A new patient named Vicky came to see me. She was pretty desperate. She had fallen down a flight of stairs a month ago, breaking her collarbone, several ribs and her pelvis.
Prior to falling, she was in chronic pain from degenerative disc disease and fibromyalgia. She has multiple other medical problems. Vicky spent three weeks in the hospital and a week in a nursing home after this fall. When she was discharged she was referred to a pain management doctor in our town.
Given that Vicky was on a large amount of pain medications prior to the fall, it was a bit surprising to me that the she was given a low dose fentanyl patch and no medication for breakthrough pain.
Within 10 days she appeared in my clinic in agony. Her previous provider had retired right around the time of the fall, so it seemed to make sense to the hospital doctors that Vicky should be referred to pain management.
Based on the amount of medication she was on prior to her fall, the fractures and surgical repair of her clavicle — one can tell that she would fail on the low dose patch she was given.
When I prescribed a narcotic pain pill for her to take for breakthrough pain, her pharmacist immediately told her she would be fired from the pain doctor’s practice. Apparently they communicate quite closely.
This patient had such high complexity and I’m so overwhelmed by an influx of patients in similar circumstances that I told Vicky I could not manage her pain since she already has a pain doctor. She was tearful and disappointed, but she tried to go back to that pain doctor and indeed she had been fired. So she returned to me. She was quite concerned what she should do next. I told her I would do my best to help, and I called her pain doctor.
Here’s how it went:
“Hello Doctor, this is Dr. Ibsen and I’m taking care of Vicky a patient who was recently in the hospital. I’m sure you’re familiar with her. She’s in a lot of pain and it seems like her pain is more acute and chronic. I’m wondering if you would take her back at a higher pain medication dose since the medication she was on was not covering her pain?”
“If I work very hard to stabilize her pain and got her on an actual stabilized pain regime, would you be willing to take her back then?”
“Probably not. She violated her pain contract. She has a long history of narcotic use. (Her previous doctor) was giving her 224 tablets a month of hydrocodone, which in my mind is inappropriate.”
“So you saw her once and determined what her pain needs might be based on your own formula and since she did not follow that she’s now fired?”
That’s it, that’s how the conversation went. A lady with multiple complex medical and physical problems is referred to a doctor to manage her pain. He sees her once and then fires her.
Words cannot fully describe how embarrassed I am to be colleagues with someone who could treat a patient in pain so callously and heartlessly.
What has happened to this honored profession I have been a member of since 1980?
I must admit I’ve been pretty depressed lately about the prospect of going to work seeing patient after patient with high complexity chronic pain issues coming to see me because their doctor has dropped them. Well, just for today, my depression is better — only because my anger and outrage are off the charts.
I don’t know what to do. I don’t know who can help me or these patients, but it sure seems like an epidemic in my world. If I was seeing 50 influenza patients a week it would be an epidemic and it would be newsworthy. If I was seeing 50 cases of gonorrhea a week it would be kept secret of course, especially since the legislature is in town. But given that these 50 pain patients I see each week don’t have a “communicable disease” the state epidemiology lab cannot help me. My state medical society has been pretty slow in taking this issue on.
I’m kind of at my wits end. I’ve tried to interest local and national news outlets. I don’t really know what can be done to create the response to this ongoing tragedy that I feel is required. Perhaps the same kind of infomercial shown in the early morning about starving African babies could be shown about Americans being tortured.
Harm is being done. Great harm to vulnerable people who have a difficult time advocating for themselves due to the severity of their pain and the disempowering nature of their circumstances.
I guess all I can do is keep sounding the alarm.
Editor’s note: Mark Ibsen, MD, is the owner of an Urgent Care Plus clinic in Helena, Montana. In a previous column, Dr. Ibsen wrote about the many pain patients he was seeing who were unable to find doctors willing to treat them.
Dr. Ibsen is currently being prosecuted by the Montana Board of Medical Examiners for over-prescribing narcotic pain medications and keeping substandard medical records. A decision by the board on whether to revoke his medical license is expected soon.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.