One of the frequent problems pain patients share with me is conflicts with their pain physicians. Neither the pain patient nor the physician wants conflicts and most can be understood and avoided.

 

There are two things to know first about your doctor:

1) Forty percent of my practice at one time was physicians and their families. I have learned that physicians are like most pain patients they are caretakers who externalize the source of their self-concept (not pathology, just learned behavior). In other words, they are just smart humans who want to help and strongly consider the results of their efforts as an indication of their value.

2) Pain physicians write large quantities of schedule 2 drugs (opiates); therefore, they come under strict scrutiny of the Drug Enforcement Agency, a federal government agency mandated to control the distribution of drugs. Pain physicians must justify to the DEA any change in scripts and demonstrate due diligence in ruling out drug addicts (they do get them). Their license to treat is therefore always on the line.

So here are six do’s and don’ts about talking to your pain physician:

1) Always begin by telling the doctor something that went well. Reason: pain patients were rated “worst patient to treat” according to a large multi-hospital outpatient survey. Why? They never get cured! Remember doctors want to help; therefore, they can get “burned out” on someone who never has anything positive to share or never makes any progress.

2) Never start out by telling the doctor your pain is over a 7 on a 0 to 10 scale. Reason: Studies show that physicians do not believe that pain can get that high outside the hospital. When doctors were told 7 or above they medicated at a 5 or 6 level; when they were told pain was 5 or 6 they medicated at a 7 or 8 level. It is human nature not to believe in the extremes. Later in the visit you can say “at times Dr. _________ my pain does get up to a ____”. Tell the truth but not initially, if your pain is extremely high; you want the doctor to believe everything you tell them.

3) Never show emotion during your visit with a pain physician. Reason: Study indicated that expressed emotions significantly increased the chances that a patient would be judged a “head case” by their pain physician. So always calm yourself emotionally before seeing your doctor to increase the chances you will be taken seriously.

4) Never mention the name of a drug without being asked. Reason: The doctor might wonder about drug seeking.

5) Never tell the doctor your dog ate your drugs, they were stolen or the pharmacy didn’t get the amount correct even when that happens. My drugs were stolen once. I just toughed it out and used relaxation and visualization to cope with my low back (lumbar) pain because I did not want my physician to have to justify another script to DEA or have him think I was misusing medications.

6) Prior to your scheduled appointment write a short paragraph describing (just the facts) your condition since last visit (be sure to say something positive). Then list two or three questions you may have to ask. Present this note to the receptionist and ask them to put it on the top of your folder so the doctor can see it before he sees you. In one study, physicians listened an average of twenty seconds before starting to consider a treatment approach. A note on the chart can get a little more attention spent on your needs.

P.S. What if my relationship with a doctor is already in the toilet? Say something like “Dr. ________ I want you as my doctor and I want to follow your treatment. Something, I don’t know, has gotten that unclear but it is true that I will follow your professional judgment.

Let me know if these suggestions were helpful.

Gene Hawkins, Ph.D.