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Tricky PM situation, how to switch care over...

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Posted 8/15/2014 3:03 AM (GMT 0)
Hi Everyone,

Ok, here's the situation....I currently go to PM doc #1 for treatment of chronic low back pain. I am scheduled for left side RFA to be done next Thurs, 8/21. I also need the right side done, but cannot schedule that until left side is feeling better, etc (not sure if this is typical), so it may be around a month before right side gets done. At least that's how long it took when I had it done last time. Relief was great!

However, today I was scheduled to see PM doc #2 (referred by my headache doc after having MRI; discovered neck pain and left arm/hand symptoms caused by degeneration and 3 bulging discs C3-C6). I have an appt with PM doc #2 on Thurs, 8/28, just for the neck. Referring doc said she doesn't want them to just put me on pain meds, she really wants them to do some "procedures" to help with things. I really do not want or need additional pain meds at this time. All I currently take is Tramadol for my back. I guess I would like maybe to have some pain meds, just something for the nerve pain that I could take only as needed, not something I have to take every day. At this point, I really only feel like there are maybe 3-4 times per week when I wish I had something to take for it, and it's generally a middle of the night thing where I can't get comfortable or get back to sleep because it hurts so bad.

Now, if PM doc #2 is good, I would like to switch my care of my lower back over to them. I'm thinking that I would really really want to have PM doc #1 do the RFA on the right side before I switch. And I really want for PM doc #2 to leave my lower back treatment plan alone...I'm happy with it. It's just the Tramadol and the RFA every 10 months or so, as needed. Obviously I can only have 1 PM person. I like PM doc #1, but only see him for 2 minutes before procedures, otherwise I am stuck dealing only w/ his PA and not-so-good office staff. I do not have much confidence in them at all.

So, how do I do this? Do I just be honest with them (except I don't think I would tell PM doc #1 that his staff is a bunch of morons)? Am I playing with fire or asking too much? I know that it can be very hard to find a good PM doc and I really don't want either of these docs to think I am sneaking around or going behind their backs or whatever. Just looking for a positive experience and to get the care i need.

Hope you all are finding a reason to smile today!!
Posted 8/15/2014 3:30 AM (GMT 0)
Sunny if I am reading your post right, you have not seen PM doc #2 yet and you have an appointment with this PM doc on the 28th of this month, is that correct? If that is the case, how sure are you  about wanting PM doc#2 to take over your care of your lower back?  I mean when you see him/her on the 28th you might not even like that PM doc!

 May I ask why your doctor did not just have your current PM doctor #1 take care of your neck and head aches? If your doctor insist that you go to the one that you were referred to, then you really don't have any choice but to change doctors do you?

I guess I am maybe a bit confused?? But if this is because you don't care for the staff or treatment by them with PM Doc #1 then just come out and tell them that your changing doctors and why, give them your personal reasons and the fact of your doctors referral to the other PM doctor for your neck!, But I would certainly wait to do all this, till after I had seen PM Doc #2 on the 28th and see if you liked him/her and also if they can and would agree to take over your complete pain management including that of your lower and mid spine and sides! Until then I would just go ahead and get my scheduled treatments with PM doc#1, and not say anything till after you have seen PM Doc #2 on the 28th  and you have made up your mind. After all there is alway the chance that maybe the new PM will not want to take over your other treatments???? You never know till you talk to them about it!

Good Luck to YOU!

White Beard 

Posted 8/15/2014 4:21 AM (GMT 0)
Best of luck with it Sunny.What would happen if PM1 found out about PM2 or visa-versa?

I'm in a different PM than I was this time last year.

Probably the best decision I've ever made.

Wish you low pain,

Rick
Posted 8/15/2014 5:43 AM (GMT 0)
I,too, am confused. You have a headache doc that discovered that you have neck pain? You didn't realize that the pain was there until she said so? Did I read all that right. Then the headache doc refers you to another doc instead of telling you to tell your present doc about the problem, is that correct?
Normally, I would be very suspicious that this headache doc is drumming up business for PM #2. Is headache doc aware of PM#1? To be honest, it sounds like you really want to get rid of #1, so would I. My advise is like whitebeard's . . . see #2 first, that will be after your first lower back procedure, right? If you like #2 then tell him about your dissatisfaction with #1 and where you are on your lower back treatment. Ask him if he can finish the procedure and break it off with #1 nice and honest . . . tell him about not getting along with the staff, etc.
I was stuck in a similar situation with my oncologist #1 . . . he told me that all of a sudden my numbers were bad, I asked him what that meant and he said, basically, that I wouldn't understand. Well goodbye #1 and hello #2. To really show you how mad he made me I went to #2 in the same cancer center so we see each other every month or so. You are the boss, find a doc to your liking, don't let them cow you . . . Q
Posted 8/15/2014 5:47 AM (GMT 0)
I am assuming that you don't have a pain contract with PM Dr 1 or any other dr.
Posted 8/15/2014 9:07 AM (GMT 0)
I'm wondering about M&Gs question as well? Your walking thin ice Sunny! PM is a whole different world then PCPs or other specialists. Your getting treatment from PM1 and a controlled substance. I'm confused over why your Dr wouldn't send any scans or reports to your onboard PM? Choosing instead to refer you to a different one? You can Not have two treating PM drs at the same time, goes against medical protocol and puts you in the soup of Dr shopping! You can try to plead it off as lack of knowledge but its not likely going to fly and you could find yourself with no PMs.

Furthermore if you go ahead and see pm2 you had best inform him of pm1 upfront before he hands you that contract at signing in and make sure it's noted by him and your record reflects that appointment is "consult only " that you take nothing in the way of prescription or treatment at that consult only and if you decide to switch from 1 to 2 you completely remove yourself from pm1s care by a registered letter stating so before you return to pm2 for any treatment.
Posted 8/15/2014 1:17 PM (GMT 0)
Sorry for the confusion!! Ok, let me see if I can clear things up a little....

@Quincy: I was having pain/tingling/numbness in left arm and neck since April 2014. Headache doc offered to do MRI because we thought maybe the pain, etc, was causing me to have more stiffness, stress, which may be leading to more headaches. Maybe in my original post it was a bit confusing, but do you really think I would have not known I had pain until MRI results revealed problems in the neck?? Wow. And I did ask to see PM doc#2, the referring doc is wonderful and caring and honest. She is in no way "drumming up business" for PM doc#2. Thanks for the rest of your comments though.

Headache doc wanted to send info to PM doc#1 to have him just add neck pain to my file (so he could treat it). However, I requested a referral to a new PM doc, which is where PM doc#2 comes in, because I do not feel confident that I would receive good treatment for the neck from PM doc#1. Simply because I wouldn't actually be seeing the doc for evaluation or determining what type of treatment to do for the neck. I want to see an actual doctor, not just his assistant.

I believe I did sign a pain contract w/ PM doc#1, but whenever I go to the clinic, they have some reason as to why they cannot get me a copy of it. (Very strange.) If I choose to terminate care with PM doc#1, do I need to do anything as far as that contract goes? I mean if I'm not seeing him anymore, does that contract still have any validity or "power"?

I agree with advice given that I should see PM doc#2 and decide whether he will be able to continue my back pain treatment, before ending my relationship w/ PM doc#1.

And yes, I will let doc#2 know of my relationship w/ doc#1 right away. Vickie, what is the "registered letter"? PM doc#1 writes a letter to doc #2 saying I terminated my treatment with doc#1? Is that correct? Who needs a copy of that letter? (I'm guessing doc#1, doc#2, and myself?)

I realize that the world of PM is very complex, lots of rules and you have to be very careful with every move you make. Bottom line is that I am unhappy with PM doc#1, have wanted to switch for quite some time, and this seems like a good time to do so. As I said before, I am not looking for additional pain meds for the neck, unless you count something for nerve pain that I could take on an as needed basis. I will let docs know about each other and will not accept any meds from PM doc#2 until relationship w/ PM doc#1 is terminated.



I do have one last question....scheduled for oral surgery Sept. 3. Not sure which pain doc I will be working with at that point, but whoever it is, I will let them know that my dentist will give me Tylenol #3. I know that is not a strong med, but I'd rather them know about anything stronger than regular tylenol that I am going to take to be safe. I do not want to be accused of breaking the rules of the contract in any way. My question is...last time I had oral surgery (about 4 months ago), I was also given Tylenol #3. It took me nearly a week of phone calls (prior to surgery) to actually get in touch with someone who would help me. All I wanted to do was find out whether it was ok for me to take those meds, and what I needed to do in order to get permission and not break any contract rules. I was attempting to be cautious and play it safe. Eventually the PA called me and said I could take the Tylenol #3 and it was a non-issue. Next time I saw that PA in the clinic, he read my chart and asked me "what other pain med did you take? and who did you talk to about it?" I said "tylenol #3, and you were the one that told me over the phone that it was ok." Turns out, he had never documented our conversation, including the fact that he approved my use of pain meds from the dentist! He then said "Oh, you don't even need to worry about Tylenol #3, it doesn't matter because it's a very weak med." So, what would you all suggest I do for my oral surgery in 3 weeks? I assume it does matter, well, at least it matters to me to have it documented in my chart that I was given permission to take pain meds (no matter how weak they are) from another doctor. I do not want to take any chances that I may be accused of sneaking around or breaking contract rules at some point in the future. I have heard the horror stories about being labeled as a drug seeker or dishonest and how nearly impossible it is to get another PM doctor when you have something like that in your chart. What should I do?


Hope I was able to clear up some of the confusion and not add to it. I appreciate any feedback you have for me. Thanks for listening.
Posted 8/15/2014 3:44 PM (GMT 0)
Registered mail is a letter you write terminating your relationship with DR1,mail it at the post office and tell them you want it registered,that means the mailman hand carries it to someone that has authority to sign for DR and that is what they do,sign a receipt saying it was received!! That way they can never come back on you and say they did not get your letter or call saying you were terminating relationship therefore terminating any and all agreements you have with them.

As for the dental procedure call them ahead of time by days and tell them your having it and this is what you will be given painmed wise and dont forget any anesthesia as it will show up as opiate in your labs. Then the day you have it ask the dentist office to fax a copy to the PM drs office and ask the pharmacy to do likewise. You have then covered every base you could. If they have an issue with you taking it then they have had ample notice to say NO and again twice more when it was faxed from the dental office and the pharmacy.

Remember you can take absolutely no scripts from DR2 until you terminate DR1 or that is a volation of a contract. If you go with DR2 that may mean a return appointment after you run out of meds from 1 and after you send that certified or registered letter.
Posted 8/15/2014 3:52 PM (GMT 0)
Hi Sunny,
I am so sorry about my wording on the neck pain issue, I was just concerned about the referral business. I have gone to docs that tell me I have something wrong that Idid not feel and refer me to a buddy for kickback and I didn't want you to get caught up in one of those things Of course I figured that you could feel the neck pain but was just checking that you didn't get ripped off.
The registered letter I think should be sent by you to #1 after you verbally discharge yourself from his services. Keep a copy for you with the postal receipt and a copy of both for both. You should receive a notice, signed by someone at #1's office showing that they received your letter of discharge. Copies again.
Finish the lower back work as relations with #1 sound pretty sour. My wife is an SSDI disabled CP and has been through this wringer,it stinks. I am a cancer patient so it really doesn't matter what I do, as it's all "Quality of Life" to them. I have written here and on other health sites that qualified CPs, ones who have been a perfect patient contract wise, should be treated like cancer patients are. At our Walgreens they will only dispense 150 Oxycodone 30's to CPs while I can gat as many as are Rx'ed. I don't have a contract nor do I suffer the "Guilty until proven innocent." Humiliation of a UA test monthly.
Posted 8/15/2014 4:02 PM (GMT 0)
It doesn't matter if the pain meds your dentist or any other dr gives you are strong. What matters is that you allow them to give you pain meds/treat you. You really need to be careful because you could end up without any pain dr and it could be very dificult finding another dr to treat your pain, if you could find one at all. It also doesn't matter if you can get a copy of the pain contract. You signed it stating you read it, understood it and agreed to it.
Posted 8/15/2014 4:04 PM (GMT 0)
PS Sunny, when you go in to #1's office to verbally discharge him get him or an NP to give you a signed release on your pain contract. You might also bring in a letter that states you are discharging his office from your medical services. If they get snarky with you just tell them that you are protecting your rights.
Once I was waiting in the surgery prep room with my wife for the surgeon to sign her off before surgery on her rt. shoulder rotator cuff. When he came in he picked up her chart, which he had had for two weeks and noticed that she was Rxed #150 Oxycodone 30 mgs p X m. He then got all huffy and said,'I don't operate on drug addicts!" I had to get in his face and explain the difference between addiction and dependence. He did the operation . . . Unsuccessfully. . . Q
Posted 8/15/2014 4:07 PM (GMT 0)
Thanks Sunny! That cleared up allot of questions! I think if I was you( and I know that I am of a different opinion than allot of the others. But I am not sure that I would even mention anything about your possible new PM doctor! I mean you haven't seen him yet so you haven't broke any contract, and when you do see the new PM doctor, if you decide that you don't like him, then don't accept any medication or treatment from him, and contract wise with your other doctor your still OK! However if you do like the new PM doctor, and want to accept medication and treatment from him, and he accepts you as a new patient, then I would immediately contact your PM Doctor #1 and terminate his services!  No breach of contract, but make sure that your new PM doc #2 knows about your previous PM doctor #1 and his treatment of you! Heck PM Doc #2 might even contact PM #1 and tell him he is taking over your treatment, and terminate your treatment with PM #1 for you!  This is not unheard of, and is no big deal. Just be open and honest with PM doc #2 when you first see him. Until then I don't think I would say any thing to PM#1, as you haven't really any reason to, as you haven't broke any contract with him! Anyway that is the way I see it! Also I would ask PM#2 when you see him the 28th about the pain  medication given for your Dental surgery!

I am saying all this, in light of what you have said, and it seems that you definitely are not happy with your PM doc#1 and it looks like you want to change anyway.   Heck something might happen and your appointment could get canceled or something, and if you have already talked to PM doc #1 he might not be happy about you wanting to change, and not want to treat you!  Doctors are human and they can be petty if they want!  That is why I would just wait to say anything to him till after I had seen PM doc #2. 

You seem to be know what you want, I am sure you will figure out how to do it! Just remember even PM doctors work for YOU, you are their boss, YOU hire them and YOU can fire them! Quincy17 has it right, ""don't let they cow you...........!""

Good Luck to YOU!

White Beard

Posted 8/15/2014 5:12 PM (GMT 0)
Thanks White Beard. I will take your advice and not say anything to doc#1 until I know I have seen and decided to change to doc#2.

I guess when I wrote the original post, it made sense to me, but that's because I already know the whole story. It's hard for me sometimes to explain my situation to others, I feel like in trying to sort of condense a lot of things into a shorter story, I often leave out important details or make it even more complicated than it already is!!

I am thankful that the people on this forum are still willing to listen and offer advice and support, as well as tell me when they don't understand what I mean. I think a lot of people would just look at it, and if they didn't totally understand, just move on to something else. Grateful that is not the situation here.

Very nervous about the new pain doc. I have seen several pain docs over the past 16 years, and haven't found any that I really liked. Praying this new one is good and actually listens and wants to help.

Thanks again everyone.
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