Does everyone experience what I do, every time I see my primary doctor?  He rarely asks how my pain level is, he doesnt take my complaints seriously and he constantly forgets what kind of tests he wants me to have done before my next visit. Next visit comes along, I havent had the testing done, and he makes no mention of it!  And not a single mutter abote my pain levels, which could range from a 2 all the way up to a 9!  And he refuses to prescribe narcotics!   Time for me to look for new PCP, dont ya think???

When I was dealing with a lot of pain all of the time, I would use a list on a 3x5 card.  Between appointments, I would list all of the questions that I had or anyone in my family might have.  I re-trained my docs.  They knew that they could not leave until all of my questions were answered.

Next time you see your doc, be ready with everything you just listed here.  Ask him.  He works for you.  The doc-being-a-demi-god thing has pretty much disappeared (not everywhere).  If your doc is a real dink, he will probably refer you to someone else (which would be great for you, because insurance doesn't question it as much if the doc drops you, instead of the other way around).

Also, if you do not like his answers about pain control, ask to be referred to a pain specialist.  I was talking with my wife's primary and the difference was immediately evident to me.  She did not know the differance between narcotic addiction and narcotic dependancy.  She even went so far, as to say that they were the same thing (they are not).

Venting, my butt.  We need to fix this for you.

If he is like that with the list.  Make two, tell him that they are the same and hand him his copy and explain that you would like to address ALL of the items on the list before you leave THIS visit.  If you can, take your husband or a close friend with you. They are not as emotionally wrapped up in your condition as you are.  For years, I would not go to a doctors appointment without my wife.  I wanted to make sure that all was asked, all was answered and that I did not get bullied by the doctor.

I understand the emotional part.  I was bounced around by Navy Medicine for a number of years before an Air Force PA took me seriously and got me into the correct care.  When the spine specialist saw me and read about what I had gone through, he flipped.  Then, I had 8 hours of surgery (including a double spinal fusion) and a several weeks in the hospital and a year of half- and part-time work after that.

It's painful to have to deal with a new doc.  The worse part (after re-telling the same thing that you have told the other dozen docs) is having to go through the entire exam that leaves you on bedrest for the next couple of days due to the pain of the extra movement, poking and prodding.

If you have anymore questions, ask and if I remember anything else, I will send it.

Good luck with your next appointment and let us know how it goes.

Hey, Doc Tom,

In Palliative Care, the term "addiction" is never used...it is always called "tolerance". When tolerance occurs, the Palliative Care Doc, will either up the mg, ml, or change to a different drug. A new rx for pain relief, could be different, but have a longer half life. In Palliative Care, many times you will see a routine drug, and an rx for break-through-pain.

The Palliative Care MD, usually hooks up with the speciality of Hospice, or in the field of Geriatrics. In Hospice, towards the end-of-life, the drugs of choice for routine around the clock will be Methadone, with Morphine for break-through-pain. This will render the patient in more of a sedated state. All of this is explained to both the patient and the family.

I have been waiting forever for Palliative Care. In this method of pain relief (not for a cure), chronic pain can be relieved without causing pain, i.e. through an injection.

We, as nurses, are taught to understand the math for the exchange of a pain med for another. It is our responsibility to check the MD orders for a possible error. We also now have to know the half life of the drugs we use. Needless to say, I do not rely on my memory...I carry my references with me.

My advice to anyone, nurse, patient, family member, to have an open mind when trying to find the right fit in a speciality area, especially in Palliative Care. I always tell my friends and family, that finding the right fit in an MD is very similar to finding the right fit in a new pair of shoes. You may have to try on several pairs of shoes to find the right fit.

I was so interested in Palliative Care, that I shadowed nurses in Hospice for 3 months. First of all, nurses in Hospice who travel to the patient's home, cannot have any marking on their vehicle due to the fact they are carrying scheduled drugs. We also must always wear footwear that we can RUN in. My partner nurse also carried "heat"...but this is what we Texans do. The count of the scheduled drugs is always maintained, and if the count is off, there is an investation launched. Hospice is not in the drug dealing business.

Most often, in the beginning of Palliative Care, OTCs can be used....for instance the NSAIDs. It has been found, with the control of pain, the ADLs of the patient improve in all aspects of their lives. This is true mostly in the control of pain due to an injury or a disease process. The patient sees the MD frequently and is suggested to keep a pain management diary at home. This helps the MD to see the time of day, the activity, stress, that cause an elevation in pain. We like to see the level of pain very close to Zero...meaning no pain at all. When the level of pain becomes at the number four, this is when we act. The level of pain is now the fifth vital sign because it is so important.

If a patient cannot swallow pills, there are gtts for oral admin, or SL medications. Also, there are patches, creams, rectal and vaginal suppositories. Absolutely no injections...this is fantastic.

With shadowning in Hospice, I witnessed many things going on within the home of the patient. One patient was obviously malingering, another was either using too much antianxiety meds, or selling them. Hospice discharged both patients.

So, if any of you feel you are not being treated correctly for management of pain, seek a second or even a third opinion. One other area where one can find a Palliative Care MD, is usually the Medical Director of a nursing home...be it from completely independent to LTC within the same facility. All you have to do is look, talk to, and consider the options.