My Client Needed Chronic Pain Medication and No One Would Help.
I find doctors have a fear of prescribing pain medications. A client of mine, who is HIV positive, moved to California near San Francisco from New york City, three months ago. There is also a diagnosis of CMS myelopathy causing chronic pain. Pain medications were prescribed by the HIV doctor and / or specialist for several years. My client came prepared to California with adequate documentation from the doctors about the diagnosis and medication dosage. The client contacted me after two months of being told neither the primary care nor HIV doctor would provide prescriptions. The doctors mantras were 1. you need to see a pain specialist 2. I am not trained to write for pain medication or 3. I only treat within my specialty.
It would be a simple task if there was a pain specialist who would take the insurance which is MEDI-CAL. The PCP office referral person told me sometimes no specialists can be found. As my client said, should I just give up and die? I personally called 35 pain specialists in a 50 mile radius of my client and 32 did not take the insurance. The other three only did injections and no pain medication management. I spoke with pain centers at two major universities, three public hospitals(no new clients or no more MEDI-CAL) and the story was the same. The office of MEDI-CAL was unable to help locate a specialists either. Four weeks later after writing letters, faxing medical notes, calling every day and getting my client to switch to a different part of MEDI-CAL was my client accepted by a university center. However, the appointment has not yet occurred so there is no guarantee of a prescription. There is reserved hope.
I do not accept that doctors can not write for pain medication especially while a client is looking for a specialist and there is proper documentation. Doctors can even call other doctors and speak directly for verification. My client came from a reputable pain center in NYC. Doctors can consult directly with a local pain specialist for guidance. Not one of the doctors would write the prescription at the dose required and two would not write at all. My client is taking one third the original dose. The emergency rooms also refused and referred the client back to the PCP. Why is it that doctors think people on chronic pain medication are drug seekers and need to go into rehab? The literature speaks to the validity of the use of pain medication. Let's not forget, my client is HIV positive, has AIDS, chronic pain and has been on pain medication for over five years.
I was appalled when an HIV doctor told my client, I only treat HIV. My client's pain is HIV related and there is no difference. I know because I worked in HIV care as a nurse and nurse practitioner from 1983-86, 1991- 2002. I started an HIV/AIDS center in Santa Fe, New Mexico. I learned to work with pain medication because it was part of the job. I knew the pain of many of the HIV related disease/ opportunistic infections and I would not let anyone suffer. I also made sure I had all the information and called whoever I needed to for verification of dosage.
So many doctors are fearful of drug seekers and being lied to. Yes, it happens to us all in practice but the drug seekers don't come in with the kind of documentation my client has. Nor do they request you call their recent pain specialist/HIV doctor or PCP. I do not understand how a doctor can allow a client to suffer when there is a chronic disease involved. I do realize the DEA is suspicious of and monitor narcotic prescriptions. The doctors who are prosecuted are the ones causing harm, writing too many prescriptions and don't have valid documentation. I don't think the DEA would prosecute a doctor who wrote a prescription for an AIDS patient who had a documented history of pain management of the specific drug dosage, and was waiting for a pain specialist to accept the referral. Is this the Michael Jackson syndrome, a fear of writing pain medication?
It certainly is a sad commentary on the state of medicine in this country. It seems fear is the driving force not sound medical care. Fear of being sued, fear of being accused of writing for too many pain medications, fear of being labeled as an easy doctor to get pain medications from are some of the underlying themes. What will happen if my client can not get the pain medication? Let's hope in this spirit of joy and celebration, that won't happen.
Posted by HealthCare Whisperer at 12/23/2009 7:39 PM 
Categories: medication, pain, specialist
Tags: doctors pain specialist medication MEDI-CAL
Categories: medication, pain, specialist
Tags: doctors pain specialist medication MEDI-CAL
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