difficult patietns

[Guest guest]

I agree w ith some on this thread- if the docotr does not follow the

rules and set firm kind guidelines then the dysfuncational patietns will

test us out to our limits and becase we did not enforce kindly from t eh

begiinning our firm rules or FORGET to make it clear in the begiinning,

then WE feel frustrtaed

However

I have done quite a bit of work on learning to take care of people with

chronic pain

while opioids are NOT the first choice ,they can be unavaoidbale and can

give people theri life back. What you are looking for is functionalality. I

have troubel with any doc who ever says " I do not precribe x " not mean

that Gordon should not be allowed to say Sorry I do not do hip

amputations in the office...

I hear about too many docs who " will not " do this or that And usually thatis

becasue the docotr feels inadequate/threatened and does not have the

training to do something, NOT becasue it should not be done .I am respectful

of a doc not going beyond their limit. Pain docs have a place. But this si

a HUGE area and primary care should have the skills here to manage chronic

pain.

Using multiple modalities for pain helps people get into the garden or back

on the bike or whatever. There are some rules like taking the meds acc to

the directions and do not open your pills over the toilet or in the dog's

dish, but most people who need pain relief can assess their pain, use one

drugstore rarely need an early fill, and if they do , have a good reasaonble

reason etc.

The example above by Krisiten was not about chrionic pain is was about a

mentally ill patient and how we care for THAT problem.

Those are my thoughts- alittel jumbled but see I teach at a residency and I

just deplore it when before seeing apatient the resdient gets teh hostile

voice and says " I am not giving him narcotics " This is not conducive to the

kind of examination of the patient's needs in an objective manner that we

owe people.