Inherited Pain Pump Patients

[MedZeppelin]

This thread is a similar branch off the inherited opioid patient thread...
Any recommendations/advice regarding the inheritance of many patients with implanted pain pumps. A local pain doc in my community is retiring would like me to assume care of these patients? I am very conservative with IT pumps and placement, and don't really feel the need to take on any more, but on the other hand, kinda feel sorry for the patients...any thoughts?

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[willabeast]

i used to work for an HMO that asked if i would take care of pain pump patients from our service area that had pumps placed usually by our own HMO about 30 miles away (so they would not have to drive for help/refills and we would not be paying for it). i said sure, after we did a time and cost analysis and had a dedicated nurse. i never heard back from administration

 

[bedrock]

Very personal decision.

I wouldn't do it because I don't believe in pumps other than for terminal cancer patients.

Besides that, you don't get paid much to manage pumps, and there are hassles getting ER calls because everyone thinks the pump is to blame when these patients get sick.

But if you truly feel sorry for these patients, and don't mind what I've mentioned above, go for it.

 

[Aether2000]

We have done it as a service to the community when a doc retired. He is using the highest dosages I have ever seen and the most bizarre combinations in my 20+ years of implanting. MS 100mg/ml at 50mg a day plus massive fentanyl dosages plus up to 240mg a day oxycontin. We accepted the patients with the proviso they will be weaned to below 12mg a day morphine and much lower if possible, and will be weaned off oral opioids. Each patient gets the initial discussion of OIH, current science in infusions, and the extremely elevated risk they have.

 

[MedZeppelin]

Thank you for the input. I have become somewhat disenchanted with IT pumps for non malignant pain over the past years due to lack of efficacy. I agree that a weaning strategy to a more manageable dosage and firm education on dosage guidelines to the patient could be implemented. Overall, in my opinion although, IT therapy for CNMP seems to be more trouble than it's worth.

 

[AvantiDoc]

Interesting thread...I'm new to SDN, but have a similar question...
I'm currently in a practice where my senior partner who has implanted many pumps over the years will soon be retiring. I personally do not like pump management , but have helped him with refills, adjustments, etc.
Question is, when he retires will I be responsible or required to assume the management of all these pump patients, even though I did not perform the implant?

 

[BobBarker]

Interesting thread...I'm new to SDN, but have a similar question...
I'm currently in a practice where my senior partner who has implanted many pumps over the years will soon be retiring. I personally do not like pump management , but have helped him with refills, adjustments, etc.
Question is, when he retires will I be responsible or required to assume the management of all these pump patients, even though I did not perform the implant?

Required? No.
Expected to? Yes

You need to get him to stop implanting if he is still doing so. You also need to decide what you are willing to do and won't do. If he would like the patient to stay with you then he needs to get the patient on a regimine that you are comfortable with now.

 

[AvantiDoc]

Thanks for the input. That's good to hear I'm not necessarily required to continue this management. I appear to have a similar mentality to most on this thread and feel that pumps are becoming a thing of the past except certain conditions. I just did not want to be held liable for abandonement, for example

 

[bedrock]

Definitely a sticky situation if you are in the same practice. Something for the fellows to consider as they look at job offers.

Agree with Bob Barker, that if your senior partner is planning on retiring in 1-2 years, I would tell him you don't want additional new pump patients, and that if he wants to do any more pumps on future patients before he retires, he must also tell those patients of his retirement plans and that they'll have to go elsewhere for pump management after he retires.

But you're otherwise rather obligated to take over his other current pump patients, but how you manage them is up to you.

 

[Ducttape]

it is a very sticky situation.


imo, you are at least obligated to appropriately taper him off of the therapy. you cant just up and say "no more refills". they are patients of your clinic, even if they are seeing "your partner". the fact that you might have done a refill also strengthens this relationship. we should ask amphab, but it seems like not accepting these patients when your partner retires would be abandonment, or close to it.

otoh, you should say "i do not feel comfortable, given the mounting evidence that is out there that suggests that high dose opiods are dangerous. i am worried about your future health and how these medications will affect you over the next 10-30 years. we are going to taper by decreasing your dosage through the pump over x months. if this is not something you want, you could find someone else to take over the pump , but we will taper nonetheless. at least, the taper will provide you a little extra time to find someone else who doesnt care about you."

or something to that effect.