[llrn7470]

I just got through an exhausting two hour appointment with my PM doctor. After trying anything but opioids for my pain, he has finally agreed that I should be on MS-IR and MS Contin for pain. This I am open to because I am going through enough Ultram to float the Navy without much relief. I guess it didn't hurt that my hubby and best friend (a CT surgeon) were there to help let this guy know that I am not functioning well despite being on and off Neurontin, now Lyrica and Cymbalta. Anyway, the big deal came when he showed me a mandatory pain contract. Now I have no problem with any part of the contract (bringing my bottles to all appointments, keeping all appointments, going to no other docs for medications, drug testing, etc). Here's the kicker. It gave them free reign to discuss my case with anyone that they wanted to. I guess that this would not be a problem for most patients, but I work as a Neuro ICU nurse in a large university hospital. The very people that they would talk to about me are people with whom I work. I do not want these people knowing about the medications that I am on. Now, obviously, I am not going back to work on all of these medications. But I thus far have been responding well to lumbar sympathetic blocks and have a shot of being one of the few who make it out of this. I refuse to have my personal medical history shared with every attending and resident that I work with before I return. I was livid and said I refused to sign that item on the contract. Essentially, per the university (which the PM works for and I am a "home hostage" insurance member) says clearly "no contract, no meds." He argued, but I pointed out the conflict of interest and I said that I have the same rights to privacy under HIPPA as any other patient. My friend pointed out that essentially the insurance puts a gun to my head with this contract, as in "sign it or else." In the end and after much discussion and ranting, I sort of ended up with a line item veto that said that I needed to give prior consent for each doctor with whom they wished to speak about my case. I pointed out that there would be such a bias should my boss and colleagues find out my drug list when I go back to work that I would be given every drug test under the stars, would be eyed at every narcotic count, and likely not get to work with certain patients who were on these medications even though I have done nothing wrong and never would. I take my license sooooo seriously. It's how I feed my family and I know that there typically is an automatic trust which people have in their nurses that comes with no other profession. I love my job and have worked hard to get where I am. I am currently in classes and graduate in December with my degree and go right into Nurse Practitioner classes. Do you think I am being paranoid or do you think that it is akin to blackmail saying that I can't get treatment without allowing anyone to get my medical record where I work???

[Jomar]

hmm , talk about a rock and a hard place..

I can kind of see the conflict from both angles, you & your privacy but also your job and responsibilities there..
I would guess it shouldn't be too much of an issue until you return to work and depending on what meds you were on at that time.

But I think because of your ICU duties at least your manager or supervisor should be aware of any meds you are still on when you return to work. {This would be classified as extremely confidential information}

Does the hospital have rules about nurses/doctors being on certain medications, like narcotics? You might double check what the policy is in that regard, you don't want to violate something that way and be terminated for not disclosing medications.

those are just my thoughts
nice to meet you

[kejbrew]

Lori Lee,

I too understand your concerns but agree with Jo. You need to investigate the hospital policy on medications that can be used by working medical personnel. You do have privacy rights, but the hospital has a responsibility to the patients is treats as well. The hospital would have major liability issues if you are allowed to return to work while taking strong pain medications that could affect judgment or performance.

I would not want everyone knowing my business either in your situation, but for your safety and the hospital's, it would be absolutely necessary for your manager or their designee to be fully apprised of your medications.

Hopefully all of this will be a mute point by you getting better and not needing to be on strong meds long term.

Best regards,

EJ

[Mslday]

Just because someone has an illness does not make them an addict and addicted to pain meds, nor does it when you are in an acute phase of a condition as you are now. You have a very good prognosis for a recovery at this stage of the game.

I hear what some are saying about their concerns when you return to work, but it is far too early to make those types of judgements.

Personally I think some professional discretion and courtesy should be applied in this situation. I would be just as alarmed and concerned as you are under these circumstances about your right to privacy. Stick to your guns.

MsL

[llrn7470]

Originally Posted by Mslday

Just because someone has an illness does not make them an addict and addicted to pain meds, nor does it when you are in an acute phase of a condition as you are now. You have a very good prognosis for a recovery at this stage of the game.

I hear what some are saying about their concerns when you return to work, but it is far too early to make those types of judgements.

Personally I think some professional discretion and courtesy should be applied in this situation. I would be just as alarmed and concerned as you are under these circumstances about your right to privacy. Stick to your guns.

MsL

Actually, I'm not worried about working on the meds. I would not be able to return ethically on these medications if my thoughts are clouded or if it is a narcotic. My real issue is that my PM will approach any one of many neurologists and neursurgeons to discuss my case. I do not want him discussing this with anyone but someone that I trust socially. It sounds stupid, but when I return to work, I refuse to have all of the docs knowing all of my personal business and talking amongst themselves about me. Also, if a lot of people were to find out about this, I'm afraid that anytime narcotic counts are off or there is an issue, I would be the person everyone would blame because of my history of taking these medications. Despite HIPPA, I know that illness among "our own" is sort of open season, as wrong as that is. I mean, it would be OK to talk to the attendings, but the residents are out of control as far as gossiping and really, what can they add to the conversation about how to treat me? My job is essentially not to allow them to kill the patients! I'm just worried that I will lose credibility if they now my business. Again, no pain contract, no pain medications. I mean, really, if a doc had rectal surgery and needed pain meds, would he sign that? There would be pics of his *** in the break room. Maybe I worry too much, but I do worry.

[Gymjunkie]

LL
I don't know the answer and I am in the UK so probably the rules are different here. That said, I have found it easier to be open and honest with everyone I work with about what is happening to me and what drugs I am taking. Why should I be ashamed about it all - it is much simpler if they know what I am taking and how I am doing. Its not like CRPS is embarassing or personal.

I hope for you that you do make it through this and get a remission. It is good that the blocks are helping you but I think you need to be realistic. Even if you do manage to get a remission, it isn't likely to happen fast. Before my CRPS inflicted severe movement disorder on me, I started to see a physiotherapist who told me that he had treated CRPS rehab patients before. He said that normally, in his experience, if patients are dedicated and motivated, it takes about 2 years for the rehab process. You said yourself that you are having to ramp up the opiod drugs because large amounts of Ultram isn't working for you (Ultram is an multi-action opiod which we call Tramadol in the UK). In the UK the other, new opiod drugs you have now been prescribed would be classed as narcotics.

This drug cocktail is all perfectly normal with CRPS so my point really just is that you need to think longer term about the drug and work issue. Your remission may only come (and remain) if you keep taking the drugs. You may not be able to work for a very long time if you are not able/willing to work whilst you are taking a cocktail of the ususal CRPS drugs either including or not including strong opiod painkilling medication.

In the UK, regardless of the job you do, employers are able to refer you to Occupational Health docs, nurses and advisers who advise them on the condition you have and your fitness for work. Whilst they may not tell an employer exactly what drugs you take, they do share and discuss sensitive medical data with other emmployees. There really is no such thing as privacy or confidentiality and we have much, much better privacy laws that you do in the US.

I think you need to step back and make a priority of your PM ahead of the issue of colleagues possibly discussing you. Maybe you aren't medically that interesting for them!!! If you can't get your pain and health under control then you may find that you are going to have even bigger problems about being able to work than just worrying about colleagues discussing you or people looking at you when they do the drug counts.

CRPS undeniably dents your confidence about your ability to do all sorts of things including your job. It has happened to me and it is taking time to get that back but it is coming slowly. Is there a way you could get help to tackle that issue rather than miss out on essential pain medication? Could you confront some of the practical issues about your job and potential restrictions your employer could place on you in a constructive way up-front? Perhaps with your union or your employer?

[dreambeliever128]

I don't quiet understand why your Dr. would discuss your case with any Dr. besides the ones you would be referred out to or one that you might pick to go to.

I just went to a Gastroenterologist this week and I had to sign a form for my PCP to send info that talks about my intestinal problem only.

If your PM Dr. needed some help on the case I would hope he would talk to someone and not use names due to the privacy act. Even at a University Hospital I would think that they would only discuss your medical records with the Drs. or PA's that work in that office with them only.

My Dr. gets out books, goes to seminars, and has called other Drs. for a little advice on issues but he doesn't use the patients name. Why would they do it?

As far as the blocks, I do hope they help you get back to work. I will agree with gymjunkie, it isn't an overnight process. It took almost 10 years to get me to where I am today. I am off of my pain meds but it sure doesn't mean I don't deal with the pain.

For some, they can get to where they can go back to work, I have seen that here. I have a friend that works in the ER but she isn't on meds. She has blocks when she thinks the RSD is trying to come back out.

I would take things one day at a time with this, like Gymjunkie says, it takes time to get better from the RSD and some don't ever get to go back to work. Work toward getting better so you can but it does take time.

Ada

[Debby]

I think what you did was appropriate. I agree that you should be able to yay or nay as to what doctors they can talk to & use your name. It is not anyone's business what drugs you take at this point in time, period. If & when you go back to work, then that may be different.

Good job sticking up for your rights.

DebbyV

[nopainever]

llrn7470,

I just noticed that your PM was going to be either switching you to narcotics or adding them in addition to Ultram. My PM made a horrible mistake and had me on both for a year and I wondered why I was in so much pain...I attached an article for you. I just don't want the same thing to happen to you.

http://rsdrx.com/rsdpuz4.0/puz_45.htm

Heather




just got through an exhausting two hour appointment with my PM doctor. After trying anything but opioids for my pain, he has finally agreed that I should be on MS-IR and MS Contin for pain. This I am open to because I am going through enough Ultram to float the Navy without much relief. I guess it didn't hurt that my hubby and best friend (a CT surgeon) were there to help let this guy know that I am not functioning well despite being on and off Neurontin, now Lyrica and Cymbalta. Anyway, the big deal came when he showed me a mandatory pain contract. Now I have no problem with any part of the contract (bringing my bottles to all appointments, keeping all appointments, going to no other docs for medications, drug testing, etc). Here's the kicker. It gave them free reign to discuss my case with anyone that they wanted to. I guess that this would not be a problem for most patients, but I work as a Neuro ICU nurse in a large university hospital. The very people that they would talk to about me are people with whom I work. I do not want these people knowing about the medications that I am on. Now, obviously, I am not going back to work on all of these medications. But I thus far have been responding well to lumbar sympathetic blocks and have a shot of being one of the few who make it out of this. I refuse to have my personal medical history shared with every attending and resident that I work with before I return. I was livid and said I refused to sign that item on the contract. Essentially, per the university (which the PM works for and I am a "home hostage" insurance member) says clearly "no contract, no meds." He argued, but I pointed out the conflict of interest and I said that I have the same rights to privacy under HIPPA as any other patient. My friend pointed out that essentially the insurance puts a gun to my head with this contract, as in "sign it or else." In the end and after much discussion and ranting, I sort of ended up with a line item veto that said that I needed to give prior consent for each doctor with whom they wished to speak about my case. I pointed out that there would be such a bias should my boss and colleagues find out my drug list when I go back to work that I would be given every drug test under the stars, would be eyed at every narcotic count, and likely not get to work with certain patients who were on these medications even though I have done nothing wrong and never would. I take my license sooooo seriously. It's how I feed my family and I know that there typically is an automatic trust which people have in their nurses that comes with no other profession. I love my job and have worked hard to get where I am. I am currently in classes and graduate in December with my degree and go right into Nurse Practitioner classes. Do you think I am being paranoid or do you think that it is akin to blackmail saying that I can't get treatment without allowing anyone to get my medical record where I work???[/quote]

[Lynns409]

Hey there!
I say, get a new doctor. Your doctor has absolutely no right whatsoever to discuss any information about you with anyone else. Especially your employers. And there are federal laws that are designed to protect you on this front. It's called HIPPA. Just google HIPPA and wiki and look at the privacy section. Every hospital and doctor is prevented from releasing any medical information to anyone- even your insurance company- unless you say that it's ok. And it sucks that this doctor is going into all of this with the assumption that you are guilty of being an addict until you are proven innocent. I mean, drug tests? Come on? Checking in once a month is more than enough for a good doctor to figure out whether or not a patient is having problems.

You are having enough stress with pain without the added stress of this. Don't let someone bully you into letting them violate your privacy. You are in pain, you need these meds. It's that simple. You shouldn't be treated like a criminal. It really really bothers me when doctors pull this kind of crap. You just have to tell him that there are federal laws that prevent him from doing what he is trying to do. And even if he's asking you to let him bypass that law, you have to assume that it's there for a reason and you just can't do that. I mean, why should he be able to do this when every other doctor is prevented from discussing their patients by HIPPA? He's not God!

Find a doctor who treats you with empathy and compassion, not suspicion. A good doctor can make all the difference. And you have every right to keep your private life private. It's your right, not anyone else's.

Linnie