Recently I took my Mom to see her Pain Management Doctor.  As was the case the last few times she had an ordinary follow-up office visit, he was not there so my Mom was treated by a very thorough and kind Nurse Practitioner.  However, this time something was different about the office visit as it seemed the plan all along for the Nurse Practitioner to treat my Mom.  That probably would have been temporarily okay with my Mom had she been told this when she made the appointment with this doctor, who she is quite fond of.  But if my Mom knew she would only see this doctor during expensive pain-reducing “injection procedures,” she would likely use a different doctor for pain management.

The sneaky substitution of a Nurse Practitioner for my Mom’s Pain Management Doctor  

Having much experience with this medical specialty, I had assumed this doctor was unable to meet with my Mom the past few office visits because an emergency had popped up.  As a chronic patient, I completely understand that needs of other patients might occasionally supersede mine and thus I have great respect for patient emergencies and for the healthcare professionals who attend to them. However, just before we were walked out of the office to make the suggested 3-month follow-up appointment, I respectfully requested that my Mom would like to schedule the follow-up appointment with her DOCTOR. The very kind appointment person told me that was not possible.  I was literally puzzled since it was his compassionate and kind demeanor which attracted my Mom to this particular Pain Management Practice, and no disrespect to the wonderful Nurse Practitioner who had just treated my Mom, I thought it not unreasonable for my Mom to want to meet, and/or speak, with HER DOCTOR – at least every other Office Visit –  if emergencies kept getting in the way.

“We can’t guarantee you will see your Doctor at your next office visit …” [because he is too busy focusing on the more lucrative injection procedures which Medicare reimburses at a significantly higher rate than they do for office visits]

By asking to see her doctor for her next office visit, my Mom and I had stuck a nerve within this Pain Management Practice as apparently this doctor was only available to perform the more lucrative epidural injections and similar complex “injection procedures” and he appeared to only see patients for office visits when his calendar was not booked with these expensive procedures for which I am sure he is paid much more handsomely by Medicare than for the humdrum monthly office visit.  When I respectfully expressed my concern in this regard, the appointment person literally told me she was going to note in my Mom’s 3-month follow-up appointment entry in her computerized calender that my Mom “preferred” to see her doctor.  But then this appointment person politely told us we were not promised or guaranteed this would happen.  My instinctive reaction was something to the effect of, “You must be kidding me?”

[Okay, to the best of my recollection I got angry and while my comment/question was substantially the same, there was a definite “intensity” attached to my statement and my body language was one step short of being enraged by what I perceived to be the greed of this doctor and Pain Management Practice. That said, I did make it CLEAR that my frustrations were not at all targeted at this very polite appointment person and if the doctor were present I would discretely take this matter up with him.   But his availability is sketchy and unpredictable, ergo this Blog Post.] 

A Pain Management Doctor more concerned with Cash-flow than his Patients?

I knew this appointment person was simply following whatever procedure was taught to her but the content of her response triggered red flags within my mind about insensitive doctors who care less about patients than they do about cash-flow.  I further expressed my concerns and the 3 or 4 office staff at the front-end of this medical practice were completely silent, too silent in fact.  That’s when I knew it was reasonable to conclude that this Pain Management Doctor was merely providing his services to the highest reimbursed procedures and not to the neediest patients.  My Mom has had many of these “injection procedures” and this doctor has ALWAYS treated her with great compassion and care but even she realized what was going on at this medical practice.

Is it “Bait and Switch”?  Is it a “Conflict of Interest”? Or is it just plain Greed?

Is it not “bait and switch” to meet with your Pain Management Doctor only to be forever serviced in future routine office visits by either a Nurse Practitioner or a Physician’s Assistant?   Is it not possible that this doctor could be steering his patients to the more lucrative Medicare reimbursed “injection procedures” when merely prescribing simple monthly pain medications would suffice?

Bottom line

When you have office visits scheduled with your Pain Management Doctor but continually see healthcare professionals other than your doctor such as a Nurse Practitioner or a Physician’s Assistant, it is time to find a new Pain Management Practice.

I intend to respectfully confront this doctor during my Mom’s next office visit.  If he AGAIN is not there, I will have my answer.  Then I will share my concerns with him via letter so that he knows why my Mom is leaving his Pain Management Practice.  Moreover, I will suggest to him that he should have become a Radiologist instead of a Pain Management Doctor if he intended to minimize his interaction with live patients.

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