Clients with chronic pain often tell me that doctors are skeptical of their requests for pain medication, and ask them questions that imply that they are concerned that they may have an opiate addiction, and even skeptical that they are being “scammed.” Unfortunately, there are a number of doctor shoppers out there without a valid medical need who are manipulating physicians into prescribing opiates.
To complicate this issue further, many states have enacted strict rules about the use of pain medication as a response to the opiate addiction crisis.
As a result, individuals with a valid need may not get the help they need.
But as a patient with chronic pain, you know that to the right treatment is a process, or a journey, that may require working with various physicians over time until you find one that really understands your specific condition and is able to treat it effectively.
So we have skeptical doctors, on one hand, and patients with a valid need for pain medication on the other hand, who are seeking a treatment that works. I have talked with physicians who want to help but also have to protect their professional reputations, and patients who are suffering and just want help.
Patients often feel on the defensive, and rightfully so. This naturally raises the question of how to best communicate with the physician around the issue of past treatment. For patients, it comes down to: “How do I approach my past history with a new doctor? I want to be honest, but I also don’t want to scare them away.”
I suspect that if you went around and randomly asked this question, you would receive a wide range of responses as to the best way to approach this issue.
As my clients have shared their experiences with me, I have always recommended that being straightforward and thorough is the best way to work with a healthcare provider. Physicians can do their best work if they have a strong sense of what you have done in the past, how it has helped or not helped, what recommendations were made after that, what happened then, etc. Doctors can be like detectives this way. Ideally, a doctor will be able to gain insight by identifying patterns that emerge in your past treatment. This may lead to a more specific diagnosis of your specific pain medication needs as well as a more effective treatment, and it will avoid wasting time “reinventing the wheel” with treatments that haven’t worked.
Furthermore, if you hold back details that you fear may cause your doctor to unfairly label you, you also risk losing their trust when these details emerge at a later time.
If you are concerned about being labeled a doctor shopper, you might want to express this concern to a new physician. You could say that you have worked with multiple professionals and tried numerous treatments and haven’t had the results that you need, and that you have no ulterior motives, and that you are seeking to partner with a professional who can make a difference. Again, honesty is the best policy, as the saying goes.
Keeping a detailed record of your past treatment is a good idea. There are websites and apps that will help you to do this. I would recommend sitting down and carefully documenting the what, when, where, who, how of your past treatment. You can bring this with you to discuss it with your new doc, and you can offer to leave it behind for him/her to review. As they say in the media these days, the keyword is “transparency.”
If your doctor senses that you are being totally transparent, then their doctor shopper alarm will be much less likely to go off.