
There MUST BE MEETING OF MINDS, to enter into any contract, which can be verbal, written but is binding if there was a "MEETING OF MINDS".
First major mistake of medical community? Calling it a 'contract' in the first instance. They will suffer massive financial loss and should ofcourse.
Second universal understanding of contract law?
No contract is ever, I mean EVER, considered a contract, if it was agreed to under coercion. Meaning one party (the doctor) using power, force and intimidation to get compliance. In other words, much like bribery and plently of doctors who decided not to defend their professions and become DEA agents, know what they have done.
They have before them a sick and in pain, suffering person, not yet a patient. They KNOW the person must have certain medicines or that person will suffer greatly, perhaps die. In most cases, that person expects to die without the medication and that to now get it elsewhere is impossible, since any reasonable effort on the person's part will leave a gap of time to great to leap. There is no time.
Who stands between that person's immense suffering is a Clinic doctor with a piece of paper that says, "Contract".
Does the 'Doctor' know the challenge that person, who wants to be a patient faces? Yes.
Does Doc recognize onset of withdraw? Yes.
Doc see fear on person? Yes
Does Doc see that it's clearly too late for this person? Yes.
Does Doc have nice prepared 'Contract' for person to sign and agree to his terms to be 'saved'. Yes.
Does Doc have advantage in this new contract? Yes.
Doc in position of power? Yes.
Doc want compliance with his and any other's form of compliance, even a Government's desire for compliance (Smell the Constitution rotting right there a bit? Don't worry it won't.). Yes.
Doc using intimidation? Most certainly yes, he's saying sign this agreement, and I will save you from potential ER visit , or death, or pain.
And worst of all for Doc's financial health and his insurer's health, it comes across loud and clear as little 20 year old Amy sits in front of the small town jury where big Clinic doctor is forced to go and Amy is crying and she says to the jury,
"The doctor said if I didn't sign it he wouldn't treat me!" and the tears flow ( they should) and the jury is bitterly angry ( they should be) and the verdict is,,,,,
CONTRACT FRAUD VIA COERCION ( and it is)
and the $$$$$$ just flows to law firms and thier patient/clients nationwide as the collective of our nation's laws transfers tens and hundreds of millions from insurance company executives ( previously worried about lawsuits from those overdose cases when they bribed congress to write the new unconstitional laws that just fell on their faces and the DEA's)
(footnote, the DEA will no doubt be reduced in size, once the magnificence of the error is discovered by congress, being bribed by many other industries)
So, people here can begin a Federal legislative or State solution or send a few bucks to firms already underway in this, quick PC search will get you there, or just spread the word at law blogs. Frankly it's a no brainer, only some stupid lawyer from a doctor's insurer would even argue the facts a minute, till the Judge, even pre bribed, would be faced with undisputed, Black's law as well as entrenched American law re: contracts.
Those pain contracts are nothing, they have no legal standing and those who were forced to sign them are victims of fraud, period. Here's a high five to Class Actions!
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