Nivens

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Hi everyone- I'm an anesthesiology intern starting a chronic pain elective at a community hospital next week. I had excellent exposure in medical school to every sub-specialty except for pain, and I figured it might be a good idea to check it out sooner rather than later in residency. Any recommendations for a good primer I could read over the weekend so I don't look like a complete idiot? Also, anything specific that would be good for me to review (ie spinal anatomy)?
 

SpineBound

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brush up on your psychiatry personality disorders (something they would expect you to know) and give your opinion about patients to the residents and attendings. They will be impressed and more likely to teach you about pain management because you have already demonstrated to be capable of learning.
 

unchockey21

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If you brush up on the relevant anatomy for some common procedures like LESIs, TFESIs, MBBs, and SI joint injections (the atlas above is a great resource), know the mechanisms of some commonly used drugs, and can do a good MSK/neuro exam, you'll be light years ahead of most of your non-pain inclined upper level residents.
 
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Nivens

Nivens

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Thanks for the advice!
 

lobelsteve

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101N

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Cmon, keep the banter to a single thread of flamewars.
The Treatment Is You: Washington State. pg 310-315

"We overtest, perform surgery, stick needles; these people are worse off." he said. "If we work on their nutrition, diet, sleep habits, smoke habits, helping [them] find work - they improve. You have to be accountable. If you give a treatment that kills people or makes people worse, you gotta stop. You can't continue making money on stuff that doesn't work."
 

lobelsteve

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The Treatment Is You: Washington State. pg 310-315

"We overtest, perform surgery, stick needles; these people are worse off." he said. "If we work on their nutrition, diet, sleep habits, smoke habits, helping [them] find work - they improve. You have to be accountable. If you give a treatment that kills people or makes people worse, you gotta stop. You can't continue making money on stuff that doesn't work."
But his rotation is in the real world, USA 2015. Not Coehlopacylpse 2020.
 
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101N

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Yea, unfortunately the tale told in Dream Land is real, and still going on.

Another quote from the book: "During these years, he remembered an applicate to the
center's pain fellowship program who was asked why he wanted the post. I want a Bentley,
the applicant replied.
 

lobelsteve

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Poor taste. Low mpg, heavy, no feel. Numb cars. Feral injectionists have run amok. Narc dealers with MDs have run amok. We are neither, nor are legitimate pain providers. I have offered the solution on the board for several years.

1. Only pain docs can rx opiates for more than 2 weeks.
2. Pain docs are govt employees with sovereign immunity from malpractice.
3. Only pain docs can do outpatient procedures (including kypho)
4. Salary set to 450k in 2016, cola, govt benefits.
5. Got to see 25-30 patients per day, 5 days per week.
6. Only job is to care. No extra money for unnecessary procedures. No ancillary income allowed.
7. Use CPRS as EMR, no meaningful use or CMS guidelines apply. No precerts.

Take it or leave it.
 

101N

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How does that square with reality, your wRVUs?
 

Ducttape

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Agree with all, except volume. There is insufficient time in a 15 minute appointment to discuss pain management, especially with respect to the psychosocial aspects of pain.
 

lobelsteve

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Agree with all, except volume. There is insufficient time in a 15 minute appointment to discuss pain management, especially with respect to the psychosocial aspects of pain.
Immediately after your visit they sit with the neuropsych or msw. Problem solved, team model. Pne roof.
 
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