As you well know, the pandemic forced us to stop all procedures and all office visits for a few weeks. Thanks to our staff, we are getting up and running again. We cannot promise to be at full speed yet, but so long as the nation as a whole keeps the virus cornered, we will be there soon. All of you have been on my mind these past two months. I can be minding my own business, doing something completely unrelated to my pain management practice, when a particular patient or group of patients will pop up in my thought stream. “I wonder how he’s doing with that last treatment?”, or “Geez, it must be 4 months since her last treatment. Can she really go this long without it?” It happens to me dozens of times a week, but I really don’t see it as an intrusion. This is my profession. It has become a part of me, and in turn, my patients become a part of my life.
Other times, I find myself wondering if what I’ve done or have been doing for a particular patient or group of patients really makes a difference for them. These thoughts ARE troubling intrusions, but nonetheless necessary ones. Neither I nor my partners want to waste your time and money while also subjecting you to the risks inherent to what we do if it is not accomplishing something very substantial.
These past two weeks have been both reassuring and distressing to us. Reassuring because patients are universally commenting upon what a relief it is to finally get back into us for their injections. Distressing because, as pain specialists, we don’t like to see our patients dealing with pain that we know we could have reduced had we been able to treat them. But, as I think about it, this distress has been with me for over three years now, ever since pain management, like every other specialty practice, has come under pressure from insurance companies to limit our treatment.
As patients, you know what I’m talking about here. You now have to wait 4 months instead of three months for your injections. You can’t get different areas of pain all treated at the same appointment as you were before. Some treatments are just no longer authorized at all. It is maddening to me, and I’m not the one living with the pain! I feel like a mechanic telling you that I can fix your exhaust this month, but you’ll have to wait another three months for me to fix the transmission. Just as bad, many of you now have to take two days off of work for treatment that used to require just one day off a few years ago.
For two years, I simply refused to change the way I practiced. I got indignant and stubborn. “If my work was considered medically indicated and authorized three years ago, then by God, I am not changing, authorizations be damned”! I had worked long and hard with my patients to assemble outcome-driven treatment protocols, my goal always being to give each and every patient the most pain relief possible for the longest time possible. I felt particularly driven because pain medication had also come under attack, and thus many of you were even more dependent upon what we could do together in the procedure room.
I’ll admit that in refusing to change my practice pattern, I enjoyed wallowing a bit in a bit of that smug self-righteousness we all enjoy from time to time. “My art is above compromise! I’ll not be swayed by the system’s miserly penny pinching!” How dare you meddle in my practice!” That sort of stuff. I know that you, my patients, did benefit as well from my two year long temper tantrum, and I have the data to prove it. We pay close attention to the questionnaire you all must answer on the tablets at each appointment. I guess in an ideal world (read “fantasy world”) that data would suffice.
Alas, we live in the real world, and it doesn’t. A medical practice is also a business, and, as I’ve learned, there is a stiff price to be paid for stubborn self righteousness, no matter how well intended.
I try to learn things from my patients. Over the past dozen or so years, I’ve had more than a few service men get sent my way after getting shot or blown up in the Midde East. Even though they are no longer in the service, most of them stay pretty salty when it comes to dealing with their pain. The mantra seems to be this: Stay Operational. Adapt. Overcome.
Who am I to argue with that timeless, hard-won wisdom?
I’ve committed myself to finding a way to stay operational, adapt, and overcome in this increasingly difficult practice environment. You, my patients, are the same folks with the same injuries and illnesses I’ve seen since I started practice in 1994. Since I’ve always asked you, despite your chronic pain, to try your best to stay operational and to adapt and to overcome, I must do the same. It would be weak and hypocritical of me to do otherwise.
Over the coming weeks and months, I’m going to be getting a lot of help from my staff, both clinical and business, to stay operational and to adapt and to overcome. My mission to help you reclaim and maintain your ability to pursue your happiness with the least amount of pain possible will never change. The logistics and the mechanics are another story, but in the end and with your help, we will continue to get it done.
Speaking of staying operational, adapting, and overcoming, who better to share some advice than you folks? Chronic pain forces you to live this very day. I’d bet that the accumulated wisdom among MPC’s many thousands of patients must be impressive. In the near future, I hope we can have a forum of sorts on the MPC website where patients can share the tricks and techniques they’ve learned or developed themselves to stay involved in life’s activities. We will look forward to sharing what you know.