Relating to your Medical Doctor

Typically people with chronic pain have been seen by a number of medical specialists. Unfortunately, there is no single medical specialty that is concerned primarily with chronic pain. Examples of medical and surgical specialists who may be involved with chronic pain patients include orthopedic surgeons, neurologists, neurosurgeons, rheumatologists, physiatrists, anesthesiologists, and psychiatrists. Sometimes you the patient gets lost in the shuffle. This is why it is important to have one person who serves as your primary care doctor, a person who is familiar with your medical history and who is responsible for coordinating your overall medical care, including prescription of medications.

Ideally, your primary care provider should be a doctor whom you trust and respect, a doctor whom you feel takes a genuine interest in your well-being. I believe that the best type of doctor - patient relationship, especially when chronic pain is involved, is a collaborative one rather than a strictly authoritarian one.

A collaborative doctor - patient relationship is based on mutual respect and includes open two-way communication. By contrast, in an authoritarian relationship, the doctor is expected to use his or her expertise to prescribe appropriate treatment and your role as patient is to cooperate and do as told. While authoritarian doctor - patient relationships are appropriate in some situations (e.g., medical emergencies), collaborative relationships are more appropriate in the treatment of chronic conditions. In the case of chronic pain conditions, there is rarely one single best or agreed upon course of action. Rather, there are typically a number of treatment options and possibilities. In collaborative relationships, the doctor discusses with you the various options, including their pros and cons, and together you make decisions as to the best way to go.

Unfortunately, collaborative relationships represents more of an ideal than a reality in a number of cases. While all doctors are trained to manage acute pain conditions, many doctors lack training in dealing with chronic pain syndromes. Another complaint I frequently hear is that doctors are very busy and do not have much time to spend with their patients. I would also add that you as a patient may contribute to the problem by having unrealistic expectations of your doctor.

One of the most common complaints I hear chronic pain patients make against doctors is that the doctor seems to disbelieve the patient's pain complaints or not take them seriously. Much of this has to do with inadequate physician education regarding chronic pain management and the fact that medical test findings often correlate poorly with patient's complaints of chronic pain and disability. Recently, there has been increased emphasis on physician education regarding pain management and recognition that people with pain have certain rights. Following is a bill of rights for people with pain taken from a book by McCaffery and Pasero (1999).

A Bill of Rights for People with Pain

1. I have a right to have my reports of pain accepted and acted on by health care professionals.

2. I have a right to have my pain controlled, no matter what its cause or how severe it may be.

3. I have the right to be treated with respect at all times. When I need medication for pain, I should not be treated like a drug abuser.

Some of the frustration that chronic pain patients experience in dealing with doctors stems from unrealistic expectations regarding what doctors can actually do. The following quote captures this nicely.

As indicated previously, it is a mistake to believe that doctors should always be able to identify the exact causes of chronic pain and then do something to fix the problem. However, if you have that belief then you are more likely to unfairly blame doctors for your pain condition rather than assume responsibility for dealing with it yourself. These unrealistic expectations lead some patients to wrongly accuse their doctors of incompetence or to assume that their doctors are deliberately withholding treatment from them. Unfortunately, the exact causes of many chronic pain conditions cannot be clearly identified with medical tests. Furthermore, there may not be any definitive cures.

Another common unrealistic expectation, is that doctors should be able to prescribe medication to make you completely pain free. As a result of this unrealistic expectation, some patients try to pressure their doctors into prescribing more and more powerful opioid pain relievers. However, as discussed later, this is an insidious trap because the more opioid pain relievers you take in an effort to completely rid yourself of pain, the more tolerance to these drugs develops and the more pain medications you need.

Therefore, in dealing with doctors you need to ask yourself, "what can I reasonably expect from my doctor?"

In my opinion, one of the things that you can and should expect from your doctor is honest information. Your doctor should tell you what he or she does and does not know about your particular pain condition. In some cases, the doctor may know more about what is not wrong with you than what is actually wrong with you. In other words, even when test results come out negative, that still be may useful information. If your doctor does not volunteer this information, then it is your responsibility to ask.

Unfortunately, some patients have difficulties interacting with their doctors in an assertive manner. You may feel rushed through the examination procedure and ushered out of the doctor's office before you have a chance to ask your questions. If so, it is important that you write down your questions in advance and bring the list of questions with you when you see your doctor. You must then assertively ask these questions keeping in mind the following patient right. It is your body that is in pain and you have a right to receive accurate information about your particular medical condition. Furthermore, you have a right to ask your doctor to explain things to you as best as he or she can in a language that you can understand. At the same time, you need to be prepared for a right that your doctor has. Your doctor has the right to not have all the answers to your every question. However, it is your right to expect that your doctor will be honest with you and tell you when he or she does not know all the answers. Unfortunately some doctors have difficulty telling their patients when they don't have the answers.

It is reasonable to expect that most persons with chronic, incurable medical conditions will require an ongoing long-term relationship with a medical professional. If nothing more, you owe it to yourself to have a qualified healthcare professional monitor your chronic physical condition. At the same time, I believe it is very important to do everything you can to foster a healthy sense of self-reliance. This is the primary purpose behind pain self-management training. Rather than trying to make your doctor totally responsible for your physical health, you assume primary responsibility for the day-to-day management of your chronic pain. To the extent that you can successfully rely on your own skills and personal resources rather than prescribed pills and other passive medical procedures, you will be much happier.

INTERACTING WITH YOUR MEDICAL DOCTOR

Richard W. Hanson, Ph.D.