Becoming 'defensive' when discussing our meds

I've had my fair share and long history of doctors making abrupt and erroneous judgments about me, my body, my life,....based on the meds I take.

I can't help but think that over time, we as CP patients have essentially learned to become defensive in advance because we already anticipate a rebuttal and a dismissive attitude?

This is something I strongly need to work on. I'm aware of it, yet I find it natural to become defensive when listing my meds. Too much experience of docs and their harsh interactions has conditioned me.

How can we overcome this? *Can* we overcome this?

We wouldn't feel defensive if we hadn't had so many encounters which resulted in some type of 'confrontation,' however it was handled.....




.......(musings for the day?)











M.

I've been lucky it seems but, then again, I'm very new to this PM world. I haven't encountered any bad doctors yet and some have even encouraged me to take more, living with the pain is silly. But I have seen this in the pharmacies when simply trying to find someone to fill them has become an ordeal.

Carrie - You mentioned "dependent on narcotics and benzos". I'm taking a strong dosage of both morphine ER (100mg/day) & Oxy IR (90mg/day) and a pharmacist commented "wow, really ...". I left there of course and was able to fill elsewhere. When you say "dependent", do you mean physically or simply that you know that you MUST have them in order to carry on with any semblance of a normal life - again, I'm new to this and feel the latter fits already for me.

I definitely think most would rather prefer we not be on any narcotics. To me the worst phrase to hear come out of a Dr or even a nurse is "the narcotics are hard on you " Really? Like CP isn't? Broad statements, everything is hard on us. Overeating, undereating,too much exercise, too little, too much sun, too little, what doesn't require balance in usage? Our meds should be viewed the same. Finding that balance and trying to use moderation to ensure we cause the least amount of harm to our bodies. Thats where finding a good PM is priceless!

Merrida,
Your comparing yourself to your sister, don't do this, she may work in this field and therefore has the access to all the top people and knows whom to go to therefore she will feel better, not everyone has this and it's hard when you don't. It'll eat at you if you keep letting this fester.
One polite reply to her might be, "I'm so very glad your doing so well."

Plus, she might be on medications and hiding it.
Your a good person and have helped so many on here.
Always remember your a good person, take heart in that, and know we will always be here to offer up support for you.

Many well wishes...

I'm so glad I noticed this topic today. I suffer severe nerve pain, that has stayed pretty much consistent for eight years now. I have been to numerous specialists, neurologists, two experimental pain clinics, so far everything in regards to my disease has progressed exactly as I was told it would since the day I was first diagnosed. I say "first" diagnosed because I have been diagnosed several times for the same thing due to the fact that many doctors want their diagnosis on record. It's like they don't trust anyone else. The same pretty much goes for testing as well. One particularly painful test I had done four separate times. The fifth request was met with understandable anger on my part, I had to draw the line somewhere.
This brings me to my concern about doctors showing anger and mistrust with patients. As I stated earlier, I've been diagnosed with Idiopathic Peripheral Neuropathy. At the time of my first diagnoses I was 43 years old and all I wanted at that time was to get back to work. I contacted the president of the Peripheral Neuropathy Assc. Come to find out she lives right here in Maine, she helped me a lot to understand the illness, and she outlined the stages as well as the progression of the symptoms and the pain. I learned that there are literally thousands of possible causes for the disease, unfortunately there is no cure. If the cause is known and the patient either stops what ever is causing it, there may be significant pain relief, but that's the best prognosis I received.
I studied every piece of literature and book I could find. I asked the different doctors I saw specific questions concerning my pain and it's likely course for the future. I feel that educating myself is the best way to help myself cope.
Here I am eight years down the road and suffering considerable pain in my legs and feet, I have sensory loss in both legs, feet and the outside half of both hands. I learned long ago that this disease is a degenerative disease. True to it's reputation, I've had to increase and/or change my pain medications altogether. I would say that up until three years ago it wasn't to much of a hassle getting medications changed. I might add that I also suffer from PTSD from an unrelated occurrence. I am being treated for that as well as high blood pressure bought on by my nerve damage. Three years ago I had to change primary care doctors for the first time since I became ill, this guy was very young. He was also in to much of a hurry to get to the next patient. I went to him for a year as they needed to do lab work to monitor my liver while taking ascittaminifin.(excuse the spelling) about a year ago I needed a routine change with my pain medication, Hydracodone, I had been at the same level and dosage for almost three years which I thought was pretty good , evidently it caught him off guard. I asked just the same as I would for any medication, well he lost it. You would have thought I was standing on a street corner looking to refill my stash. Not only didn't he want to discuss my request he was unfamiliar with my disease. He accused me of "Doctor Shopping" stating that he's seen it before and he wasn't going to be responsible for my meds winding up on the street.
Now I knew this guy was new, but I have never had a doctor respond like that to a legitimate medication change. Naturally I conveyed my disappointment in his response, I then went home to sulk. Thats when it hit me, my course of action against this doctor. I called a friend of mine who lives out of state, he's a Pulmonary Surgeon who I met back when my best friend was being treated for Cystic Fibrosis. His response changed my opinion of doctors, as well as how I interact with them. I was told that for one thing, the doctor works FOR me, I am his employer. What I did next took a lot of people by surprise, but my health and pain management was in question here. In a sworn statement, which I had notarized, was sent to my soon to be "X" PCP. I fired him, right then and there. I fired him for slander and submitting false billing information. As I mentioned before he was a doctor who came into the exam room where I've been waiting in some cases for half an hour, and gives me eight minutes then if necessary writes out a prescription and he's out the door. In one whole year he never once even listened to my heart rate or anything else. I caught him while reviewing my Medicare statements. He charged me one full hour for my annual physical exam. I saw the physical on the monthly statement, the hour cost about twice the normal visit. I never received a physical. Long story short, I, on the advise of my attorney, requested and received a review by the corporate officers of the facility I had been attending for fifteen years. I'll tell you this, he wasn't very happy with me after that. I really don't care. They assigned me a new PCP whom I get along with just fine, I am now working with her as well as a Pain specialist who only manages my pain meds. No more fear no more inappropriate treatment.
I learned a valuable lesson with that experience, when it comes to my medical needs, and I have many, when all is said and done, I have the last word. I am the boss and I pay his salary. If a doctor ever presents him or herself in a threatening or intimidating manner. Just remember that your running the show, and you do have a say in how your being treated. It is your life so protect it. It sure does feel good not having that nervous feeling anymore.............

The best defence is a good offense. When a doc makes a fuss about your pain meds; ask him if he's a CP? The answer will be 'no' at which point you simply tell them they don't know what they're talking about. Some will take offense, but the good ones will simply say something along the lines of 'fair enough'.

Of course, it is their job to try to keep your dose as low as possible; on the other hand, as responsible adults, that is our job as well. So I serious talk person-to-person raher than patient-to doctor might to a lot of good.

Oh..sorry, I got carried away. "What the neck" is what I meant..:)

The brilliant pain management researchers would beg to differ with those saying chronic pain just needs a little shot here or there, so I don't feel bad. Ever. I work in a medical system with a high research function and love having free access to pubmed and scopus articles that prove many aholes wrong. I find it becomes more critical the more conditions you add to your surgeries and whatnot. I urge everyone to peruse the latest research when possible and arm themselves with concrete data as an educated opponent usually becomes a teacher instead of an opponent. Although some aholes are aholes no matter what data you give them. *shrug*

I find I am defensive most with family members who have been through pain mgt and think they know MINE based on theirs.

When I was originally diagnosed with cancer, doctors tried to control the pain, but at 30-50 mg total morphine ER a day I was having unacceptable side effects, so there just wasn't a right dose for me and I was in constant pain. My doctor said, "that's a pretty low dose you're on..." but I just couldn't tolerate more.

Weeks pass, and a few days ago I'm up to 200 mg total morphine ER per day plus neurontin 1200 mg, as prescribed by a newer PM specialist, but, knock on wood, my body must have adjusted or something because I'm almost pain-free and the side effects are minimal, no brain fog, no drowsiness.

I went to my doctor yesterday and after I told him the amounts, he said, "That's a pretty high dose you're on..."

Sigh.

The look on my face must have said it all, because he immediately added, "But you seem to be doing well and you said you aren't having side effects, so..."

So, yeah, there's a stigma and always pressure to take less (which is not a bad thing if less works, but...). A suspicion of drug-seeking is always in the back of a lot of minds, I think. At my previous PM cllnic, which specializes in all PM issues and not just cancer, they were particularly into that. They only started behaving more respectfully when they started thinking of me as that surprisingly-healthy-looking cancer patient, rather than that injury patient who barely needs a cane--but what if I'd had an actual injury rather than cancer?

Also, I think a lot of people misunderstand that drugs for this level of pain, if they're working right, do not make you high. I've never done recreational drugs, but I've never enjoyed one minute of side effects from prescribed drugs--it's always yuck get that away from me, never again, or, wow that makes me feel almost like myself again and I barely know I took it, let's schedule it at that level.

I try to avoid now saying how much I'm taking daily to nurses or doctors, unless necessary, because the amount is what scares people. If possible, I try to just discuss symptoms for a bit first to show I'm "normal,"--or at least as normal as I ever get, which is kinda weird to begin with, LOL, so that might not actually be helping! But you know what I mean. And then talk about the amount, so they can see it's not affecting me except in positive way.

But I have the advantage that there won't be any life after pain medicine for me, so there's no ethical reason to get me off drugs, even though I'm surely physically "addicted" to the chemicals and even emotionally "addicted" to this feeling of being normal rather than suffering.

For those who might have a future life without drugs if an injury is eventually healed or a new treatment comes along or who knows, I can't imagine the pressure to constantly get off the absolutely necessary drugs that are truly helping you function right now.

(Edited to fix typo--just realized it should be "pretty low dose," not "pretty lose dose" in the first paragraph. Oops.)

Backtolife said...
JamesBW - I cannot believe that any doctor would ever, ever question you about what you're taking. That's just unbelievable.

I think he realized the same thing really quick, and that's why he continued on so fast commenting on how it seemed to be working well for me, LOL!

Because he's my oncologist, he only sees me once a month for check-ups right now, but I've been in and out with the palliative care doctors/nurses almost constantly these days getting pain medicines figured out, so I think the oncologist just got caught by surprise how much they'd had to increase dosages.

But even the oncologist figured out quick, if it works, it works, and that's how it should be!