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iSpine Discuss Pain Management-How do you change doctors? in the Main forums forums; I'm trying to get a second opinion on my treatment and options from my pain management doctor. Every time ...

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Old 02-17-2011, 09:27 PM
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Default Pain Management-How do you change doctors?

I'm trying to get a second opinion on my treatment and options from my pain management doctor. Every time I call another pain manager, they put me on hold and come back and tell me to send my records. They will look at them and call me to make an appointment. I had one come back and tell me they only treat acute pain. What does that even mean?

Is this normal? They ask why I need the appointment and when I tell them they say "Uh-huh, well just send your information."

This is the first time I have seen a pain management doctor. Anytime a doctor wants to do a procedue, I would normally get several opinions. Have I been black listed in some way or is there a law that says you can't change PM doctors?

Thanks.
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Old 02-17-2011, 10:57 PM
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Default In my case

I was Worker's Compensation for my low back so I had to have my Nurse Case Manager call the office back after I made the initial call and they had to get the records to the office and then the office would decide if they would see me (this was in CA). I had no problems in CA being seen or switching doctors.

Then I moved to Florida for a year and a half. Before I moved I called numerous PM offices and they all said what you were told "send your records" and I had bought a house in Fla as my Mom was sick at the time and was moving never daring to think it would be a problem to obtain PM care out of state. Out of 200 offices only one PM in Tampa would see me with my CA Worker's Comp and all the rest said "no" many after I sent my records in or my Nurse Case Manager did as they "didn't take CA WC" was the big message.

Eventually the PM in Tampa tried to manipulate me into doing whatever he wanted re PM because he knew no one else would see me and even made a comment to that effect. Fortunately my husband had gotten a new job back in CA so we moved back.

When I returned I just called a PM in San Diego that I wanted to see and his office asked that my Nurse Case Manager call and everything was set up after that. So don't know if your insurance has anything to do with it or if perhaps it might be a good idea to get a referral from your Primary Treating doctor (Primary Care or Orthopedic or Neurologist or Neurosurgeon).

Last edited by Maria; 02-17-2011 at 11:01 PM.
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Old 02-18-2011, 12:29 AM
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Well, I know it can't be the insurance. I got their names off of our provider list after my Internal Med doc gave me the names. I have an appt with him next week and will ask if he can help in any way. I just don't understand why it is so difficult. I'm going to call our insurance tomorrow and talk to them about a case manager. I think they have some kind of program.
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1995 & 2005 L4/5 Discectomy (no disc left)
3/2010 4 Level ACDF C3-7
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Old 02-18-2011, 03:13 AM
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I am in California with no attachments to my treatment . My primary care referred me to a friend of his in pm. Otherwise i could not get into his practice. I really knew nothing of pm before that. I went to see him and he prescribed meds and had me up what i was taking and i felt like a new person in a day and was so happy. WHen he heard who my surgeon was he bluntly said i dont work with him. So some apts were good and some he was not so friendly. Well my spine surgeon always does his own ESI. Apparantly the pm doc was mad at that everytime i reported having any and when i had the thoracic discography and he had not done it that was the last straw. He emailed me a nasty letter. I sent one back (nice one) and then he apoligized. But told me another pm doc who should see me

New doc is associated with my spine surgeon. On my way to my apt like 10 minutes before i get a call from someone at her office. They wanted to know why i thought i could go to 2 docs, or why was he not seeing me anymore. All kinds of questions. It was a strange first meeting. She sounded like she did not like my spine surgeon either and said that is how they make their money and she was going to see if the first doc would take me back.
NIce to feel wanted!!!!
I am still with doctor #2. I am having injections the day after i see her with my spine surgeon and i don't know if i should even mention them.
so i am kind of afraid to change if i heard of someone great. I'd say try to get a referral from a doc as your primary care , seems to go smoother that way.
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2007 ACDF 4-7
2008 hip , knee scope, hip replacement
2009 thoracic T-5 thru T-11fusion
2009 VATS T7-8, posterior only T11-12. removal of thoracic hard wear
2010 lung surgery
2010 T2-L2 kyphosis correction
2010 Kyphoplasty T-3, T-4
2011 Cervical osteotomy ,revision C4-T5
2011 Foot surgery
2011 Revision fusion T7 thru L4/laminectomy
2012 Hammertoe correction left foot
2012 Revision fusion T-12 thru L5
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Old 02-18-2011, 05:50 PM
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I had no problems changing doctors but then again, I didn't give any history over the phone, just made an appointment stating my gp thought I needed a pm.

During first appointment, I gave him my history- end of story.

Now having said that, I'm sure the other shoe will fall because I remember saying the same thing about my US ADR surgery being approved by my ins co only to have the plug pulled with only 1 week to go.


Dale
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Old 02-18-2011, 08:47 PM
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One of my previous CA PM providers did get sort of upset because I chose to get my ESIs with an anesthesiologist that didn't work with the PM practice. My current PM told me outright that's what PMs make their $ off of not the office visits for scripts so the $ is in the injections (ESIs and other).

Now WC no longer authorizes ESIs for me so I'm hoping this PM will continue to see me just for prescription refill. I normally see him every 3 months just for scripts now and I travel several hours to see him as I have a very good rapport with this PM of the last 6 years.

Good luck getting someone to see you. May take a while. I wouldn't want to waste an insurance copay if I were paying out of pocket or my time sending records back so I personally do inquire about the practice and whether the PM prescribes medicines, does injections and so forth. In the past I wouldn't have wanted to go to one that didn't prescribe medicine or do injections (ESIs). Not saying you have to tell your whole history over the phone but in order not to waste your time you might want to ask some routine questions of your own regarding the practice to make sure it's what you're looking for before agreeing to send records. I have usually asked to speak the office manager about this and never had a problem with getting information about the practice.

I got a Nurse Case Manager when my 2nd spine surgery failed and I was deeply depressed and verbalizing some pretty "deep" thoughts/emotions that were "red flags" to bump up my level of care and case management. The insurance companies don't usually pay for a case manager unless it's deemed necessary as it's an added expense to them. Since I decided not to have another surgery after a number of years my Nurse Case Manager was pulled.

Last edited by Maria; 02-18-2011 at 08:53 PM.
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Old 06-07-2012, 08:27 AM
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Default Changing pain doctors---Threats pain doctors use

I had the worst, most frustrating experience, that led me to fire a pain doctor, for many reasons, including his not even trying to treat my neuropathy.
His tactics should be considered or made illegal.
I had gone to this pain doctor's office for over 4 years, and I never once even flunked a surprise drug test.
I was the perfect patient. Always paid on time, etc.
I had been going to his office because I have a serious illness that causes a great deal of physical pain.
Here is my experience from hell.
This happened after my going to his pain office for over 4 years.
In retaliation for my telling his new office manager named Danny (who I never met in person) that I was seeking a second opinion from another doctor, and that I wanted to hire a board certified neurologist to deal with my newly developed neuropathy, the doctor had his office manager threaten to label me in my medical records as a "drug shopper!!!!"
I have a MAJOR, potentially fatal chronic illness that was diagnosed a decade ago.
He had me on opiates.
But the doctor made no attempt to help with the neuropathy, which is not treated with opiates, but with other drugs.
When I went to this guy's pain office, I rarely ever got to see the pain doctor, himself---He was usually never there.
Instead, in my over 4 years of going there, at 98 percent of my monthly visits, I just got passed off onto one his seemingly endless series of ever-changing PAs. They were sometimes unknowledgeable about pain meds. I knew more about opiates than some of the PAs. Because the doctor was trying to make as much money as possible, herding patients in and out, I just mainly saw these inexperienced PA's that were a revolving group of people that would quit or get fired.
The guy just seemed like he wanted to rake in the most money possible.
So they triple booked.
That meant the usual wait to see anyone was around a 45 minute wait. That was annoying enough.
His front office staff girls were inept, and constantly screwing up my appointments. I would make an appointment for a specific date and time. i would show up at that time, and the front office girls would deny I had an appointment!
Yet, I would show them the appointment card that THEY filled out with that time and that date!
This happened on a handful of dates.
Then after a few years, I developed severe neuropathy. One of my other longtime doctors, who is my primary care doctor, mailed the pain doctor a letter, stating I now have neuropathy, and could he please treat me for it.
I then called the pain doctor's office, mentioning the letter that my other doctor said he sent to their doctor, and I then begged to see the pain doctor (not a PA) for help me with this painful neuropathy.
I showed up on the designated time and day of the appointment to see the pain doctor about it. But when I got there, they sent me to see a PA instead. I told the PA that I was there to see the real doctor, I wanted to see him about my neuropathy, I had made an appointment to see him, and I told the PA about the letter to him from my primary care doctor.
The PA left the room, and I could immediately hear the pain doctor in the hallway, going off that I did not have an appointment to see him, and why in the HELL was I there at his office?
I went out in the hallway, and I explained to the doctor that my primary care doctor had sent him a letter about my neuropathy, and that I had made an appointment to see him, and that this was the appointment's time and date.
As it turned out, the inept front staff never bothered to tell the doctor about the letter, or give it to him.
Nor did they bother to tell him I had an appointment scheduled with him.
No one there could even find the letter my primary care doctor had written to him about my neuropathy.
Frustrated, in front of the pain doctor, I grabbed my file, and I sifted through it, and I found the letter---just arbitrarily stuck in the middle of the over 4 years worth of paperwork in my file!
The pain doctor then gave me a shot for my neuropathy that was worthless, and he said for me to make an appointment to get another shot from him in 2 weeks.
He said his PA's don't give the shots. It has to be HE who gives it.
It was just some lidocaine type shot, and not an opiate, or any major drug.
So I did as the pain doctor told me to do, and I kept calling his office, begging for a follow-up appointment. The weeks and months went by, and I couldn't get an appointment with the doctor.
I was suffering, in so much pain from the neuropathy.
"He's booked up, he's booked up."
Meanwhile, I was really suffering from the pain of it.
Not only did I need to be treated for the neuropathy, but I also needed to be diagnosed for the neuropathy---meaning, I needed to find out the cause of it, why do I have it at such a young age, etc.
So after suffering for weeks of neuropathic pain, unable to get to see the pain doctor to get the follow up shot or talk to him, I finally made a consult appointment with another pain doctor/neurologist.
Then I called the old pain doctor's brand new office manager named Danny that I was going to see another doctor, just to deal with my neuropathy problem.
The office manager Danny said that if I did, I would be "violating the contract" and that I would be "doctor shopping."
I told him the whole story, that I had been trying to see the doctor for 4 months, and I had a right to treatment for my neuropathy, it had been going on long enough, I was physically suffering from it, and I had a right to a second opinion.
And I had a right to be treated.
This Danny guy then kept calling me on the phone, harassing me, saying that he talked to the doctor, and that the doctor said that if I see another doctor, he is going to put it in my medical records I am "shopping for drugs."
So not only was I being threatened for seeking a second opinion, and trying to get help for my painful neuropathy, but I was being LIABELED medically, in revenge, falsely accused of being a doctor shopper!
I said, "Look, I have a right to a second opinion."
The office manager kept threatening that he told the doctor I was doctor shopping.
I called the office repeatedly.
No one would allow me to speak to the doctor.
So when I came to my next pain appointment, they had a brand new PA for me to see (the previous one had now quit, too), so yet again I would not be seeing the doctor. So I would STILL not get help for my neuropathy.
Meanwhile, the Danny guy kept threatening me, of these dire consequences if I get a second opinion from another doctor.
Plus, he said they would cold turkey me from 4 years of opiates!!!!!
It gets worse.
The new PA, who didn't even know me, said he talked to the Danny office manager, and that he would now no longer give me my regular opiate pain pills. I asked him why he was switching my pain drug after 4 years, and he said, "These have less street value if you sell them," as if I was a dope dealer.
I was SO enraged by this, I never went back.
Pain doctors that use the tactic of labeling you as "doctor shopping," a drug dealer, and who threaten you as a patient, and that threaten to dangerously cold turkey you off your opiates if you want a second medical opinion (especially when they are not even treating you for a new condition, and they just pass you on to PA's that are inexperienced in pain management) should be investigated.
This doctor was just running a drug mill.
I took only ONE of the new pills the new clueless PA put me on, and I literally immediately blacked out for 24 hours!
I missed a day of work!
I was out cold for 24 hours! He overdosed me on that pill. And the idiot PA put on the pill bottle instructions that I was supposed to take TWO of these pills a DAY!!!!
I knew would have likely been dead if I followed his inept instructions.
I never took another one of those pills, and I never went back again.
But I am sure it is in my records, all this false accusation of doctor shopping, as revenge for going to another doctor.
I have not requested my records from that doctor, because I am afraid I would be too upset seeing the lies in them.
One day if I ever have time, I am going to report this place to the medical board.
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Old 06-08-2012, 05:33 AM
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Im going through this too, after almost 9 years with the same pill pusher it's time to move on. He's an internist and I need a pain manager. I've found a pain management doctor on the NJ DHSS registry and I keep telling my lawyer to make the insurance co. send me there. I have to find a doctor soon before I run out of pills. My old one wont see me anymore (long story). I take alot of Roxicodone (90mg every 3 hours) Exalgo & Lyrica and I have enough to hold me for a while but they better hurry up! Nobody does anything quick unless there's $$$ involved. I'll call the lawyers again tomorrow. What a pain in the back, leg, hip, and ass.
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Old 06-08-2012, 04:39 PM
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I feel your pain. I once a few years ago was fired by my pain management doctor. He never liked my spine surgeon and told me at the first appointment that he works closely with spine surgeons . When he asked who mine was he said "I don't work with him" so rocky start, things got OK and then one day when i had discography with another doc, he fired me , told me he couldn't treat me anymore.
Fortunately my spine surgeon found me a new pain management doctor right away.
But i did have a few weeks of panic wondering if i would have to endure pain without medication for a while.

Good luck to you in finding a new doctor
judy
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2007 ACDF 4-7
2008 hip , knee scope, hip replacement
2009 thoracic T-5 thru T-11fusion
2009 VATS T7-8, posterior only T11-12. removal of thoracic hard wear
2010 lung surgery
2010 T2-L2 kyphosis correction
2010 Kyphoplasty T-3, T-4
2011 Cervical osteotomy ,revision C4-T5
2011 Foot surgery
2011 Revision fusion T7 thru L4/laminectomy
2012 Hammertoe correction left foot
2012 Revision fusion T-12 thru L5
2012 Revision fusion L4-L5
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Old 06-08-2012, 07:02 PM
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Wow! I think that most of us who are chronic pain patients for a substantial length of time could write a book. I alreay have a title and I've asked my pain management doctor about making a presentation to his staff. It's called, "the indignities of being a chronic pain patient".

Having said that... Lisa, your story is really bad. There is no excuse for this type of treatment. I would consider writing the doctor a letter that expresses your concerns BRIEFLY. But, the letter would contain the threats and the fact that they changed your medications WITHOUT YOU HAVING A DISCUSSION WITH YOUR DOCTOR, and for no medical reason; seemingly in retaliation for the offence of insisting on seeing the doctor and for talking about seeking a second opinion.

If you have a change in symptoms and there is no doctor to consider the new symptoms and diagnose them appropriately, that is dangerous. It's possible that the new symptoms could be related to a problem separate from your source of chronic pain. (eg. diabetic neuropathy?)

Good luck... please keep us posted. If you don't get any appropriate response, I would switch to a new doctor AND file a complaint with the state medical board.

All the best,

Mark

PS... Eddie, IMHO we should be with a pain management doc when we get into the mode of maintenance meds instead of investigating procedure options. The only problem is that they are skewed to meds and procedure and don't have enough 'balance'. We are all in such a tough spot.
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