Advice?

[Lecithin5]

Lately I've been getting patient referrals from patients who have been to one or more pain physicians in the local area. For example, a patient may go to a pain doctor- and that doc would do all the interventions, and after (presumably) ineffectiveness, start them on opioids. Then for whatever reason (such as breaking an opioid contract), they get referred to me. Sometimes the pain doc himself will refer to my clinic, and other times the patient would go back to their PCP, and then that PCP would refer the patient to me.
-Why is it my problem that another pain doc started this patient on opioids, and then they become my 'problem'?! The PCP obviously wants nothing to do with the patient, and neither did the original pain physician. What am I supposed to do? Because in the end, I look like the bad guy, and it reflects poorly on me in the eyes of the PCP (ie from a referral standpt etc).
-What is the etiquette of PP pain physicians referring to another PP pain physician in that same community? Seems kind of weird, right? It's not like I'm at an academic center, etc.

Thanks

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[willabeast]

Lately I've been getting patient referrals from patients who have been to one or more pain physicians in the local area. For example, a patient may go to a pain doctor- and that doc would do all the interventions, and after (presumably) ineffectiveness, start them on opioids. Then for whatever reason (such as breaking an opioid contract), they get referred to me. Sometimes the pain doc himself will refer to my clinic, and other times the patient would go back to their PCP, and then that PCP would refer the patient to me.
-Why is it my problem that another pain doc started this patient on opioids, and then they become my 'problem'?! The PCP obviously wants nothing to do with the patient, and neither did the original pain physician. What am I supposed to do? Because in the end, I look like the bad guy, and it reflects poorly on me in the eyes of the PCP (ie from a referral standpt etc).
-What is the etiquette of PP pain physicians referring to another PP pain physician in that same community? Seems kind of weird, right? It's not like I'm at an academic center, etc.

Thanks

This is not a reflection on you. The patient is probably demanding a #2 opinion, and you are it. Give the patient a fair review, then state your opinion. Be nice, because the other pain docs will be getting your patients for #2 opinions.

 

[SeniorWrangler]

I get this kind of patient all the time, just give them your best advice without badmouthing any other providers. It is annoying when the other guy saw the patient, did a series of questionable procedures, then dropped them like a hot potato when the series of three was done, but that's not the patient's fault.
Make sure they know at the beginning that you're not going to take on their opioid prescribing, though -- before I learned to do this I got very angry patients who thought there was an Rx waiting for them at the end of the visit.

 

[lobelsteve]

This is not a reflection on you. The patient is probably demanding a #2 opinion, and you are it. Give the patient a fair review, then state your opinion. Be nice, because the other pain docs will be getting your patients for #2 opinions.

If tbe other doc did bad work or unnecessary care or rx outside guudelines, it goes in my note. We document 3x that i do not rx opiates to new patients, only do an eval. Make a fuss at the consult, no follow up is scheduled.

 

[BobBarker]

Just give them as evaluation same as you would any new patient. Maybe they have done all the procedures except for the SCS or the referral for surgery for severe canal stenosis that will ultimately help them. or maybe it was there right hip, not a radic the entire time.

 

[Ducttape]

you are being dumped upon.

assess the patient and get a feel if this is someone you think would genuinely benefit from your recommendations regarding multidisciplinary pain medicine, and someone you think you could "work with". go ahead. cherry pick.

if you are getting a referral directly from the other pain doc specifically stating to take over opioids (or suspect so), or someone that you wont be able to work with (ie opioid fixated), treat these patients as consults, tell them that you are seeing them as consults to assist your pain colleague. send consult note back to the other pain doc. soon enough, the other pain doc will get the message that you arent going to take his castoffs, and, especially, they remain responsible for tapering patients off of the opioids they started.