my first chirstmas present from a patient!

The other day at clinic, my “pain contract” patient had an appointment (groan!!). Other docs will know what the words “chronic pain patient” entails! I will describe my patient, who I believe is somewhat stereotypical of chronic pain patients everywhere! Joan has an ‘idiopathic’ condition that has caused chronic pain for years. Idiopathic meaning that so far there is no medical evidence or reason for the pain. The original diagnosis was made elsewhere and old records have not been obtained yet. Joan requires daily pain medications to function, and guess what she's “allergic” to just about every pain medication out there (meaning she’s tried them all and none of them work to control the pain). I researched the condition and all possible treatments and went over the list of therapies with Joan. Most of the things on my list had already been tried, and… big surprise, did not work! These types of patients can be extremely trying, and also take a significant amount of time.

Patients who require long term narcotics for pain control sign a “pain contract”. Basically it says that the patient agrees to
1.visit only ONE doctor (me) for their pain control needs
2.fill their narcotic prescriptions at only ONE pharmacy
3.take only the drugs prescribed and take them as prescribed
4.take a drug test at each monthly visit (to ensure that the drug prescribed and only the drug prescribed is present)

So my chronic pain patients only see me and they see me at least once a month, which I guess means that we get to know one another more. Which in this case translated to me getting on Joan's Christmas list!

At the appointment the other day, Joan actually looked pretty good, and was in a good mood. Despite this fact, she still reported that the latest medication we tried did not work, and so we are now trying the last long acting narcotic on my list, and hoping for the best! Afterwards I was in with another patient and I heard a knock on the door. It was my ‘difficult-chronic-pain-patient’ who handed me a gift card and wished me Merry Christmas!! The gift is a big deal when you consider my patient population. It was unexpected, but the gesture was much appreciated!

I’m sure there will be other Christmas cards or gifts for “the doctor” as I progress in my career. We’ll see if they can beat my free meal at Jack-in-the-Box from the patient I least expected to give me a Christmas present!