Wednesday, September 16, 2009

Making the Most of Your Pain Clinic Appointment

In our area and I suspect even in areas with better funded healthcare systems there is a shortage of people willing to deal with chronic pain and consequently a long wait list for new appointments. As one of the docs who does see new patients it appalls me at how patients waste theirs and my time when they finally do actually get an appointment.

Here are some suggestions.

1. Just because I can't charge you for your missed appointment doesn't mean I'm not pissed off. (That doesn't make sense of course I am pissed off.) Not just at the consult fee I am out. Just about every week I deal with a sob story from a family doctor or patient advocate and I have to try to figure out how to fit the latest sad story of the week into an appointment. So when you miss your appointment, someone else didn't get an appointment.

2. If you are late for your appointment, I may not be able to see you. If I do see you don't be surprised if I am in a hurry. Try being late for the bank or the airlines.

3. Your medical records are your property. While it would be nice that your family doctor sent all the relevant records with his referral; this usually doesn't happen. If you bring them in yourself I will actually have them to peruse. If you bring in a huge binder however, I will try to read them but much later.

4. There are about 200 types of yellow pills. I can't guess which one you are on or were on. Your pharmacy can give you a print-out of everything you've been on in the last few years. It would however be nice to know what didn't work, what gave you side effects etc.

5. Please don't call all the doctors, you have seen in the past, idiots. The first thing I think about when I hear this is how you are going to be calling me an idiot in six months.

6. Your WCB or Disability Claim may be really important to you. All I can go is send them a copy of my consultation. The semi-retired antiquarian doctor who is responsible for your disability/WCB file has already made up his mind. The best advice I can give you is to forget about it and get on with your life. If that isn't possible you need to see a lawyer.

7. It's not possible to be allergic to anti-depressants as a class. That is like saying because you are allergic to broccoli, that you can't have tomatoes.

8. Try and figure out what your goals are. Then think how realistic those goals are. Then try and figure out what your goals are again. Your family doctor may have some goals for you as well. They may not be what you have in mind. Try and discuss this before your pain clinic appointment.

9. Just about everything I will prescribe for you and everything everybody else has prescribed for you in the past has side effects. What you need to do is weigh how bad your pain is and whether you are going to put up with the side effects.

10. Even in the unlikely situation where I actually have all your records, I may want to ask you all the questions again. It's called getting a fresh perspective. Don't keep telling me, "its all in the chart".

11. I realize medication is expensive. Don't complain about the cost of the medication I prescribed unless you: Don't smoke; Don't drink bottled water; Don't own a cell phone better than mine.

12. If your last three MRIs were normal, I am not going to order another one. In fact in 16 years treating chronic pain patients I am still waiting for an MRI that actually helped me with my diagnosis and treatment.

13. I am not going to write a letter to authorize out of country treatment by the doctor you found on the internet.

14. Please don't bring in forms to be filled out at your first visit. These forms are legal documents, I need to get to know you before I can fill them out. Please don't expect me to lie on the forms. I could face professional discipline or your insurer could sue me. When you get turned down please don't blame it on me; what you think is disabled and what insurers think is disabled are two entirely different conditions.

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