EMSGuy1982 Posted October 2, 2016 Share Posted October 2, 2016 Interesting article. A well known pain management conglomerate was shut down due to over prescribing which resulted in deaths, leaving thousands without their prescription. It's a pretty inflammatory article that looks to paint a picture that we as providers are heartless. Perhaps it's time to hand out the CDCs recommendations on opiates? This problem isnt going anywhere for awhile. http://komonews.com/news/local/patients-flood-ers-hospitals-after-pain-clinics-shutdown Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 2, 2016 Administrator Share Posted October 2, 2016 My practice has absorbed a few, probably 10, from Seattle Pain, although I've only seen 3 myself. The big deal there isn't that no one does pain management, it's that no one who does pain management takes medicaid. Seattle Pain made it profitable by charging for UDS every visit and then ignoring the results. It's probably not possible to treat medicaid patients for pain in a non-money-losing manner, which I suspect is why no one NOT engaged in rampant fraud even tries. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 2, 2016 Share Posted October 2, 2016 I am east of the Cascades. The Seattle Pain Clinic was in the building next door to us. The police were there frequently. Their patients quite literally spent a lot of time jonesing in our front stoop waiting for them to open some days. My outside look into their fish bowl showed a lot of folks on a lot of drugs with little "therapy" or coping skills. I agree with Rev. NO ONE takes Medicaid and certainly not pain mgmt. I haven't looked up the stats lately but about 2 years ago the East Side of Washington had ZERO board certified pain mgmt specialists and those who proclaimed pain mgmt were often FPs and one physiatrist "dabbling" in pain mgmt. Seattle Pain Clinic was shiny and supposedly board certified. That didn't get them very far. In my practice a few years ago we had options of consulting by phone with Dr. Tauben at UW Pain but that was cumbersome and often not helpful. The pain guidelines mention biofeedback, psychology, PT, Massage, acupuncture and all the other necessary co-therapies. We don't have those in great number AND state insurance just flat won't cover it. No coverage for biofeedback, forget acupuncture. Psychiatry or psychology - might as well start growing a horn - it would be easier. We don't have enough and those we have will not take ANY form of subsidized insurance plans. We have SIX board certified psychiatrists for a population center of close to 750000 people. And we draw patients from 4 more states due to our locale. The shortages are painful. Not enough rheumatologists, neurologists, physiatrists, psychiatrists and nowhere near enough psychologists. The one physiatrist has a waiting list for Molina patients. He takes ONE A MONTH. He is scheduling into April 2017. He says he cannot afford to see these folks and nothing is covered. He loses money every time one walks into his office. We, as a society, somehow created this idea that there was some guarantee of a PAIN FREE life and folks started handing out copious numbers of dangerous pills that don't work long term and never developed an exit strategy - didn't even mention an exit to patients 95% of the time. We have only seen 3-4 patients and would only take those who have already been seen in our practice. We simply do not have room for these folks in a 35 year old practice with nearly 10000 patients on paper. We don't have the staff to handle them. One that we did see if on close to 180 MED of narcs AND tricyclics AND benzos AND sleep aids. We told her she had options and had to choose. We would systematically wean her off in 6 months - zero controlled substances - OR - she could find someone else to take care of her. She is scared and exhausted and stoned. She wants off but is terrified of pain and dysfunction. She might work with us. One other - we gave those options and he bolted. A reminder to those of us in Washington dealing with these folks. The Prescription Monitoring Program does NOT reflect ANY meds from Air Force bases or VA government dispensaries. They don't play with the state and don't report. Thankfully, my patient brought in his bottle and has actually logged EVERY PILL he has taken in the past 3 years and is taking so little it shouldn't even count in my opinion. I lucked out and am grateful for this nice smart guy. Clinics like these make us all look bad. Bad medicine, bad business, bad ethics, bad idea..... I hope these folks can get clean and get real help. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 2, 2016 Administrator Share Posted October 2, 2016 A reminder to those of us in Washington dealing with these folks. The Prescription Monitoring Program does NOT reflect ANY meds from Air Force bases or VA government dispensaries. They don't play with the state and don't report. Actually, the VA started playing ball. I know this because as I was firing one patient for getting narcotics from us and the VA (which I saw on the PMP report), he complained that they just sent him pain medicine for no good reason. Military, however... Yeah, they still don't play ball. Never seen a Madigan Rx in ANY PMP query. Link to comment Share on other sites More sharing options...
BruceBanner Posted October 3, 2016 Share Posted October 3, 2016 When I was in school I thought "pain management" sounded kind of cool....like the cutting-edge science of relieving people's pain. Now I realize it's just legal addiction facilitation/management. Couldn't pay me enough to do it. I'm not even sure I'd do it if someone offered to pay off all my loans. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 3, 2016 Share Posted October 3, 2016 These folks abandoned by Seattle Pain are in a unique and hopefully not repeated situation. They have perceived pain - not sure what workup has been done. They have become habituated - addicted, whatever term - to meds that have dangerous implications. We have still failed to educate the public about pain and perceptions and life. It still pains me to try to help folks understand that sometimes pain is pain and we don't have a 100% specific known cause and certainly not a cure. We have somehow messed up a few generations regarding self responsibility, self reliance, reality and expectations. Folks don't even use a thermometer or try OTC cold remedies before presenting for the unneeded antibiotic. I would like to see WSMA, MQAC, health departments and ultimately the AMA take on a campaign of patient education for these issues and support those of us practicing who do follow guidelines and adhere to safety instead of waiting for disaster and then trying to backtrack and fix a giant mess. I know - pipe dreams - but, a girl can dream....................... Now, back to my regularly scheduled Monday. Link to comment Share on other sites More sharing options...
CAAdmission Posted October 3, 2016 Share Posted October 3, 2016 We have still failed to educate the public about pain and perceptions and life. It still pains me to try to help folks understand that sometimes pain is pain and we don't have a 100% specific known cause and certainly not a cure. Wiser words have seldom been said. "Candyman" docs have made life hard for conscientious practitioners. Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 3, 2016 Moderator Share Posted October 3, 2016 Wiser words have seldom been said. "Candyman" docs have made life hard for conscientious practitioners. and honestly I feel they should be held accountable for their actions "first do no harm" you violate that willingly for $$ then you deserve your punishment.... Link to comment Share on other sites More sharing options...
EMSGuy1982 Posted October 3, 2016 Author Share Posted October 3, 2016 When I was in school I thought "pain management" sounded kind of cool....like the cutting-edge science of relieving people's pain. Now I realize it's just legal addiction facilitation/management. Couldn't pay me enough to do it. I'm not even sure I'd do it if someone offered to pay off all my loans. I had the same thought about addiction medicine. That is until I completed my last rotation in it... Their claim to fame was "integrated" medicine. It was painfully obvious that it was nothing of the sort. Unfortunately on the other side of pain management is this addiction medicine which is in business for the same reason the Seattle Pain Clinic was. For $$$$. In my opinion if you can get someone in a 7 day detox do it. Then give them their Vivitrol injection and it can change their life! (As long ass they keep getting them) Suboxone is just a replacement, although it's slightly better than methadone. Link to comment Share on other sites More sharing options...
EMSGuy1982 Posted October 3, 2016 Author Share Posted October 3, 2016 Actually, the VA started playing ball. I know this because as I was firing one patient for getting narcotics from us and the VA (which I saw on the PMP report), he complained that they just sent him pain medicine for no good reason. Military, however... Yeah, they still don't play ball. Never seen a Madigan Rx in ANY PMP query. Did not know this about the PMP. I think it's a great tool, especially working in UC where most folks come in "shopping". Some providers don't see it as a useful tool and believe it it takes up to much time.... (Insert prolonged blank stare) Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 3, 2016 Administrator Share Posted October 3, 2016 Some providers don't see it as a useful tool and believe it it takes up to much time.... (Insert prolonged blank stare) You can tell which ones. They're the 12th or 15th docs who have RX'ed controlled substances for the patient in the last year... Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted October 4, 2016 Moderator Share Posted October 4, 2016 and honestly I feel they should be held accountable for their actions "first do no harm" you violate that willingly for $$ then you deserve your punishment.... Couldn't agree more. Until drug overdose is no longer the leading cause of accidental death, I'm all in favor of aggressive policing of loose and/or unsafe prescribing habits of licensed providers Link to comment Share on other sites More sharing options...
CAAdmission Posted October 4, 2016 Share Posted October 4, 2016 Medicine needs to do a better job managing expectations. For some reason the general public has a sci-fi like idea that everyone has a right to live an idyllic life completely free of any pain, anxiety, depression, etc. It's been my experience that things don't work like that. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 4, 2016 Share Posted October 4, 2016 I had the hardest time yesterday with this anxiety patient who described her horribly complicated and "busy" life and how it stressed her. It was unbelievably hard not to tell her to "take a number" and we are all in her situation. Harder not to outright laugh at her based on some of what she said stressed her. Crap I deal with day in and day out and so does everyone else. I know people cope differently but I do not believe better living through chemistry should numb one of having to deal with life. Thus, big girl panties. Dispense 7 pair. Sig - wear daily, wash often Link to comment Share on other sites More sharing options...
sk732 Posted October 5, 2016 Share Posted October 5, 2016 Medicine needs to do a better job managing expectations. For some reason the general public has a sci-fi like idea that everyone has a right to live an idyllic life completely free of any pain, anxiety, depression, etc. It's been my experience that things don't work like that. We need to do more reality TV medicine shows, but do it like "he Night Shift", with timings, showing how long things take to get done...like lab work for instance. Or having to wait in the queue for an XRay or CT (despite what our Chief of Staff, who's a radiologist, says, ER patients often get bumped by the patients that have booked appointments for scans - not unusual to be NPO for 8 hours prior to arrival and then having to wait NPO for another 8 waiting for a CT in my facility). Even better - getting a good look at the faces of the people waiting 8 hours in the department with a cold and getting told they have a cold not getting antibiotics for same. Maybe that might help... SK Link to comment Share on other sites More sharing options...
SHU-CH Posted October 5, 2016 Share Posted October 5, 2016 We need to do more reality TV medicine shows, but do it like "he Night Shift", with timings, showing how long things take to get done...like lab work for instance. Or having to wait in the queue for an XRay or CT (despite what our Chief of Staff, who's a radiologist, says, ER patients often get bumped by the patients that have booked appointments for scans - not unusual to be NPO for 8 hours prior to arrival and then having to wait NPO for another 8 waiting for a CT in my facility). Even better - getting a good look at the faces of the people waiting 8 hours in the department with a cold and getting told they have a cold not getting antibiotics for same. Maybe that might help... SK If only we didn't function in a world governed by Press-Ganey surveys... Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted October 5, 2016 Moderator Share Posted October 5, 2016 Even better - getting a good look at the faces of the people waiting 8 hours in the department with a cold and getting told they have a cold not getting antibiotics for same. Maybe that might help... SK That's called a "therapeutic wait" Link to comment Share on other sites More sharing options...
EMSGuy1982 Posted October 5, 2016 Author Share Posted October 5, 2016 That's called a "therapeutic wait" I've been waiting for years for the FDA re-approval for Normalzine (comes in a nice 10cc flush). This drug was around for awhile in prehospital(street) medicine. Perfect as a combination with the therapeutic wait. I've heard it cures all colds/cough/malingering/opiate withdraw symptoms. I've seen some good patient outcomes happen with the therapeutic wait.. Ethics Smethics.. Link to comment Share on other sites More sharing options...
SHU-CH Posted October 5, 2016 Share Posted October 5, 2016 I've been waiting for years for the FDA re-approval for Normalzine (comes in a nice 10cc flush). This drug was around for awhile in prehospital(street) medicine. Perfect as a combination with the therapeutic wait. I've heard it cures all colds/cough/malingering/opiate withdraw symptoms. I've seen some good patient outcomes happen with the therapeutic wait.. Ethics Smethics.. I bet Cebocap was a blessing in the days before the internet. Link to comment Share on other sites More sharing options...
EMSGuy1982 Posted October 5, 2016 Author Share Posted October 5, 2016 I bet Cebocap was a blessing in the days before the internet. Just rename it Debocap.. people take anything that starts with the letter D. Link to comment Share on other sites More sharing options...
sk732 Posted October 6, 2016 Share Posted October 6, 2016 I've been waiting for years for the FDA re-approval for Normalzine (comes in a nice 10cc flush). This drug was around for awhile in prehospital(street) medicine. Perfect as a combination with the therapeutic wait. I've heard it cures all colds/cough/malingering/opiate withdraw symptoms. I've seen some good patient outcomes happen with the therapeutic wait.. Ethics Smethics.. Tincture of Time is still treatment... SK Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 8, 2016 Share Posted October 8, 2016 There is movement next door at Seattle Pain and they aren't moving out........... A receptionist came over and told our front desk that they expect to be back open by the end of the month. This is confusing. I don't know if they are opening as Seattle Pain or another business name and venture. Either way - not entirely welcome if they are bringing back the same staff and mode of operation............................. Link to comment Share on other sites More sharing options...
LoRezSkyline Posted October 8, 2016 Share Posted October 8, 2016 An aside, but for anyone looking for a fascinating read/listen laying out all the factors that brought us to this place - check out "Dreamland" by Sam Quinones. https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521/ref=sr_1_1?s=books&ie=UTF8&qid=1475887947&sr=1-1&keywords=dreamland It ties together the hollowing out of America's heartland, the rise of disability & Medicaid, the initial shift towards opiates being seen as "safe" and "non-addictive," Oxycontin's debut as a blockbuster drug and all the lies that accompanied it - and last but not least, the wave of cheap black tar Mexican heroin that followed. It gets a little redundant by the end (I listened to it via Audible) but it's well worth your time regardless as some of his points deserve to be driven home. So many lives destroyed, lost, down the tubes - it's just too much to comprehend by the end. I'm off to check "Hillbilly Elegy" by J.D. Vance next, which I've heard is equally good... https://www.amazon.com/Hillbilly-Elegy-Memoir-Family-Culture/dp/0062300547/ref=sr_1_1?s=books&ie=UTF8&qid=1475888519&sr=1-1&keywords=hillbilly+elegy Link to comment Share on other sites More sharing options...
8404PA Posted October 8, 2016 Share Posted October 8, 2016 Good read for me as a didactic student. Do you guys feel any pressure from the powers that be and the authorities to prescribe copiously? I had a MD undergrad professor rant about how the AMA rides them if they don't prescribe enough, presumably to fill the pockets of big pharma Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
Reality Check 2 Posted October 8, 2016 Share Posted October 8, 2016 I think the tides are turning on the opiate process and it is now frowned upon to be The Candy Man and certainly if your patients die from your rx meds. Most pain folks get generic meds, especially if on state insurance. The newest brand narcs are not cheap and hardly covered by a lot of insurances since morphine, hydrocodone, oxycodone and even methadone are generic. My last foray in corporate medicine stressed being frugal and managing as few narc patients as possible due to their time intensity and potential for aberrant behavior. They aren't profitable and aren't considered good for Press Ganey. But if you "serve" just enough chronic pain pts as a corporate entity - You can tell the public you are generous to your community. So, my take - less and less pressure to take and see chronic pain pts and more folks standing up for their individual licenses and ethics. Pain is real and needs treatment - hard to find a middle safe ground. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.