A Bad Time to be a Chronic Pain Patient & A even worse time to be a Pain Management Physician, Just ask Jayam Iyer MD at the Creative Health Center


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With the pseudo-chrisis continuing in Florida, Doctors are more worried about being police interrogators then physicians. It recently came to my attention of an episode where a patient was postsurgical for a two-level spine fusion and since the patient was seen by a chronic pain management physician preop, the surgeon elected to not write any medications for this patient postop to manage the pain but instead, the patient was to immediately follow up with his outpatient pain management physician. It is a simple plan and under normal conditions would have worked fine. Unfortunately, the pain clinic had been closed by the authorities with no plan for outpatient follow-up of these patients, other than fend for yourself and good luck with that. It was the impression of the office staff that the patient  had arrived at our office without adequate documents to verify his situation.  They were able to find an MRI that was about a year and a half old but the one that was done before the most recent surgery was not available and the patient could not remember the name of the MRI company. He was asked to return with this information and in his pain and frustration, returned to the surgeon’s office asking for pain medications  instead. The surgeon however was in surgery so no one was there to prescribe to him and they recommended that he go to the closest ER as he was showing signs of going into acute withdrawal which was compounding his acute postsurgical pain syndrome. We have repeatedly tried to contact this patient but the phone number we have is not working.

Physicians have always been cautious about prescribing pain medications to patients. The dominant problem in the medical community has always been the undertreatment of chronic pain conditions.  This situation is being made even worse now by law enforcement and politicians grandstanding on the magnitude of this problem with the exaggerated claims like a person a day is dying in the state of oxycodone overdose.   We all know that statisticians and liars figure and if you have proof that this is occurring, please call my office at 352-224-3139 and cite the reference that this statistic is coming from. What I do know however, is that there are 34 people per day who are dying in this country from gunfire. This is a far more severe problem than the “war on drugs”.   No one is holding a gun to the head of any person who goes to a physician’s office and states that they have pain and requests medications to manage that pain.  It is a difficult situation, and as a physician if I can tell the person is lying to me, I will not prescribed to them.  Now in the current witch-hunt environment, history is simply repeating itself. Any doctor who prescribes pain medications especially oxycodone or Xanax is a street-level drug dealer and should be put in jail. Complicated issues are frequently simplified by prejudice. Prejudice is an efficiency of the mind just like gut instinct is. It is a way for the human mind to cope with an overwhelmingly complicated situation.

The solution is not to charge doctors with third-degree felonies or to charge them with  Five counts of manslaughter as they have done with a doctor in Winter Haven Florida. As a pain management physician, I do believe that there are chronic pain conditions, I do believe that sometimes medical management is indicated, sometimes interventional pain management blocks and procedures are indicated, and sometimes surgery is indicated. All these tools are used by myself and our colleagues and judiciously applied on a case-by-case basis. I do dominantly have to believe and trust my patients when they say they are in pain. Should I assume that everyone is a liar? If you come to me as a patient should I assume that every word out of your mouth is a lie? At the end of the day, the individual patient is responsible for their behavior and whether they are compliant or noncompliant with the way the medications are prescribed. Myself and other colleagues of mine, have not prescribed to patients  and referred them to the addictionologist when we have detected that there is a problem. We usually do not get a thanks! Sometimes our safety is even put in danger. Even in the best case scenario, there is an unpleasant verbal confrontation. I personally had a patient who claimed that she could not pee for a urine drug screen throw coffee on me. Many of my colleagues have had guns pulled on them by patients they refused to prescribe to. I invite you and all who criticize and blame the doctors to go to medical school and residency and pay your dues for the 12 to 15 years to become a pain management physician and become a front-line provider for this challenging patient demographic. I’m sure you’ll find it easy, enjoyable, and will always have a relaxing day at the office.

As a bonus, you will relish the new strategy to balance the healthcare budget by charging all the doctors with Medicare fraud and for then asking for the money back. To add insult to injury, a new law has been passed that if anyone is charged with Medicaid fraud, your license to practice in the state of Florida which only last for two years, will not be renewed! Suspending your ability to be a physician! By reciprocity, all the other states will then discipline your license to practice, and suspend your license!  As physicians, we unfairly suffer through double jeopardy, multiple punishments for the same offense by every state that we own a license in, and the brainwashing of the public by ambulance chasing attorneys that we are the bad guys!  As a bonus, if we ever make a mistake, it will be available for the public to see for the rest of our lives in the national practitioner database. As a precaution, most hospitals will then refuse to offer you privileges just in case you might not be perfect in the future.   50% of the contracts for locums tenens physician services that I review request a doctor who has never been involved in any lawsuit.  Before I completed my residency, however, we were pre-warned in a lecture given by an attorney to anticipate that we would be involved in an average of four lawsuits or more during our career. My attorney has advised me because of the legal jeopardy and risk involved, that I should no longer accept Medicaid patients. This new legal jeopardy for Medicaid providers is just a bonus kick in the crotch since it is already the poorest payor that we ever see in office. Don’t believe me, see the attached article on Medicare fraud sweep includes 10 arrest in area by clicking here. PS: if you are looking for information Jayam Iyer M.D., the principal Dr. and owner of the creative health Center in Clearwater Florida, see this article starting approximately at the sixth paragraph.

May God bless you, and may God bless and protect the pain management physician and his patients.

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