In general, it should be the surgeon doing that, and telling the patient that if they're acutely or sub-acutely post op. If someone is in my office acutely post op, my first question is not how long the opiates are going to continue, but instead, why are you not in the surgeon's office? My view, is that it's a surgeon's job to manage his patient's post op pain, routinely, for routine cases. It's a surgeon's responsibility to deal with the complications of his knife. A surgeon wouldn't operate and once a wound infection pops up, dump the patient on ID and tell ID to "give antibiotics for 10 days and tell the patient that's it," would he? Should he?
No. Now, if there's a complex case and a need for consultation, that's a different story. But a consultation is a two way street. It's not a transfer of care, unless that's mutually agreed upon. It should never be a dumping off process.
Post op pain, as an expected complication of surgery, is similar. The surgeon should treat the post op pain, and as the patient heals, taper the opiates off when the acute pain period ends. In 2018, having had surgery should not mean you're expected to be kept on a lifetime of opiates, just because you had surgery.
That being said, you take each case one at a time because there can be extenuating circumstances and in such cases you do what makes sense and document the reasons. But as a routine, I rarely get referred a patient that has fresh acute post surgical pain, because the surgeons are routinely treating that pain as they should.
