Yup.

 

You should have fucking left. I've done it to the pain guy twice and my surgeon once. He got me back by being an hour late to my fusion surgery.

You should plant mics  in the waiting room. Some of the shit I've overheard...like "I hope he's on time cuz I got a appointment with dr. X in an hour and he always prescient more."

I thought only drug users and addicts went to pain med centers ? And non addicts go to the doctors office ?

My Spouse is a Physician, the one time that she had a person come up to her and complain about being kept waiting for 15 minutes, was the day that an older gentleman collapsed and had a heart attack, she was in the back room doing compressions on him for those 15 minutes.  It's a Doctors office, things happen.    Old guy lived.  Disgruntled patient was disgruntled and did not want to hear it.   Guess who she cared more about?

With most Doctors being booked out 6 months, I am sure they will survive, they might miss you ( I know my wife forms very close bonds with her patients, even does house calls), but a medical practice costs a lot of money to keep open.

They aren't free your insurance pays big money for them.  Glad you have good insurance.  Many patient's don't.  Medicine has become an assembly line industry as each year the cam goes up, salaries for employees go up, taxes go up, CME costs go up and reimbursements go down.  And congress holds a 15-21% cut over doctors for the first quarter of the year until they dump more money at a broken system.  Imagine if your employer decided not to pay you from Jan-March....

Doctors fill an hour with as many patients as they can see, then some ass-hat walks into a 15 minute slot in V-fib which he described to the $12/hr scheduler as "my left arms been bugging me for a couple of days."  That 8:15 appt is why your 3pm ends up being a 4pm.  

In PM you exacerbate that by 10 fold.  I play in this space and there are places with completely honest doctors that have a key for the bathroom and the roll of toilet paper you have to give your license to use.  In miami there are armed guards with shotguns in the waiting rooms.  Most patients are victims of ignorant ER's or doctors that just throw opioids at chronic issues and make addicts out of injured blue collar workers.  The stories are pretty sad.  Comorbidity with psych issues are 70%+

To the OP - policies are standard for the specialty and are "selectively" enforced just like "random" drug testing.

I have a left shoulder torn at near 50% with impingement. My right hurts the most at being"close" to complete tear, last MRI DR. said ~70% torn, with nerve impingement.

I have 2-3 disc in my neck that need surgery. I have moderate to severe carpal tunnel in both wrist.

I have from L-4 down that are jacked.

I have Plantar Facetious in both feet with spurs on my tendons.

Some kind of auto-immune deal where I run fever, fatigue, flushing, night sweats, and extreme intolerance to heat, joint/tendon pain. Some labs go whacky, then normal, then whacky. Vanderbilt Oncology Dr. calls me his enigma. He wanted to submit me to NIH as case study. I did not go.

Doctors told me five years ago to go on disability. I do not do that, I have to work my day job, run a side business, and family. I am on pain meds at a low dose. Had to go see a Pain Specialist, they wanted increase my dose, I refused. They say I have 4-5 health reasons for disability why do I still work so hard?

This pain med/specialists make me feel like a criminal sometimes.

But I am tired of hurting and taking pills, so I  scheduled rotator cuff rebuild on Nov. 7. I am hoping to go back to work on light duty in 4-6 weeks. Just do PT on lunch break.

GOOD!

I'm glad that I was able to work my way off of pain meds after fracturing both legs back in 99.  I started breaking the pills in half, then spacing them out further and further, until I quit using them.  I made only one visit to a pain specialist for one last scrip, the people in the waiting room looked like a bunch of spaced out freaks.  This was not a typical "pain clinic" either.  Nevertheless, after nearly 8 months on opiates, I was off of them for good, though I still dealt with pain.  Even to this day, my left ankle hurts A LOT, but I just grit my teeth and take it.  I don't want to be one of those people so strung out on meds that I have to go all the time begging for the stuff.

It depends. A practice that is staffed by fellowship trained and board certified specialists is going to have a reasonable cross section--largely failed back surgery syndrome and cancer and various other real and painful ailments. They'll provide PT, nerve blocks, nerve ablations, spinal cord implants, psychotherapy, etc.  They weed out a large portion of the drug seekers, although no system is perfect.

You got a "pill mill," OTOH, and you'll have standing room only of unwashed redneck and hoodrat bodies who are there only for scripts. Mention and "epidural steroid" injection to them and they run away.

Usually if a patient calls with an emergency, or illness, or bad weather, or whatever, the fee is waived. It's really there to deter the chronic time wasters.

My wife's favorite are patients who NC-NS when the practice has paid for an interpreter to be there.  Then they call to reschedule and demand an interpreter again.  

Two interpreter fees for one Medicare payment!

If you prove yourself not to be a shitheal they may not enforce that on you.  

Our ER gives out opiates very very hesitantly.  I'm sure I don't hear about all of them, but some number of opiate seekers get a psych consult for referral to substance treatment.  I'm not talking about fractures and bullet wounds and obvious disk bulges etc, I'm talking about chronic pain seekers that only want Dilaudid or Norco/Lortab 10s.  

On our unit, I make clear that I do not give new opiate meds.  I will continue pain meds once I check with the pain clinic, pharmacy and drug screen.  I often work with patients to reduce their opiates down in dose or frequency as I talk with them about tolerance/withdrawal, and if they are chronically on a high dose that they don't need, the opiates won't work as well when you really need them.  Also discuss hyperalgesia from opiate meds.  

Pain meds are like fire.  Good to warm and cook, when you really need it.  A tool to be feared and respected.  Can get out of hand, sometimes very quickly and cause alot of problems.

Blaming the ER for opiate problems is like blaming the grocery store for people being obese.  

New federal law moves Vicodin/Loretab and other oxycodones into Schedule 2.  That means:



No refills.

New prescription required every time.



That, combined with new Obamacare law requiring doctor visits once a year to qualify for prescription meds, should cut down on the drug-seekers.



Or not, since they will ALWAYS find a way.



 

FPNI

It's a little more complicated that the spoon made you fat.  There are genomic issues, lack of follow up issues, compliance issues, etc.  Your ER is responsible, most Docs are opioid sparing but rewind 7-12 years and ER's were candy factories and 4-8 years ago dispensing offices were no different.  Please understand that "we" likely have the same opinions on modern PM but this forum for this level of discussion does not really provide the level of granularity for a complete discussion.  No offense ment.

This. Dope Fiends aren't reliable, but they always pay.

I'm not a doctor, I'm a physical therapist, and I deal with enough bullshit day to day that I know exactly why they have rules like that.

Unlike a doctor who might have one or two patient slots every half hour, we have a large open gym facility and each PT typically books 4-5 patients in an hours time. A no show or cancellation doesn't affect our bottom line quite as much as it does in a doctors office/practice.

There is almost always someone who shows up way late. Or way early. Or not at all. Or on the wrong day. The guy who owns the clinic has instructed his front office staff not to turn away patients. So basically certain people (typically the Medicaid slackers, the "disabled" losers, etc) show up whenever the hell they want to, buttfuck my schedule, and expect good service in the mean time.

I'd LOVE to institute cancellation fees, no show penalties, etc, but they would never be enforced and I'm sure we would end up being called a racist again.

On the other hand, unlike many physicians, when you book an appointment with me, you WILL be seen within at least 15 minutes of that time, and you will have my undivided attention for at least 15 minutes or more. No answering-questions-as-I-back-out-the-door type of stuff.

Sounds like they have a long-term experience with problem patients.

You really think it will slow down pill seekers that have all sorts of free time anyways?  All that it will accomplish is adding trouble to legitimate users.

Pill mills have rules like that.