One of my most unhappy patients is a man that I’ve been seeing for a long time for several chronic painful problems including diffuse peripheral neuropathy, back pain, and osteoarthritis. As you might have guessed, he’s also depressed, and it’s hard work to get a smile out of this guy.
One day he asked me to refer him to a pain specialist regarding his back pain. I had mentioned this option several times at previous visits. This seemed like a great opportunity to send this unhappy camper to someone else\'s office and to give me a breather. If anyone asks me if getting a consultation is a good idea when dealing with a difficult patient, my usual advice is "share the wealth." Sending this patient to see a pain specialist certainly seemed more appealing than having him request more pain medication from me. I would probably even have paid his one-way cab fare to the other doctor’s office.
It turned out that my golden opportunity was short lived. No sooner had I referred Mr. Difficult Pain, than I got a message from the pain doctor’s office. They wouldn’t see my patient before he had an MRI scan. They wanted me to help their office efficiency by ordering the MRI before they even saw him.
I didn’t think this patient needed an MRI. If the specialist had ordered the MRI, it wouldn’t have bothered me as much. But the idea of ordering an MRI scan so the specialist could tell my patient to do back exercises and take ibuprofen bothered me deeply. I gave the patient the option of returning to see me again or seeing a different specialist that was willing to see him first and then decide if he needed an MRI scan. He chose to see another pain specialist, and I was happy to take my own advice and share the wealth.
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind.