Monday, March 16, 2015

The Culture of Pain

Chronic pain is an issue I feel pretty passionate about. Aside from a debilitating back injury I received in a 2002 car accident, my body is now wracked with arthritis in all my major joints. I've already had one total knee replacement and am due for another. So yes--I deal with pain every single day, and I do my best with the cards I've been dealt. No matter how bad my pain gets (and some days it's very bad), I try to keep in mind that there are a whole heck of a lot of other people out there whose daily battle with pain is far, far worse than mine. So no--I'm not lying on my couch, eating bonbons and watching soap operas and whining about poor little me with enough metal in my back and knee that I have to carry a special ID listing all my titanium if I have to go through any kind of security checkpoint. I have fairly ambitious physical plans for this spring and summer that will hopefully result in me being able to walk at least 2-3 blocks, which is something I've not been able to do for a couple of years now. 

Today was my bimonthly appointment with my pain management physician. If you're not a chronic pain patient, you may not know that we have to sign a 'pain contract' with the doctor who prescribes our pain medication. The contract is usually pretty standard--can't get pain meds prescribed by another doctor, random urine testing and pill counts, can't get refills for 'lost' or legitimately lost medication, etc etc--all of which I've signed without blinking. Makes sense to me on all levels, especially with malpractice issues, the potential of accidental or intentional overdoses of narcotic medication, and the plethora of pill mills like this one in east Tennessee that was busted recently and included a former police chief on the arrest list. 

But understanding a physician's need to not only protect himself legally and to effectively monitor pain management programs for his patients doesn't make the life of a chronic pain patient any easier. For example, unless a bone is protruding from my skin, I'm not going to go to the emergency room if I hurt my back worse than it already is. Especially not the *insert name here* Medical Center in this town. Why? Because even though all my medical records are available instantly via the computer network that links all medical facilities in the area, if I go to the ER complaining of pain, I am treated like I am a drug addict looking for her next fix. Seriously. It's a humiliating exercise in futility, so why even bother? A friend of ours who is also a pain patient went to the ER with a serious illness, and they assumed he had overdosed on his pain meds and pumped his stomach! And God forbid your slow-release pain medication is something like methadone, as both our friend and myself are. Pain patients take minuscule doses of methadone--as in as little as 2.5 mg per dose up to 8 or 10, whereas addicts using methadone for withdrawal will take four to sixteen times as much. And yet, chronic pain patients are treated as if they are just like those recovering addicts, sometimes before they are even evaluated for new injury or illness. 

The reason I'm with the pain management doctor I'm with right now, despite the fact that his office is an hour away, is because at my first appointment with him three years ago he sat down with my husband and I and said--and this is a word for word direct quote--"You are not an addict and should not be treated that way. You have a serious pain issue, and as your pain medication physician I must respect that as I try to find a way to alleviate it." 

Hard not to like a doctor who talks to you like that. No condescension, none of the holier-than-thou aren't-you-exaggerating tone. Even harder to find a pain management physician who thinks that way. Although he's an immensely busy young doctor with a full practice, he still takes the time to sit down with me every single appointment and find out what's been going on since the last time I was there.  So singing his pain contract was no big deal for me--it was standard, and he knows I'm not the kind of patient to violate it. 

So back to today. 

Today, there was an addendum to the contract that absolutely blew my mind. The addendum is a warning that if a patient is loud, aggressive, threatening, or abusive to anyone on the practice's staff, they will be 'fired' as a patient. 

Wait a second. 



The situation I related above is 100% accurate--not just in Ohio, but in a lot of states--and understandably so. Even though it's a pain in the wazoo if you do something stupid like I did once and accidentally knock five days' worth of pain meds into the toilet, a pain contract spells out the requirements for a mutually respectful and positive relationship between the doctor and the patient. And as chronic pain patients, we NEED that respectful and positive relationship with our pain management doctors, nurses, and staff. 

So exactly how stupid do you have to be to jeopardize all that by yelling at the staff, bullying the physician's assistants, or cussing out the young lady who answers the phone and makes appointments? Apparently pretty darn stupid, and evidently there are a lot of those stupid people who seem to think they are entitled to their physician's time and attention. When I knocked my pills into the toilet, consigning myself to multiple days with no medication on hand, I didn't call my doctor's office and scream at his assistant, or bully his nurse, or demand that he drop what he was doing and write me a prescription to replace what I lost. It wasn't his fault that I'm a clumsy idiot. Nor was it his problem to solve. Instead of demanding replacement drugs, I called his office and asked to speak to a nurse, calmly informed her of what had happened (due to those random pill counts that contractually they are entitled to ask for), and calmly asked her for advice on how to deal with those medication-free days--what might help, what to avoid, what OTC medication would prove effective. 

Yes, a lot of chronic pain patients resent the culture that's grown up around our medical care. Yes, we have to jump through a lot of hoops in order to get the treatment we need just to get through the day--and no pain medication or regimen eliminates chronic pain, believe me. But we also have to remember why things are the way they are--the "patients" who were pill shopping, seeing multiple doctors and getting multiple prescriptions for narcotics, selling the pills for profit, going to pill mills, lying about the severity of their pain and going to the ER for a pain shot on a weekly basis, "losing" their prescriptions and asking for replacements. THOSE people are the reason I can't go to the ER when my back is so seized up that I cannot sit or stand for assistance. THOSE people are the reason why I have to sign a contract with a physician I trust and who has no reason to distrust me. 

And one thing I know for damn sure--I'm not going to be such an idiot, such an ungrateful asshat, that I'm going to abuse the people who are doing everything they can to HELP me. When I was tending bar, I occasionally had to let people know that they were not entitled to be served alcohol at my bar. Drinking was a privilege, and not a right. As patients with an ongoing medical problem, we are entitled to health care and we get that from our pain management doctors. However, we are NOT entitled to anything above and beyond what that doctor has already prescribed for us. We are NOT entitled to act like jackasses and bully that doctor and the caregivers in their practice. We are NOT entitled to anything other than what is laid out in our pain contracts, and to jeopardize that by being abusive makes absolutely no sense whatsoever.

You'd think that adults would be capable of realizing that without being told. But since some cannot seem to figure that out on their own, another layer of contractual responsibility has been laid down upon the rest of us. Once again, medical care for chronic pain patients like myself is being impacted by people who don't know how to act. Our physician is one man, dealing with hundreds of patients, and the rules have to be the same for everyone. No exceptions.

I don't blame my doctor for adding that stipulation to the pain contract he requires his patients to sign. Not one bit. I'm just shocked that it was necessary to do that at all.

Thanks, ungrateful and abusive asshats. Thanks for your ridiculously idiotic behavior and choices.

...I can't wait until you're fired...