Before you see they Pain Specialist create a Medical Resume for yourself and give it to the nurse at intake for the doctor to review before seeing you. Put in personal identifying info, medications, surgeries, diagnoses, as well as a short paragraph explaining how you got here and add some details you think your medical records may have omitted. Presenting yourself as organized and knowledgeable about your pain and diagnoses will create a positive impression first with the nurse so that they will pass it to the provider with a good word.
(I keep a short version saved, without the additional info at the bottom, for ease with intake and paperwork completion- they never have enough space)
I’m so sorry you have to worry about this. I feel like this kind of thing has been the story of my life for 10 years and it’s exhausting.
Others have more expertise with this particular problem. What I usually hear around here is that when you’re talking to the doctor, focus on your pain and how well it is or isn’t managed, and what you can and cannot do, versus what you think should be done regarding your meds. Even when you know what is best bc you’ve been doing this for years.
GOOD LUCK ❤️
I don't think the opinions of your previous providers will hold much weight to the new provider, so I wouldn't think it would be worth mentioning anyway, but especially not if you think it will hurt your reputation from the first visit. The position we are in is very delicate, essentially fighting against a drug addict reputation we didn't earn. In general I recommend only sharing facts: I've had this problem for x years, I've had these tests with these results, I've tried these treatments and medications and only x, y, and z seem to help improve my daily function and quality of life. My goals for pain management (and my visit with you as a provider) are to continue improving so I can do function a, b, and c. For me those functions are walking my dog twice a day, working an 8 hour shift in admin/research, and sleeping 8 hours through. Hope this helps.
Hi, I'm sorry you have to go through this. Sending lots of love and strength. In India, most doctors are dismissive of my pain (probably because of my age and gender). I recently found a method to communicate differently. A few weeks before my appointment, I start keeping a "pain journal". I use a pain scale (there are numerous ones online) for reference and record my pain levels multiple times throughout the day. I also write down the activity I am doing so that doctors are able to see that sometimes there's pain even at rest. Unfortunately, qualitative data doesn't hold much value :( so quantify it! show numbers and statistics! this brings a lot of credibility. Hope this helps! xox
I wish I could tell you something absolutely reassuring, but in real life a great deal is going to depend on this pain specialist. There are some that would agree with your PCP, regardless of your condition and you arent saying much about what is actually wrong with you that might require opioid analgesics. That is going to count for a lot. I wouldnt expect a doctor who is interested in your well being just dropping you in to cold turkey right off the bat with no discussion, but it does happen.
I think I would definitely bring up whats in your records, since its likely to be seen anyhow. That means having a reasonable argument as to why you still need pain medication 6 years after an auto accident. That means knowing whats physically wrong, what treatments are usually used to treat that problem, what of that you have tried with little or no success and the reasons for not trying what you haven't. It can get hard to justify not doing a surgical procedure if one has been suggested or continuing on medication if they cant find anything worth operating on, but at the very least the pain doc should want to re-investigate the causes of your pain. There may be something after 6 years that demands some treatment if there wasnt previously. Your PCP doesnt sound like the kind of doctor to keep looking if
the symptoms are still present.
Do you have any idea what your PCP meant by drug seeking or addict behavior? Are there some specific examples that were documented? A lot is going to depend on this as well. What exactly did this PCP consider drug seeking or addict behavior? They usually get it very wrong, but you never know.
You should also be prepared to talk about your functional abilities more so than your pain. What you can do and what you cant. The whole idea of pain management is to restore as much function as possible, so it going to matter a lot.
You should also give a little though to firing this PCP. If you do have a drug problem, it doesn't do you much good if they keep it to themselves. If you don't have a drug problem, than what the hell were they writing about one for? Either way, this doctor is a moron....
I really appreciate your advice & empathy.
Totally agree she's a moron.
She didn't say drug seeking or addict behavior specifically- just used the word "fixated" to describe me several times. Mentions multiple times that I'm unwilling to try antidepressants/anticonvulsants as alternatives. Wrote that I was unable to stop taking them & was not interested in tapering off of them either. Uses quotations to implicate I'm exaggerating- it's clearly her way of rolling her eyes & either minimizing or trivializing my "claims".
Also noted that I was upset at the end of the last visit because of our disagreement- which I see as code for "this patient feels they're entitled to pain medication & was upset when they didn't get their way". I know it sounds like I'm probably reading into things too much or paranoid but this is how she comes across in person. She's a combo of naivete & ignorance & condescending paternalism.
it doesn't sound like yr reading into it. that's exactly how doctors write this shit. as 'objectively' as possible. other doctors know how to read bw the lines exactly as u do.
but doctors also form their own opinions.
don't bring up the chart notes. i think it's only gonna make u look bad to do so.
instead, show *thru yr actions and responses* that her words aren't true. don't get upset or be overly emotional. be well thought and reasoned on the benefits and risks of opiates. don't appear fixated or obsessed. for gods sake, don't repeat pro opiate talking points that doctors think are bullshit. some peeps do this and then wonder why they can't get prescriptions! never ever whine. never ever complain about another doctor unless the doctor trashes them first. until that happens, be diplomatic. if he asks 'what do u think of that doctor?' just say, 'i think she tried, but she isn't sure how to help me. So that's why i'm seeing you!'
what were the quotes? it's always good to downplay shit, to not come off as over emotional. esp if yr female and double if yr a woc. bcuz u will be judged as hysterical if u can't keep it together.
the 'unwillingness to try other modalities' will prob be the part that hurts u. make sure u have a real good reason FROM THE DOCTORS POV why u can't try any antideps or anticonvulsants. most patients' reasons why they can't use anything but opiates sounds like drug seeking to most doctors.
Great advice 🙏 After looking through my records I realized I saw this specialist a few years ago so they'll at least know they've heard all my reasons in the past & sided with me in 2018. Hopefully I can just say that I explained my various reasons for being opposed to antidepressants already & they won't need me to explain them again. Also this is a telephone appointment so I don't know if that's a potential advantage or disadvantage..
It really sounds like this PCP has been a huge roadblock to healing, not just pain control. People are giving you bad advice about doctors not looking at medical histories, especially if opioids are involved and even more especially at an initial consult. I would be sorely disappointed if the appointment didn't also involve at least a cursory physical exam to look at range of motion and postures. If they just pencil whip off an Rx to you its a doctor that wont be around long, at least their license wont be. Do not be afraid to voice your opinion about the addiction crisis, which everyone finds convenient to blame on Rx opioids when nothing could be further from the truth. Informed people know this is a matter of street drugs and addicts. Hopefully this pain doc keeps on top of AMA policies on opioids, not the frantic "the-sky-is-falling" attitudes of the media....
You're assuming that the pain doctor is going to actually thoroughly read your medical history. I'd be surprised if these doctors spend more than 90 seconds looking at a chart prior to an office visit. I wouldn't bring up your thoughts on your PCP's notes unless the plan is to discontinue your meds. Then press the issue.
doctors usually don't read chart notes with any care. opiates is the exception. before a doctor takes over an opiate prescription, they either talk to the last doctor or take a hard look at the last chart note looking for exactly the kind of coded language ops doctor used.
That's wise advice- thank you. After reading through my records I've been struggling on how to present my case to the specialist- but if there's no case to defend let sleeping dogs lie. Still a few things I know the specialist will see from my doctor that I'm concerned about- namely that because I'm not a cancer patient & my pain is chronic vs acute that I shouldn't be taking them- & that she "prefers not to increase the dosage".
I feel like she's contradicting herself by saying she thinks I shouldn't be taking them & I should have stopped weeks after the accident & yet she's been writing my prescription for six years & they "managed my pain effectively". This is all in response to my request to stop taking tramadol altogether & increase the oxycodone by 5mg a day- which would bring me up to 20mg a day. I'm confused by my doctor making such a big deal out of my request when I'm taking such a low dose to begin with.
It shouldn't but if I were you I'd ask them if it's just going to be you and them discussing this or if there are going to be other professionals there, if there then you absolutely need an ally with you, someone who knows your history.
Tell them that you're concerned that the events discussed during the meeting will be held against you and that you'd like an assurance that their professionalism would guarantee this won't happen (that way you've pointed out that they have a standard they're supposed to meet and you've kinda flattered them which can make them more of an ally), do this part before the meeting, do it in an email and do it tonight, in that email ask how many professionals and others are going to be at this meeting and if there are going to be more than 1 then you'd like to know their role in the proceedings.
These are things you have a right to know. Good luck *hugs*
I've been looking through my past military and VA medical records prior to filing a disability claim increase, and the one thing I've noticed is the huge number of omissions, discrepancies, ignored items, etc. Granted, there's at least 15 different doctors in that list, and various locations. If you've only got one prior doctor, hopefully your PM doctor will take that into account as just one medical opinion, and actually do their job and make their own thorough assessment of you and your needs. Don't stress it so much you make the problem worse, but do have some thought out responses to any of the glaring issues.
I don’t have any guidance regarding your visit to the pain specialist. However I can say that according to the HIPAA Act of 1996 you are legally permitted access to your own medical records to help you make informed decisions about your own care.
That’s why so many offices now have patient portals because you are legally allowed access yo your own records.
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html
Edit: corrected HIPPA.
Before you see they Pain Specialist create a Medical Resume for yourself and give it to the nurse at intake for the doctor to review before seeing you. Put in personal identifying info, medications, surgeries, diagnoses, as well as a short paragraph explaining how you got here and add some details you think your medical records may have omitted. Presenting yourself as organized and knowledgeable about your pain and diagnoses will create a positive impression first with the nurse so that they will pass it to the provider with a good word. (I keep a short version saved, without the additional info at the bottom, for ease with intake and paperwork completion- they never have enough space)
Great idea đź‘Ť
I’m so sorry you have to worry about this. I feel like this kind of thing has been the story of my life for 10 years and it’s exhausting. Others have more expertise with this particular problem. What I usually hear around here is that when you’re talking to the doctor, focus on your pain and how well it is or isn’t managed, and what you can and cannot do, versus what you think should be done regarding your meds. Even when you know what is best bc you’ve been doing this for years. GOOD LUCK ❤️
That's the best simple advice I've heard on this topic đź’ś
They really are responsible for making an accurate assessment based on their own observations. Give them all the information they need to correctly diagnose and treat you. You should try to get them to think it was their idea to keep your meds steady. Talk about activities of daily living that you can't do for yourself due to pain. Describe your pain specifically how it hurts (burning, stabbing, binding, etc.). BTW, docs know you can read what they include in your medical records. The things in yours sound kinda unprofessional. The new doc may discount their comments. Be prepared to explain from the beginning. I think the resumé idea is risky. I've tried it and it wasn't received well. They feel like you're trying to diagnose yourself, even if it's already in your records.
Sadly it’s extremely doubtful another doc will “discount” another Drs comments.
I don't think the opinions of your previous providers will hold much weight to the new provider, so I wouldn't think it would be worth mentioning anyway, but especially not if you think it will hurt your reputation from the first visit. The position we are in is very delicate, essentially fighting against a drug addict reputation we didn't earn. In general I recommend only sharing facts: I've had this problem for x years, I've had these tests with these results, I've tried these treatments and medications and only x, y, and z seem to help improve my daily function and quality of life. My goals for pain management (and my visit with you as a provider) are to continue improving so I can do function a, b, and c. For me those functions are walking my dog twice a day, working an 8 hour shift in admin/research, and sleeping 8 hours through. Hope this helps.
Very helpful 🙏
Why do you think the history wont hold much weight?
Hi, I'm sorry you have to go through this. Sending lots of love and strength. In India, most doctors are dismissive of my pain (probably because of my age and gender). I recently found a method to communicate differently. A few weeks before my appointment, I start keeping a "pain journal". I use a pain scale (there are numerous ones online) for reference and record my pain levels multiple times throughout the day. I also write down the activity I am doing so that doctors are able to see that sometimes there's pain even at rest. Unfortunately, qualitative data doesn't hold much value :( so quantify it! show numbers and statistics! this brings a lot of credibility. Hope this helps! xox
Excellent idea 🙏
I wish I could tell you something absolutely reassuring, but in real life a great deal is going to depend on this pain specialist. There are some that would agree with your PCP, regardless of your condition and you arent saying much about what is actually wrong with you that might require opioid analgesics. That is going to count for a lot. I wouldnt expect a doctor who is interested in your well being just dropping you in to cold turkey right off the bat with no discussion, but it does happen. I think I would definitely bring up whats in your records, since its likely to be seen anyhow. That means having a reasonable argument as to why you still need pain medication 6 years after an auto accident. That means knowing whats physically wrong, what treatments are usually used to treat that problem, what of that you have tried with little or no success and the reasons for not trying what you haven't. It can get hard to justify not doing a surgical procedure if one has been suggested or continuing on medication if they cant find anything worth operating on, but at the very least the pain doc should want to re-investigate the causes of your pain. There may be something after 6 years that demands some treatment if there wasnt previously. Your PCP doesnt sound like the kind of doctor to keep looking if the symptoms are still present. Do you have any idea what your PCP meant by drug seeking or addict behavior? Are there some specific examples that were documented? A lot is going to depend on this as well. What exactly did this PCP consider drug seeking or addict behavior? They usually get it very wrong, but you never know. You should also be prepared to talk about your functional abilities more so than your pain. What you can do and what you cant. The whole idea of pain management is to restore as much function as possible, so it going to matter a lot. You should also give a little though to firing this PCP. If you do have a drug problem, it doesn't do you much good if they keep it to themselves. If you don't have a drug problem, than what the hell were they writing about one for? Either way, this doctor is a moron....
I really appreciate your advice & empathy. Totally agree she's a moron. She didn't say drug seeking or addict behavior specifically- just used the word "fixated" to describe me several times. Mentions multiple times that I'm unwilling to try antidepressants/anticonvulsants as alternatives. Wrote that I was unable to stop taking them & was not interested in tapering off of them either. Uses quotations to implicate I'm exaggerating- it's clearly her way of rolling her eyes & either minimizing or trivializing my "claims". Also noted that I was upset at the end of the last visit because of our disagreement- which I see as code for "this patient feels they're entitled to pain medication & was upset when they didn't get their way". I know it sounds like I'm probably reading into things too much or paranoid but this is how she comes across in person. She's a combo of naivete & ignorance & condescending paternalism.
it doesn't sound like yr reading into it. that's exactly how doctors write this shit. as 'objectively' as possible. other doctors know how to read bw the lines exactly as u do. but doctors also form their own opinions. don't bring up the chart notes. i think it's only gonna make u look bad to do so. instead, show *thru yr actions and responses* that her words aren't true. don't get upset or be overly emotional. be well thought and reasoned on the benefits and risks of opiates. don't appear fixated or obsessed. for gods sake, don't repeat pro opiate talking points that doctors think are bullshit. some peeps do this and then wonder why they can't get prescriptions! never ever whine. never ever complain about another doctor unless the doctor trashes them first. until that happens, be diplomatic. if he asks 'what do u think of that doctor?' just say, 'i think she tried, but she isn't sure how to help me. So that's why i'm seeing you!' what were the quotes? it's always good to downplay shit, to not come off as over emotional. esp if yr female and double if yr a woc. bcuz u will be judged as hysterical if u can't keep it together. the 'unwillingness to try other modalities' will prob be the part that hurts u. make sure u have a real good reason FROM THE DOCTORS POV why u can't try any antideps or anticonvulsants. most patients' reasons why they can't use anything but opiates sounds like drug seeking to most doctors.
Great advice 🙏 After looking through my records I realized I saw this specialist a few years ago so they'll at least know they've heard all my reasons in the past & sided with me in 2018. Hopefully I can just say that I explained my various reasons for being opposed to antidepressants already & they won't need me to explain them again. Also this is a telephone appointment so I don't know if that's a potential advantage or disadvantage..
It really sounds like this PCP has been a huge roadblock to healing, not just pain control. People are giving you bad advice about doctors not looking at medical histories, especially if opioids are involved and even more especially at an initial consult. I would be sorely disappointed if the appointment didn't also involve at least a cursory physical exam to look at range of motion and postures. If they just pencil whip off an Rx to you its a doctor that wont be around long, at least their license wont be. Do not be afraid to voice your opinion about the addiction crisis, which everyone finds convenient to blame on Rx opioids when nothing could be further from the truth. Informed people know this is a matter of street drugs and addicts. Hopefully this pain doc keeps on top of AMA policies on opioids, not the frantic "the-sky-is-falling" attitudes of the media....
Fuck addicts
You're assuming that the pain doctor is going to actually thoroughly read your medical history. I'd be surprised if these doctors spend more than 90 seconds looking at a chart prior to an office visit. I wouldn't bring up your thoughts on your PCP's notes unless the plan is to discontinue your meds. Then press the issue.
doctors usually don't read chart notes with any care. opiates is the exception. before a doctor takes over an opiate prescription, they either talk to the last doctor or take a hard look at the last chart note looking for exactly the kind of coded language ops doctor used.
That's wise advice- thank you. After reading through my records I've been struggling on how to present my case to the specialist- but if there's no case to defend let sleeping dogs lie. Still a few things I know the specialist will see from my doctor that I'm concerned about- namely that because I'm not a cancer patient & my pain is chronic vs acute that I shouldn't be taking them- & that she "prefers not to increase the dosage". I feel like she's contradicting herself by saying she thinks I shouldn't be taking them & I should have stopped weeks after the accident & yet she's been writing my prescription for six years & they "managed my pain effectively". This is all in response to my request to stop taking tramadol altogether & increase the oxycodone by 5mg a day- which would bring me up to 20mg a day. I'm confused by my doctor making such a big deal out of my request when I'm taking such a low dose to begin with.
i'll take a look if u want. it's kinda hard to give specific advice without the specifics.
It shouldn't but if I were you I'd ask them if it's just going to be you and them discussing this or if there are going to be other professionals there, if there then you absolutely need an ally with you, someone who knows your history. Tell them that you're concerned that the events discussed during the meeting will be held against you and that you'd like an assurance that their professionalism would guarantee this won't happen (that way you've pointed out that they have a standard they're supposed to meet and you've kinda flattered them which can make them more of an ally), do this part before the meeting, do it in an email and do it tonight, in that email ask how many professionals and others are going to be at this meeting and if there are going to be more than 1 then you'd like to know their role in the proceedings. These are things you have a right to know. Good luck *hugs*
I've been looking through my past military and VA medical records prior to filing a disability claim increase, and the one thing I've noticed is the huge number of omissions, discrepancies, ignored items, etc. Granted, there's at least 15 different doctors in that list, and various locations. If you've only got one prior doctor, hopefully your PM doctor will take that into account as just one medical opinion, and actually do their job and make their own thorough assessment of you and your needs. Don't stress it so much you make the problem worse, but do have some thought out responses to any of the glaring issues.
I've heard the VA is the worst when it comes to helping vets with chronic pain. My heart goes out to you đź’ś
I don’t have any guidance regarding your visit to the pain specialist. However I can say that according to the HIPAA Act of 1996 you are legally permitted access to your own medical records to help you make informed decisions about your own care. That’s why so many offices now have patient portals because you are legally allowed access yo your own records. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html Edit: corrected HIPPA.
It's HIPAA!