Nothing More to Offer

[EruditeDoc]

I have a few patients in which there is nothing further that I think I can do for them. They call the office within days after injections and complain about lack of pain relief. Usually, I have also rotated them through a number of medications to no avail.

What do you guys do with these patients? Do you flat out tell them there is nothing more you can do? Do you refer them to another pain doc in the event that another set of eyes is helpful. Do you let them disappear into a slow fade....

In some cases, I really wish I could help ..

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[Dr. Ice]

Put a stimulator in them cause if you don't someone else will. That's the physician mantra in a competitive market..if you don't..someone else will.

This is s struggle for me as well. You can only do what you feel is right.

 

[kstarm]

If you really believe you have the right diagnosis, have done the right treatments, and addressed the contributing factors and barriers to improvement appropriately then I say something like: "In the year 2017 this is the best treatments we have to offer. I am happy to refer you to Dr. X (someone who will not aggressively do things that will make the patient worse) for another opinion."

Usually the barriers and contributing factors have not been addressed adequately to move the patient forward in these cases.

 

[deleted472101]

Refer to a "tertiary " center for a second opinion. That is what I do. You never know and fresh set of eyes may ask the right questions or it's the same thing

 

[Dr. Ice]

Yes the "tertiary" care docs see 15 patients a day and can afford to spend an hour with each patient figuring out zebras. This is not possible in the private practice world.

 

[Taus]

I verbally review the categories of treatment with patient. (Time, lifestyle/activity modification, PT, reasonable meds, braces/devices, manipulation by D.C. or D.O., injections and other minimally invasive procedures and surgery). If all have failed and surgery not an option, then my remaining options are a second opinion, trying complimentary/alternative treatments, i.e. Acupuncture or CBT. Let's em know you at least thought it through. Wish em luck...


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[EruditeDoc]

If you really believe you have the right diagnosis, have done the right treatments, and addressed the contributing factors and barriers to improvement appropriately then I say something like: "In the year 2017 this is the best treatments we have to offer. I am happy to refer you to Dr. X (someone who will not aggressively do things that will make the patient worse) for another opinion."

Usually the barriers and contributing factors have not been addressed adequately to move the patient forward in these cases.

I also have a subset of patients with insurance barriers to care! bleh...strangely enough the opioids seem to always be covered

 

[oreosandsake]

I verbally review the categories of treatment with patient.

I pretty much do this at every evaluation. set expectations. they always expect Magic Wand category which i explain doesn't exist. i dont mind when it's awkward and quiet in the room when i try to let them soak in that being 80 and having OA and "you mean I have to live with this for the rest of my life?!" is not out of the ordinary, and I cannot make them 18 again.

 

[hrmm]

How often are you guys referring to pain psych? Is it early via a multidisciplinary approach or last ditch effort when you're out of ideas? I have very few patients who say it is significantly effective.


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[Ducttape]

all the time, tho primary insurance rarely covers (Medicaid). pretty much every single patient, unless they express complete disdain for anything involving thinking. (time to cue in inappropriate joke about candidate who came in wearing a "Make America Great" hat...)

 

[DODOCSS]

Medicaid patient and trump supporter are mutually exclusive

 

[lonelobo]

Medicaid patient and trump supporter are mutually exclusive

Your are joking, I think?

Trump voters would be among the biggest losers in Republicans' Obamacare replacement plan