Inherited opioid pts

[Disciple]

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or, if one is unlucky, some new young pain doc will move in to the area who did not live through the past 20 years of opioid addiction. this pain doc will think its fine to give "low dose" opioids to any and all...

I would like to believe that pain fellows are now being taught current best practices.

My main concern would be the young doctor knowing better, but being bullied, by patients, his/her private practice employer, hospital admin., referring doctors, into prescribing inappropriately.

 

[Disciple]

Yup got the same junk developing in my area as well.

Its even worse when they decide to give the patient a bunch of MSContin or Norco during the time they do the procedures but decide that they "dont prescribe long term" after the 30 year old they started on these medications decides the "injections didn't help but likes the MSContin"

We've all had that happen at least a few times. Be diplomatic where you can, but there are some instances where you need to put your foot down.

There have been a few occasions where I've had to personally call the referring physician and politely let him know that we are colleagues in the same specialty, and that he is to never again refer an opioid seeking patient to me that he has done multiple ineffective injections on and no longer wants to deal with.

 

[NJPAIN]

We've all had that happen at least a few times. Be diplomatic where you can, but there are some instances where you need to put your foot down.

There have been a few occasions where I've had to personally call the referring physician and politely let him know that we are colleagues in the same specialty, and that he is to never again refer an opioid seeking patient to me that he has done multiple ineffective injections on and no longer wants to deal with.

I grew up in Staten Island, NY. The guys I grew up with make the Sopranos look like florists. I may need to have a guy named Tony to bring over a fish.

 

[101N]

We've all had that happen at least a few times. Be diplomatic where you can, but there are some instances where you need to put your foot down.

There have been a few occasions where I've had to personally call the referring physician and politely let him know that we are colleagues in the same specialty, and that he is to never again refer an opioid seeking patient to me that he has done multiple ineffective injections on and no longer wants to deal with.

Oh, and BTW doing procedures on addicts - while prescribing them opioids - is insurance fraud.

 

[drusso]

Oh, and BTW doing procedures on addicts - while prescribing them opioids - is insurance fraud.

...said no one ever. Because a patient on Suboxone can't get spinal stenosis...

 

[DrCommonSense]

Oh, and BTW doing procedures on addicts - while prescribing them opioids - is insurance fraud.

What about surgery or PT, is that allowed for them?

 

[bronchospasm]

Taking over medical management patients is not advisable unless your background is psych / pain.

Initially I was referred a lot of these patients, I even took over some of these patients. Maybe 20-25. Same recurrent theme of not showing up for procedure, sinus infection or driver not available, family member is dying etc etc. But never miss an office visit.

Try discussing lowering their opioids and they act like you have run away with their wife.

1/10 patient will benefit from your services. More than likely you will be stuck prescribing meds to these patient for the near future.

Over the past 3 years, my policy has evolved to not accepting med management for anyone more that 30 MED. Patients understand that as they get better we will wean the medications down.

This approach has been more successful.

It will piss off some PCP's but over time they will get over it and stop dumping patients on you.

Luckily, there is a very large NP driven pills for injections practice an hour away where a lot of these patients end up.

Hope this helps.

 

[Ducttape]

...said no one ever. Because a patient on Suboxone can't get spinal stenosis...

Agreed.
But I like to think that 101 was specifically referring to opioid analgesics, not addiction therapy, in his prior comment.


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