Pain management is a growing problem across the country, often forcing clinicians into the awkward position of trying to determine if a patient is legitimately seeking pain relief or just seeking drugs. This month’s case focuses on a vital issue in making that determination – communication. Whether it’s communication between providers or between a provider and a patient, the old adage “knowledge is power” holds true, as does the opposite. Without proper communication, and the information that comes from that communication, a clinician may not be able to make the best decision for a patient.

Dr. P, 49, was a physician specializing in pain management. Over her twenty year career, she had worked in various practice settings, but for the past three years she had been working in a pain management clinic. Dr. P’s patients were referrals from other practitioners, and Dr. P was highly regarded as a pain management specialist.

One of Dr. P’s referrals was Mrs. L, a 37-year old woman with a past medical history of chronic pain related to chronic sinusitis and multiple sinus surgeries, as well as anxiety, panic attacks, sleep difficulty, and depression. Mrs. L had originally been seeing a pain management physician, but after his retirement, her pain was managed by her ear, nose and throat (ENT) and infectious disease physicians, until they both referred the patient to Dr. P.

Dr. P was not given the full information in the referrals, however.  What Dr. P did not know, and was not told by either referring physician, was that both doctors had received letters from the patient’s medical insurance provider warning them about the patient’s prescriptive habits and potential opioid and methadone abuse. The referring physicians neither shared the letter with Dr. P, nor alerted her to the fact that the patient had been obtaining duplicate pain medication prescriptions from multiple medical providers – a process commonly known as “doctor shopping.” Thus, when Dr. P scheduled a consultation with Mrs. L, she did not have the full facts about the situation. And although Dr. P had requested the patient’s medical records from the referring physicians, they had not arrived by the date of the consultation.