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Mar. 9th, 2004 07:59 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
adrian_turtleMy employer is changing health insurance companies at the end of March. My primary care doctor is not listed in the new plan, so I have 3 weeks to find a new doctor. For some people, this would be an administrative nuisance. For me, it is a matter of profound terror.
The political rant is being saved for another post. The medical rant, mixed with plenty of worry and some background information, is behind the cut tag.
My chronic pain is currently under control (just *barely* under control) because my current doctor lets his native good sense and compassion overrule his knowledge of what he is supposed to be doing under current best practice. That is not to treat "benign" pain, where the pain is the main problem, rather than a symptom of something else. At least not in young patients. He tried sending me to specialists - orthopedists for the hand pain, chronic pain clinics, a neurologist for the migraines and weird neurological symptoms. After the hand surgery and physical therapy did so much damage, and my frequent migraines transformed into continuous pain (I suspect there may be a connection there), I tried more neurologists, and osteopaths, and various kinds of therapists.
The consensus of the experts is that I am too young to be taking narcotic pain medication every day. I should "learn to live with the pain" even when that means spending most of my time crying and unable to do much of anything. They advocated all kinds of medications that were supposed to help with sleep, or inflammation. None worked for me as well as valerian and naproxen, they all had vicious, vicious, side effects, and none really helped with the pain at all. My primary care dr had tried prescribing a small dose of narcotic pain meds, and we discovered it helped. Each time he sent me to consult a chronic pain expert, I would have to stop taking the stuff that worked...maybe, months later, the expert would grant permission to resume using it at half the previous (inadequate) dose. Or maybe he would say I shouldn't be taking it at all, how nobody my age should be taking these terrible, dangerous, addictive, drugs, and put a letter to that effect in my file. And my dr would dither, intimidated by the experts, as I kept begging him, "Isn't there ANYTHING we can try that might help?" Until finally he shrugged and said, "Try this just for a week. I want to talk to you Tuesday."
Now I'm still in pain, but I'm taking enough medication that my head is clear, more days than not. (When my head isn't clear, it's pain that clouds it. I'm undermedicated - partly because my dr is cautious of going against expert wisdom, partly because I'm afraid of pushing too hard and losing what I have.) I can work full time. I can live alone and take care of myself. Mostly. (If the supermarket didn't sell pre-chopped vegetables, I'd be in trouble.) But I am painfully aware of how precariously my lifestyle is balanced. And I am terrified of losing it.
When I had access to Usenet, I used to read alt.support.chronic-pain. (Conveniently, my Usenet difficulties coincided with their being eaten alive by trolls.) Back when it was an active support group, I learned about the problems of chronic pain patients being mistaken for drug addicts. This is a problem in the world at large, and in doctors offices. Apparently, one of the terrible things drug addicts do, one of the things that marks them as addicts and proves they're unworthy of any help or consideration, is called "doctor shopping." They go from one doctor's office to another, complaining of something painful that doesn't show up on x-rays or blood tests. Something like migraines. They might say they've already tried all the non-narcotic treatments for this problem, and none of them helped. Or they might say another dr used to prescribe a particular narcotic, the last time this problem occured, and it worked great. Sound familiar? Many doctors are terribly afraid of being taken in by a doctor-shopping addict who tells a good story. They don't want to aid and abet addiction, which is commonly taught to be somewhere between sin and damnation. They don't want to risk bringing the wrath of the DEA down on their clinics.
Does anyone have any suggestions for how I can ask a prospective doctor about this delicate subject before making him or her my primary care doctor? I don't want to come across as excessively single-minded (obsessed. drug-seeking. desperate.) but this really is a deal-breaker for me. There are doctors out there who won't prescribe the kind of medication I need, at all, to anyone, for any reason. They have philosophical objections, or they're scared of the DEA, or something. I don't care - they're not a good fit for me. My big concern is that a doctor who would be willing to prescribe it to a known patient if there was trust, rapport, a damn good reason, etc, might turn away a stranger who just phoned and started asking.
Note to faraway readers: It is my understanding that attitudes towards pain medication vary by region, and the old Puritan tradition is very strong in New England. Doctors in the Southeastern US, for instance, are much more liberal about prescribing narcotics for both chronic and acute pain. I have considered moving for this reason, but the transit options and diverse intellectual/spiritual communities are keeping me here.
Note to local readers: My new health insurance is the Harvard Pilgrim HMO. I'd prefer a doctor near the Red Line, 77 bus route, or at the Lahey Clinic, but I know I'm not in a position to be picky that way. Do you have direct personal experience of a compassionate doctor who is good at listening to patients? Someone who recognizes that different patients can react differently to the same treatment. Someone who doesn't say things like: "You'll just have to learn to live with it" or "It's not helping? You should take more of it. Don't worry about the side effects."
The political rant is being saved for another post. The medical rant, mixed with plenty of worry and some background information, is behind the cut tag.
My chronic pain is currently under control (just *barely* under control) because my current doctor lets his native good sense and compassion overrule his knowledge of what he is supposed to be doing under current best practice. That is not to treat "benign" pain, where the pain is the main problem, rather than a symptom of something else. At least not in young patients. He tried sending me to specialists - orthopedists for the hand pain, chronic pain clinics, a neurologist for the migraines and weird neurological symptoms. After the hand surgery and physical therapy did so much damage, and my frequent migraines transformed into continuous pain (I suspect there may be a connection there), I tried more neurologists, and osteopaths, and various kinds of therapists.
The consensus of the experts is that I am too young to be taking narcotic pain medication every day. I should "learn to live with the pain" even when that means spending most of my time crying and unable to do much of anything. They advocated all kinds of medications that were supposed to help with sleep, or inflammation. None worked for me as well as valerian and naproxen, they all had vicious, vicious, side effects, and none really helped with the pain at all. My primary care dr had tried prescribing a small dose of narcotic pain meds, and we discovered it helped. Each time he sent me to consult a chronic pain expert, I would have to stop taking the stuff that worked...maybe, months later, the expert would grant permission to resume using it at half the previous (inadequate) dose. Or maybe he would say I shouldn't be taking it at all, how nobody my age should be taking these terrible, dangerous, addictive, drugs, and put a letter to that effect in my file. And my dr would dither, intimidated by the experts, as I kept begging him, "Isn't there ANYTHING we can try that might help?" Until finally he shrugged and said, "Try this just for a week. I want to talk to you Tuesday."
Now I'm still in pain, but I'm taking enough medication that my head is clear, more days than not. (When my head isn't clear, it's pain that clouds it. I'm undermedicated - partly because my dr is cautious of going against expert wisdom, partly because I'm afraid of pushing too hard and losing what I have.) I can work full time. I can live alone and take care of myself. Mostly. (If the supermarket didn't sell pre-chopped vegetables, I'd be in trouble.) But I am painfully aware of how precariously my lifestyle is balanced. And I am terrified of losing it.
When I had access to Usenet, I used to read alt.support.chronic-pain. (Conveniently, my Usenet difficulties coincided with their being eaten alive by trolls.) Back when it was an active support group, I learned about the problems of chronic pain patients being mistaken for drug addicts. This is a problem in the world at large, and in doctors offices. Apparently, one of the terrible things drug addicts do, one of the things that marks them as addicts and proves they're unworthy of any help or consideration, is called "doctor shopping." They go from one doctor's office to another, complaining of something painful that doesn't show up on x-rays or blood tests. Something like migraines. They might say they've already tried all the non-narcotic treatments for this problem, and none of them helped. Or they might say another dr used to prescribe a particular narcotic, the last time this problem occured, and it worked great. Sound familiar? Many doctors are terribly afraid of being taken in by a doctor-shopping addict who tells a good story. They don't want to aid and abet addiction, which is commonly taught to be somewhere between sin and damnation. They don't want to risk bringing the wrath of the DEA down on their clinics.
Does anyone have any suggestions for how I can ask a prospective doctor about this delicate subject before making him or her my primary care doctor? I don't want to come across as excessively single-minded (obsessed. drug-seeking. desperate.) but this really is a deal-breaker for me. There are doctors out there who won't prescribe the kind of medication I need, at all, to anyone, for any reason. They have philosophical objections, or they're scared of the DEA, or something. I don't care - they're not a good fit for me. My big concern is that a doctor who would be willing to prescribe it to a known patient if there was trust, rapport, a damn good reason, etc, might turn away a stranger who just phoned and started asking.
Note to faraway readers: It is my understanding that attitudes towards pain medication vary by region, and the old Puritan tradition is very strong in New England. Doctors in the Southeastern US, for instance, are much more liberal about prescribing narcotics for both chronic and acute pain. I have considered moving for this reason, but the transit options and diverse intellectual/spiritual communities are keeping me here.
Note to local readers: My new health insurance is the Harvard Pilgrim HMO. I'd prefer a doctor near the Red Line, 77 bus route, or at the Lahey Clinic, but I know I'm not in a position to be picky that way. Do you have direct personal experience of a compassionate doctor who is good at listening to patients? Someone who recognizes that different patients can react differently to the same treatment. Someone who doesn't say things like: "You'll just have to learn to live with it" or "It's not helping? You should take more of it. Don't worry about the side effects."
