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Possible as part of an Ortho practice.... I rarely rx. Occasional short term w acute compression fracture or hot radic.
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so who prescribes opioids in your ortho group? orthopods themselves?
Possible as part of an Ortho practice.... I rarely rx. Occasional short term w acute compression fracture or hot radic.
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So your clinic is mostly injection based?
No. I inject maybe 1/4- 1/3 of my patients. Apparently shots and narcotics are not the only tools to treat pain....
PT, HEP/lifestyle change recs, adjuvant/non-opioid meds, occasional DC/DO referral, etc, some injections/Rf/Scs, some surgical referral.
I am also not just seeing "chronic" failed everything patients. I see a lot of acute and subacute issues with a favorable natural history. If patients just want their opioids refilled they can go elsewhere (with rare exceptions).
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Same practice here.
Hospital employee. Major metro area.
Very rewarding.
Do you have PT/pain psych in ur clinic or do you send those out?
Nice! Good set up, Where do u get most of ur referrals from and how do u market urself ?They r both part of my hospital system, but not in my clinic itself.
Steve I need your password to see it... cough it uphttp://www.medscape.org/viewarticle/878672?src=mkmcmr_driv_stan_mscpedu&uac=71590CK&impID=1370047
I still see the benefits of opiates within cdc guidelines for well selected patients.
http://www.medscape.org/viewarticle/878672?src=mkmcmr_driv_stan_mscpedu&uac=71590CK&impID=1370047
I still see the FINANCIAL benefits of opiates within cdc guidelines for well selected patients.
Except that im a hospital employee on salary and see most of these working aged working folks every three months. Guess i could be like otjers and demand monthly visits. But then no time for OR, cancer, kypho, scs trials, and acute radics.
I still believe that if all you do is procedures, you are in it for thr $$$ and not a pain doc, you are IR without the vascular. And if all you do is offet narcs, you are a drug dealer.
PCPs also don't usually send the stable, functional, appropriate-dose opioid pts. They send the ones they feel "uncomfortable" with...Totally Agree .. but what is your solution when you get dumped on like crazy. PCP's writing norco 10/3 and then 3 years later referred to pain management. No PT, nerve membrane stabilizers, muscle relaxants, NSAIDS, no interventions etc. just back surgery and opioids.
Believe me majority of referrals tend to be this way. With the expectation that he will continue the same regimen that the primary care physician has the patient on. Some of these patients may agree with the multi disciplinary approach but majority of the patients are there for one reason only.
I have tried t The multidisciplinary approach but after four years of doing this, I realize that the best way to approach it is to limit accepting patients who are not on control substances.
http://www.medscape.org/viewarticle/878672?src=mkmcmr_driv_stan_mscpedu&uac=71590CK&impID=1370047
I still see the benefits of opiates within cdc guidelines for well selected patients.
Umm...opioids for CNP is supremely non-EBM, for a dude who often harps about EBM in pain practices on here.
I don't know if you are able to see the magnitude of the contradiction in your attitude and practice...
I don't prescribe opioids at all for CNP, because abundant data shows that it leads to no improvement in pain, worsening disability, serious side effects even when used appropriatelly, and to top it all off there is this little thing called the opioid epidemic going on. Which is to say, these medicines you are prescribing are ruining peoples lives and damaging society. Statistically speaking, no matter how clean and tidy you perceive your narcotics protocols and prescribing patterns to be, many of the pills you are dishing out are being diverted or missused. Whether or not you really have the guts to face that fact it's up to you…
It's not quite that black and white. I think everyone agrees with your statement to a point but it's honestly not that cut and dry. If it were there wouldn't be daily debates like this all over the media, internet chat rooms, doctors offices, ERs, hospital conference rooms, etc...Umm...opioids for CNP is supremely non-EBM, for a dude who often harps about EBM in pain practices on here.
I don't know if you are able to see the magnitude of the contradiction in your attitude and practice...
I don't prescribe opioids at all for CNP, because abundant data shows that it leads to no improvement in pain, worsening disability, serious side effects even when used appropriatelly, and to top it all off there is this little thing called the opioid epidemic going on. Which is to say, these medicines you are prescribing are ruining peoples lives and damaging society. Statistically speaking, no matter how clean and tidy you perceive your narcotics protocols and prescribing patterns to be, many of the pills you are dishing out are being diverted or missused. Whether or not you really have the guts to face that fact it's up to you…
YesIs 350-450k a reasonable salary to expect as a hospital employee in a no narcotics practice 5-10 years into your practice?
All the debate has nothing to do with the state of the evidence in the literature.It's not quite that black and white. I think everyone agrees with your statement to a point but it's honestly not that cut and dry. If it were there wouldn't be daily debates like this all over the media, internet chat rooms, doctors offices, ERs, hospital conference rooms, etc...
Except that im a hospital employee on salary and see most of these working aged working folks every three months. Guess i could be like otjers and demand monthly visits. But then no time for OR, cancer, kypho, scs trials, and acute radics.
I still believe that if all you do is procedures, you are in it for thr $$$ and not a pain doc, you are IR without the vascular. And if all you do is offet narcs, you are a drug dealer.
I don't put much stock in "evidence based medicine". We all can quote a study that's FOS. Take for example this study showing that "penis' aren't real things". I assume you'd argue otherwiseAll the debate has nothing to do with the state of the evidence in the literature.
The state of the evidence is remarkably unambiguous for a question in clinical medicine.