bioethics of pain contracts

Welcome to HealthRcovered’s Chronic Pain patient community. You can also read doctor approved Chronic Pain Articles and watch Chronic Pain Videos.
27 posts / 0 new
Last post
Starshine
Offline
Last seen: 3 years 2 months ago
Title: Member
Joined: 11/19/2008 - 2:23pm
bioethics of pain contracts

Everyone who has a pain contract with their health care provider should listen to each one of these tapes.

URL Removed - Please contact Starshine via PM for further info.
How do they impact patient care?
Is it an effective tool?
Does it promote physician/patient relationships?
Is it a legal document or an AGREEMENT?
Are they used to protect the physician (documentation)?
Do they prevent abuse and are useful as a tool for communication?

Has it given any of you some good insight?

EDITED

Standards agreement and posting rules
Please note that Spine-Health reserves the right to edit any messages posted or submitted or e-mailed to the Company and use them for content on the website or in other company materials. No e-mail solicitation or advertising of other companies, products, services, or web sites is permitted in the Spine-Health.com forums.

Post Edited by Administrator Dave

advertisement
Kris-NY
Offline
Last seen: 11 months 1 week ago
Title: Member
Joined: 08/05/2009 - 6:23pm
Paper

Sometimes you need to consider something for what it is not what you want it to be. A pain management contract is just a piece of paper. It is not going to stop someone from taking their meds incorrectly. It will not stop someone from selling their meds. It will not stop them from demanding ever increasing dosages.

It is a piece of paper that says you will do X and the office will do Y. If you don't do X then they don't do Y.

There is no legal or medical need for a "PM Contract". No law mandates it. No court will enforce it. It could aptly be entitled "Rules for getting narcotics in this office".

It's a piece of paper, that's all.

Aviatrix36440
Aviatrix36440's picture
Offline
Last seen: 2 months 2 weeks ago
Title: Member
Joined: 09/29/2009 - 10:35pm
Paper

Kris,

Very well said!! I think some doctors get "unearned" power or control over people. Most people see a contract as a legally binding document. Hummm....

Brenda

PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.

happyHBmom
happyHBmom's picture
Offline
Last seen: 4 years 8 months ago
Title: Member
Joined: 11/28/2009 - 12:09pm
Exactly Kris. You can also

Exactly Kris. You can also ask "is this physician going to treat me if I don't sign one?"

And, of course, if you DON'T have one, you can ask yourself "does it leave me any less at risk of losing my pain care if I am careless or misuse my medications?"

and

Does the pain contract or lack thereof leave me any less responsible for taking my medication as directed by my physician?

Personally, it has never been difficult for me to stick with my prescribed dosage. I know it is the law for controlled substances and I feel that it is my ethical obligation to my doctor. So a pain contract was never an issue for me, as long as it went both ways.

happyHBmom
happyHBmom's picture
Offline
Last seen: 4 years 8 months ago
Title: Member
Joined: 11/28/2009 - 12:09pm
Brenda, what do you mean a

Brenda, what do you mean a "binding contract?"

Like they think they can't switch doctors? I do feel that way sometimes, but not because of the contract. It's just because of the nature of the beast.

Starshine
Offline
Last seen: 3 years 2 months ago
Title: Member
Joined: 11/19/2008 - 2:23pm
contract

It is an agreement not a binding contract but take time to listen to what is on this site.

Interesting how some docs feel and how patients feel about contracts. What's interesting is there is very little research on if these agreements work or not. Some ppl need a contract to abide by what the dr.prescribes and some ppl don't. Dr. should use their skills and ability to decide who needs a contract. It is the communication you have with the dr. that can determine to him or her if you need one.(this is from tapes)

And it is the doctors responsibility to detect this. After all they have the education. If they feel that they don't have the time or are unable to determine this then they have to have this agreement to protect their licenses and hopefully protect some ppl from the dangers.

I talk to this about my family member who is an emergency medicine doc. in a county hospital and he has to judge whether to give the patient opiates frequently.

i wanted to tell you that the tapes on the site answers the questions i posted. I was hoping to get some discussion on what you heard. Anyone?

Aviatrix36440
Aviatrix36440's picture
Offline
Last seen: 2 months 2 weeks ago
Title: Member
Joined: 09/29/2009 - 10:35pm
HB

In line with what Kris was saying in so far as "law enforcement" of said "contract." Some people think that if they sign this contract, they are locked into *this* doctor whether they get along or not. As you know, a relationship has to be amicable. So if I don't like this doctor *I* can cancel that contract and go to another.

To me when a doctor tries to get me to sign that piece of paper, *I* feel like I am being judged. If this doctor agrees that I need pain management, then maybe I should get *him* to sign a contract with me of his ethics and veracity? I guess I don't like the one way street. Trust works both ways. Sorry, I'm rambling..(G)

Brenda

PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.

happyHBmom
happyHBmom's picture
Offline
Last seen: 4 years 8 months ago
Title: Member
Joined: 11/28/2009 - 12:09pm
But emergency medicine is

But emergency medicine is not pain medicine.

Pain management doctors face a unique set of challenges. The ER doctor doesn't have to worry daily whether his patient, for example, is going to misuse his medication by taking "just a little extra," and convincing himself that it is within his rights and it will be OK regardless of the fact that the law, professional opinion, etc suggest that taking medications as directed is an important aspect of the doctor-patient relationship. An ER doctor sees a patient once and he's gone.

I can probably guess that most of us who are, ahem, approaching the hill have friends and loved ones who are doctors, lawyers, etc and have had such discussions. Everyone has an opinion.

But the reality is that things are only getting harder as far as opiate prescriptions go. For Schedule II meds, doctors are going to have to re-certify, and some are saying that fewer doctors will be available to prescribe the meds. For those of you who take a few schedule III meds here and there, maybe going without a contract is an option- for some of us, our choices are limited at the start, and we're given the choice of contracts or no meds.

I understand perfectly why my doctor's office has contracts. It is not because the contract will save their a$$ in court, it won't- in California you can't sign away the right to sue for negligence. What it does do is give them an easy out when someone starts exhibiting signs of not being a candidate for opiate therapy. Those signs are on the contract.

Now, a doctor who knows their patient is doing these things and still gives them dangerous medications? With no contract or any other controls? Is that good care? Long-term opiate prescription standards (which differ entirely from short-term standards) *requires* a physician to be on the lookout for signs of misuse and to deal with any signs he sees.

Starshine
Offline
Last seen: 3 years 2 months ago
Title: Member
Joined: 11/19/2008 - 2:23pm
Happy, Emergency med docs

Happy,
Emergency med docs are not pain docs but they do see pts more than once- sometimes frequently because half the pts that come to er's do not have insurance and they come their for pain. And they do worry about the meds they give whether is one dose or 50 doses. Have u seen the nations er's lately- it's a mixture of everything because ppl need health care and can't afford it!!Even people in pain

Isn't too bad that doc as u say have to find the "easy out" because some try to see pts every 15 minutes or overbook so they can make some money instead of taking the time to find out more about their pt. Love my docs -they spend as much time as i need. Wouldn't have it anyway else

yes agreed, a doctor has the right to refuse to give pain meds or have a pt sign a contract. It is their responsibility.

happyHBmom
happyHBmom's picture
Offline
Last seen: 4 years 8 months ago
Title: Member
Joined: 11/28/2009 - 12:09pm
An ER isn't going to

An ER isn't going to prescribe long-term opiates for anyone. That is what pain management is for, and making sure that the patient is willing to take on their share of the responsibility is part of it.

And making sure you have good doctors is not an easy task for any specialty. Doctors who care will spend the time, contract or no contract, whether they are a pain doctor or an ophthalmologist.

t9crushed
t9crushed's picture
Offline
Last seen: 6 months 4 days ago
Title: Member
Joined: 06/26/2008 - 9:59am
I have never signed one but

I have never signed one but have seen that they are not all the same. The first one I saw I thought was horrible. It was written by a lawyer and was all about protecting the doctor and giving him complete control over everything.

Another one I saw more recently was much more patient friendly, but I still did not want to sign it.

Pages

advertisement