Never seen such disrespect in my life.

I wish people could see the things we see. You've never seen such a collaboration of helpless people. People stripped away of their entire lives and reason because of these pills. These people come in for at least one office visit, thinking they're going to get the medicine they want. When they find out they aren't getting their medicine they treat us horribly. They say the worst things you can imagine. They're the ones doing wrong yet they blame us? I hate the doctor's that became engulfed in their own greed to breed these people. These people are just so freaking horrible.

Today a patient came in with his wife and two kids. Slum of the earth I tell you. They ungratefully sat in the patient room. Complained because their wait was over thirty minutes. You know what, they aren't even paying for their office visit. You are paying for their office visit. Your tax dollars are going to the scum like this. I walk into the room with the doctor and the wife immediately becomes unsettled. Glaring at me and saying is this even authorized. Look lady I work here, and I need to be in here because God forbid you make up something about the doctor. Anyway the doctor tells her that she needs to get out of the room he wants to talk to the patient by himself without the children. She goes on a hissy fit. Then started complaining about the wait time and left. The husband was such an ass. About 35 years old. Tells us he's never taken pain medicine before in his life and this sob story. Then goes on to say hydrocodone and percocet do not work, he's a big guy and needs the strongest. Yeah, get the hell out of here. For back pain? Anyway he continues to make sly remarks to me. Belittling both of us. I won't even get into what him and his wife said while we were in the room. My boss told the patient we would call him with an opening. A breath of relief. But before they left his wife shoved disability papers through the window. She wanted, after treating us like shit, to fill out disability papers for her husband? He didn't even get medicine, so you think our boss thinks he is disabled? What a joke lady, get out of here and quit wasting the tax payers money. This isn't even the worst of it.

They waited in the parking lot...

One of the girls left from work early....

The husband goes up to her and grabs her arm. Calls her a bitch a slut and a whore nurse. Then said we were all whores. He complained about how he didn't get the medicine he wanted. He literally grabbed her and pulled her. All in front of his children.


This is my defining song of the day :

Just take the flipping urine test

Top 10 excuses for why you can't take a urine test

(inspired by the crazy woman who comes in every month and harasses us. Yes I may be a smart ass, but no one likes you because you are SO DANG MEAN, for no reason)

1. You ran to the restroom before we called you in the room. Oh you can't pee? Here's some water. I only need a little ;)

2. You're on dialysis. 

3. For some reason you can only pee once a day and on this particular day you already peed.

4. Your insurance company only lets you take one urine test a month. Conveniently your PCP already drug tested you. BTW to the woman who told me this, I called your insurance company and you lied. Plus with your medicare replacement plan I will never have to get urine test authorized. Who's the smart ass now?

5. You can't find your penis and you can't sit on the toilet

6. It's against your religion

7. Your in so much pain you can't reach your arm down their to hold the cup, long enough or steady enough. But you can sure hold that cigarette to your mouth can't you?

8. You're on a regime of antibiotics that for some reason won't let you take a drug test.

9. Your special medicine makes you positive for all different types of street drugs. That dang diabetes medicine making you positive for cocaine again?

10. THE ACTUAL REASON: you took some drug, didn't take your actual prescription and you're afraid to be discharged.

Intoxicated before Noon

Lately when I have been running the urine test I've noticed a lot of our patients are positive for ethanol. Could it really be that I have a flock of drunk patients? Or maybe this was their first pee of the day after a long night of drinking.. Either way. Why?

About two weeks ago we had a patient frantically run into the office and had to use the restroom. Up front we have a patient restroom but it is currently out of order since we're too cheap to hire a plumber. There has been crap sitting in that toilet for about a month. She runs straight into that restroom, although there is a huge sign that says OUT OF ORDER. She actually used the restroom. When things like this happen, just let it happen.
Later that day she kept giving us a problem. Coming up to the desk asking when she's going to be seen numerous times. I noticed though as she talked to her us she seemed more than doped up. She was drunk. Slurring her words. Her face seemed half paralyzed. When she got into the room she started to get aggressive with the girls. Telling them that the doctor was going to pay her lawyer for her wait time in our office and all this nonsense. Before you could bat an eyelash she was out the front door wandering down the street. I figured she was never coming back.. I was wrong.

Three weeks later she makes an appearance, much uglier than before. This time she's really on a rant and lets everyone in the waiting room and the staff know how displeased she is with life. One of our patient's is a retired nurse and she had much input to say about this woman, confirming my suspicions of the ladies intoxication.
Well she must have been going on about how she used to go to this 'pill mill' and they would see thirty patients at a time. They would also serve them BBQ as they waited in line.  Now I believe a lot of patients in pain management are addicts but some patients are not. Talk like this must embarrass them, disturb them, offend them because I believe a lot of our patients truly are in pain. They come into the office and have one on one interaction with our doctor. They accept alternative treatment (most of the time) and can be very receptive and sweet. They were really upset with this woman today. If it weren't so busy we probably would have heard her in the lobby. But the patient's said she was going on and on about pain medicine and this and that and this doctor gave her this blah blah blah - lady we have a sign that says SHUT THE HELL UP ABOUT MEDICINE IN THIS OFFICE. They said she kept dozing off, then becoming belligerent.

Luckily for me I triaged this patient. When I came back in she didn't even recognize me. I asked her who gave her all her bruises and she began to cry. Saying she was an alcoholic and a drug addict and blah blah blah. I felt bad but the doctor was not so empathetic. At this point he was irritated with the scene she caused in the lobby and was hell bent on discharging her. Sorry, don't talk badly about the doctor and don't talk about medicine in the lobby, hell don't talk at all.
Well when he came in, she started to flip out. This gave him all he needed to discharge her. But he sat quietly didn't really respond to her rants, just went on about the office visit. She first states she wants her 'oxy's' and doesn't know why he wont give them to her. She's yelling and drunk so you can only imagine this woman. Her hair is frizzy, pretty young, eyes closing and pasty skin. Then she goes on saying how he owns a blue ferrari and why the hell not write her the medicine. BTW my boss does not have a ferrari... Then she starts cussing at him, F this F that F YOU. Asks him if he knows a neurologist. He starts to mess around and is like, no I don't associate with them. And shes like HE"S TRAINED EVERY DOCTOR IN THE USA AND HE HITS ON ME. Great... just great.
My boss gave her a script for Mobic (lol Lol LOL) and gives it to her and she takes one look at it and flips out. She runs out of the office again, like the last time before we told her she could not come back. I guess I'll just wait till her next phone call to advise her. Until next time she'll probably be waiting in line at that one pain management clinic behind the gas station with the BBQ stand.

Tips on being the best chronic pain patient you can be

Foremost, I'm not going to blab how to convince your doctor to write you the pain medication you want. I'm probably a pro after the thousands of addicts I've seen run through, but I'll keep my secrets to myself. In any event if this is what you are trying to achieve, please go see a primary care doctor who actually isn't a pain physician and pay them a boat load of money.

Anyway if you're trying to not be such a jerk when you come in for your follow up here are some tips:

1. You really do not know which medication is best for you. If you've already tried these medications maybe you should check yourself into a rehab.

2. If you haven't had your pain longer than three months, it is not considered chronic and you have no business making an appointment at a pain management office. You just had a tooth pulled? Follow up with your dentist. You just had a surgery about three days ago? Follow up with your surgeon. None of these instances are considered chronic.

3. This is not walmart. This is not burgerking you can't always have it your way.

4. I have yet to meet anyone that is actually allergic to aspirin, Tylenol and anything that isn't dilaudid. Just because the tylenol makes you "sick", it does not mean you are allergic to it. The doctor is NOT going to write you the hydromorphone or 'oxys' you prefer, that you said you've been taking for YEARS. If this is the case, go back to your old doctor. Oh wait? He's in jail?

5. There is a slim chance that the reason you are positive for meth/cocaine/marijuana is because someone put it in your food or drink. If you are taking these drugs you shouldn't be in a pain management clinic. End of story. Maybe your long history of addiction is causing your body to shut down and now you really are in pain, but congratulations your reputation has caused everyone doubt what you say.

6. If you can sit with the doctor and argue with him, argue with me, and slam doors and basically act like a two year old, you've lost all credibility regarding your "chronic pain". Please get out.

7. Pay your flipping copay. Medicaid only has a two dollar copay. If you can't afford two dollars, you better go elsewhere.

8. Fibromyalgia does not warrant a script for oxycodone. If your primary care doctor told you you had fibromyalgia, chances are he just wanted you to get out of the office. It isn't real. Get up off the couch. Stop feeling bad for yourself. Narcotics aren't going to solve your problems. Anyways do a little research for yourself, neuropathic pain doesn't even respond to opioid medications.

9. If you're in SOOO MUCH PAIN and the doctor suggest different types of treatments aside from pain medications, take it into consideration. Upping your dose of narcotics is stupid, and unlikely to happen in our office. 

10. Do not talk about your medications with other patients. I'm listening. If I hear it I will tell the doctor. You will be discharged.

11. It's probably time you've sought out a psychiatrist or therapist.

12. Above all, please treat the staff with respect. We understand you are either agitated because of your withdrawals and your previous pain management doctor just left the state or you really are in pain but treat the staff with respect. It is discouraging on a daily basis to meet such miserable people who are ALL CONCERNED WITH MEDICATIONS. EVERY SINGLE ONE OF YOU, IN LEGITIMATE PAIN OR NOT. If you consistently treat us like crap, we do tell the doctor, and you'll be discharged. But I doubt our time with you will even get that far as you have already moved on to the next doctor who will write you your script of dilaudid. Good luck trying to get that filled.

Sometimes honesty is the best policy

I mean are there people out their who feign their own illnesses and disabilities to get free things in return? Not in our office! We like to be as honest and upfront as possible...

Maybe they weren't gifts

The patient that came to our office in a frenzy on friday afternoon returned today to use our phone. He doesn't own a phone so he figured he drop by and use ours. He needed to call the lost and found because apparently on friday he lost a watch. I didn't want to tell him yet that he actually gave the watch away to the doctor as a present on friday (if he even remembers coming in)....

Someone put cocaine in my food on two separate occasions

On friday a patient came in who for the second time was positive for cocaine. I wasn't in the exam room but I heard every bit of the conversation because she was screaming. She couldn't figure out why she was positive for cocaine again but she needed medication.
"SOMEONE PUT IT IN MY FOOD"
"YOU'RE LYING"
"YOU DON"T CARE ABOUT MY SITUATION"
"ITS JUST COCAINE"

She was scaring everyone so I opened the door to make sure she wasn't murdering the doctor and she gave me the scariest glare I've ever seen. The only other time I've seen this look on someones face was when we walked in on a woman doing heroin in a gas station bathroom.

What am I doing with my life.

Disregard your appointment time as long as you're bearing gifts

On fridays we stop seeing patients around 1 so that we can watch netflix and basically do nothing. Around 345 we started closing up and one of our older patients ran through the front door and brought in a bunch of groceries. He was franticly speaking gibberish and this isn't an uncommon theme we see throughout the day but it was odd to see someone come in so late. He then parked his bike in our waiting room and brought in more sodas, presents and a card. The whole time he was profusely sweating and speaking really fast. The doctor was sitting up front with us while this was happening. The man then threw the gift down at him and pulled out a pocket knife. He threw the pocket knife on the counter and told him to use it to open the gift. I admit I was scared at this point. I've seen enough episodes of cops to know he was on something that probably starts with the letter M and ends in -eth. To diffuse the situation we put him in an exam room. I hid the knife in the drawer. We ended up seeing him and today was his lucky day because we gave him a random urine test. When I was bringing him to the bathroom he went on to speaking gibberish and told me there was water running in the streets. Alright then...
Right before he pulled out a scraper for paint and told us he found it on the street. Then as he was getting his bike out of our lobby my boss was like "hey you forgot this" obnoxiously... He came back in to get his tool and left.
I guess it was okay aside from the mini panic attack that I had. He brought us soda, food and a watch. We kept the unopened foods because apparently someone saw him dropping the sandwiches by the dumpster about thirty minutes prior to him coming in..

Same story, different patient

I'd say about theres a 1 in 2 chance the patient standing in front of me will approach our conversation with hostility. An older gentleman walks in today and shoves his hand through the window and extends to us his medicare and medicaid cards. The two golden tickets. Now we must bow down. Paperwork was given and he sits down.

Only five minutes later the man jumps up to the window, extremely agitated and asks "when will I be seen". Literally five minutes after taking his paperwork, that he didn't even touch. The girl at the front replied it could be up to an hour depending on how quick you fill out the paper work.

He screams " WOULD THE DOCTOR WAIT AN HOUR FOR ME???"

He runs out of the office without his insurance cards and he took our clipboard. Looks like his visit was cut short but just to reassure us that he was not going to be coming back to our office he returned to retrieve his collateral and tell us he "WAS NOT COMING BACK".

Well at least he was short and to the point. I rather not have someone with such a short fuse hanging around long enough to find out he won't be getting the medication he hoped for.

Chicken Boned

About two weeks ago we had a patient who came in but was displeased with the amount of people in the lobby. He decided to go wait in his car. He never checked in with the front desk and never filled out his new patient paperwork. We knew he was out there because he harassed everyone that walked by his car. Around 1:00 the suspense was killing him and he stumbled into the office screaming he had to pee. Yes, all my good stories start out about a patient griping about using the restroom.

Another patient helped this man into the door and he had all of his weight on her. I thought he was dying but she told me he had to go and he had to go now. Awesome. I ask him politely what was wrong and he looks at me and says,

"you should know you should have my records."

Me: "But I don't even know your name you aren't even a patient here"

"They sent my records you should know read them, I have to go to the bathroom"

Ok.. So After one step I realize this man can barely walk. I'm a psychology major and abnormal psych is still fresh in my head and all I could compare what I saw was to those involuntary movements schizophrenic patients exhibit. I'm not diagnosing him but this is what I saw on all the youtube videos we played in class.... He was dragging one leg and gripping the wall and then gripping me. He kept complaining about the government how they're bringing us down and I have barely made it 20 feet before I realized I needed to switch the subject or else I wasn't going to make it to the bathroom. I tell him,

"wow those sure are some nice shoes!"
At the rate he was going, dragging his feet those shoes would have been worn out in three days, but they were brand new.

"They're older than you, and I can't even take them off"

"oh that's real nice"

I really have nothing left to say so I just ramble on because he's rambling on, and were both just having this great time you know, me supporting his body weight and the other girls in the office just pretending he's not there. Why didn't I get him a wheel chair? Well he insisted I HELP HIM. Ok so I did. One girl in the back asked him if she could help him as well. He got mad. He only wanted me to touch him no one else. Great, just great I made a new boyfriend and I don't even know his name.. But I should, that's what he told me.

We get to the restroom and he grabs the sink and then starts to fall into a split like he can't control his legs. He screams
"help me up help me up I have to pee. I can't find it I can't find it"

What in the Lords name. This man is doing a split on the floor and telling me he can't find it. So I help him up and I tell him to sit on the toilet. He says he can't and he needs to pee and he points to his crotch.

"I can't find it you need to find it"

This man just asked me to find his penis. So that he could pee on the floor, or me, or both. I told him I'm going to give him some privacy and I shut the door. I told my boss who with all his wisdom goes back to the bathroom and opens the door while this man is sitting on the toilet mid pee. I thought he couldn't sit down... My boss asks him why he was trying to have my touch his you know. The man has no response. Afterwards he walked out of the office completely fine and waited in his car until the patients were gone...

The end of the day was great because two representatives from an insurance company (I won't mention any names) came in for a surprise visit! YES. AND MY NEW BOYFRIEND WAS STILL OUTSIDE. He conveniently decided to walk in just as they were making their tour. He reluctantly filled out his paperwork and we brought him into the room. He then went on to tell me he lived out of his car and he had 72 hours worth of urine in the car. I asked him if he had any MRI reports he said he had a whole trunk full of film from these scheming doctors. Anyway I couldn't get out of him what his pain was so I waited for the doctor.

My boss walks in and evaluates him and asks him why he is walking the way he was. He tells us,

"They told me its in my head but it aint, I chickenboned myself 20 years ago"

Chickenboned. The act of which you pull the leg off of a chicken and it snaps. He was chickenboned by someone who probably worked for a government agency. A secret one.

He then proceeded to pull his pants up to reveal his groin and then a little further to show his whole package. He looks at me and goes "you've seen this before right?"

No sir, I have not....

Well he was given maybe an anti-inflammatory and sent on his way. He's studying this prescription hard and as always I'm mentally preparing myself for the throw down. Why didn't I get Roxies why didn't I get the blue ones. Well he looks up and asks,

"These aren't psycho meds right? I don't take those psycho meds, those things aren't right."

Rest assured, these are not psycho meds.
As he left the office I ran up the stairs to our attic. I was not going to be the one to check him out.

I just got off the phone with my grandfather. He did a couple of blood test and they're going to test him for cancer - as he tells me something that starts with a M, associated with high calcium and protein in the blood. His doctor already started to lecture him on radiation, etc. He's 78. Really instead of us being in shock, we just complained about how these doctors were going to work him up for all his medicare replacement plan was worth. That's why I love him.

Anyway he said if he starts to ache (being in pain is for the weak), he'll just come visit me at work.

I think for now were just going to limit his diet, no more milk and protein shakes Pops!

Great Lengths

It has been relatively calm in the office this week. When the patients aren't acting up, us staff members take it upon ourselves to really get things churned up amongst each other. Joking.. Sort of. I guess were going a little stir crazy, it's been TOO calm.

Anyway, a new patient arrived along with her CNA. Now I've always been skeptical of people bringing along others to their pain management visits. It just makes me feel uncomfortable for the patient. Relative or not, the company at hand likes to have an input on the patients medication regime and their plan of care. Well this woman comes up, half awake (never a good sign) to the window, in her wheel chair. The CNA stands impatiently by the window. She hands over an envelope of medical records to me. I proceed to ask her for the patients photo ID and insurance card and she gives me a blank stare.

"This is all tha facility gave me" she says.

Now if this were any other type of office maybe we would let it slide. I'm not sure how other doctor's offices of different specialties handle a patient that cannot take care of herself and did not bring in a photo ID - but in pain management I'm going to assume you are not the person you are claiming to be. I don't think I've ever come across this type of impersonation yet, but I wouldn't put it past anyone that claims to be void of their photo ID or any form of identification. Sometimes we have the best actors and actresses stroll through our office and they are nothing short of Hollywood worthy. People will go to great lengths to get pills. I mean they come in with their best limps, best groans and then I have to take a double look at them when I see them sprinting around in public.


Luckily, the CNA agreed with me and took the woman back to her facility. She said she would return with identification. I was already geared up for the argument about how the patient needed her Roxys. Bless that woman's heart, I didn't have a panic attack that day.

I can't wait

Today there was one common theme that influenced every patient’s attitude as though there was an actual invisible parasite that climbed up everyone’s ass. No really, almost everyone that walked through the door was on edge and demanded that we cater to THEIR needs. In most cases I do not mind the irritability but today for some reason it seemed it was on everyone’s face. Maybe it’s the approach we have when they initially walk in, or the fact the office is getting too small. Whatever the case I hope it is resolved when we move to our new office. In the mean time I’m stuck pondering where we went wrong. Maybe its just pain management in general but I probably won’t know till it’s too late. But here, indulge yourself in my frustrations.

Today a younger woman, with a shower cap and slippers walks in at 8:30. She’s a new patient. I feel as though I may have seen her before at my old job at the Children’s Place. Oh my memories of retail theft are still as strong as ever and when I see these people time and time again I laugh because I remember how they would react to being caught. Anyway she looks vaguely familiar. She comes up to the window about 15 minutes later, not even having her paperwork finished and asks when she is going to be seen. I wish I could have taken a moment and said look around. You see all of these people? Yeah it’s going to be awhile. But I do not work at the very front window and she was told the wait may be a little long today. Well she wanted to be in and out. Not sure how you can be in and out at a doctor’s office when you’ve never even been seen before. I assume at other pain management offices they just hand you the script through the window after you hand them a couple hundreds. Well sweetie, in our office our doctor doesn’t just write scripts for whatever medication tickles your fancy and I don’t see anyone scrambling to pay us more than their Medicaid two dollar copay (and even then they complain – I’ll tell you the story about how we had to call the police because a man refused to pay his Medicaid copay).

The woman was not pleased to hear this information and demanded she be rescheduled. She was rescheduled and told to take the paperwork home to expedite the process. Now here is where I am innocently assaulted. Today I saw a couple patients but mostly I’m in the back dealing with other issues. I’m walking across the front to find something and this woman glares at me and sticks her hand through the glass with some paperwork. Now I just love when people do this because they’re just waiting for someone to even walk by, could even be the janitor and they feel that you should wait on them THIS SECOND. I usually hate when people just give me hand gestures and rude glares, but I knew what she was there for so I grabbed her paperwork and I told her I would get her chart together. She prompts me: “Well I gotta pee and I need to go take a urine test now.” One, how does she know she has to take a urine test and two I don’t have her chart even together. Before you think I’m over reacting she’s yelling this in the waiting room with her hand on her hip. I told her that once I got her chart together I would call her back and see what the situation was. I know everyone has to take a urine test but I don’t like him or her to think that because then they start to predict when and where they will fake their urine results. Anyway, she proceeds to tell me she’s been waiting over 45 minutes. Cool. I then find out she’s the lady who rescheduled this morning and this pleases me. Why is she back in the office five hours later? Lying to someone else just so she can get in and out?

So later she goes back into the room with her child running up and down the hallway. She doesn’t give him a second glance because you know; he’s not her responsibility when she’s in public. She then goes in the room and proceeds to say how unprofessional I am and rude. Good. Sorry I couldn’t assist you because you just waved some papers in my face and technically you shouldn’t even be here, you forfeited your appointment. Then she proceeds to ask for Dilaudids. She states the insurance rep that referred her here said the doctor would get her what she wanted. Lucky for our doctor this insurance rep so happens to be his friend and I find it hilarious she sends us all the drug addicts. But in our office girls that do not work with him on the daily are nothing short of angels. We are just lowlife servants that he can take out his frustrations on. But it pleased me to hear her repeat that woman’s name over and over and how she said that the woman told her that doctor would give her the pills. Dilaudid. Yes, of course what else would you like a medium coke? Well anyway by this time it was 4:30 and I was finally taking lunch. I kept watching her storm out of the office into this car then back in about two times. She then called up the insurance company and told them what happened. The doctor didn’t give her medicine. All the while she’s running around like a maniac. I wonder if she complained of back pain. She was fine, I’m sure. Maybe next time she’ll realize that you can’t just get things for free and she should have went on topix.com to find her doctor.

Topix.com, City-data.com

When people think of drug issues they think of kids and young adults, scampering around with our pills. I have seen very few people under the age of 30 come into our office for pain management. You know who the real culprits are? Middle age white people. If you'd like to see them from the safety of your computer screen I highly recommend typing into google something like where can I find oxycodone? Roxycodone? Or try one of these websites: Topix.com, city-data.com. These are live feeds of people right in your neighborhood! Usually I browse these sites for updates on current drug trends and motives and plots to get pills. 

I never knew what blues were till I found topix.com. Good thing for me because I actually had an encounter with a patient who told me only the blue ones worked. Right. What she meant to say was only the blue ones SELL. 

I just do not think the majority of the public really understands the sub-culture that these people have created. Do not fool yourself either, these people are not just the typical, run of the mill trailer park crew. They are the men and women who work right beside you. Maybe your superiors. They're the older ladies who really aren't so old, they just look that way. They're the cashier, or anyone who can come up with a positive MRI. Most likely they're the mom at the school play who complains to everyone about how hard it was for her to get out of bed this morning. Trust me, if you've heard a neighbor or someone complain about their back because of a motor vehicle accident or because they have fibromyalgia (I'll touch on this condition later), I'm sure they've washed up into some clinic before and I bet they still continue to do so. You can find some shady street lined with primary care doctors opening up shop under the alias of pain management. Usually these places only accept cash, and I don't think disability can cover those expenses $$. They'll write anything for the right price. So, try not to be so judgmental of the typical drug seeker. They're really just like you or me. Except I've had too much of them and I rather not ever get into the business of taking and dealing narcotics. I'll leave that one to the pros.

Really though check out http://www.topix.com/forum/drug/oxycontin

It will make you disgusted, but maybe you can manage a couple laughs out of it. 

I really love Mondays and I really love when Monday's happen to be on the first of the month.

The first of the month is always a dreaded day for me but its repute holds much more than paying the rent; insurances change on the first. I make my disdain pretty widely known in the office, because on that day I have to come in and verify that the patient’s are eligible. One probably thinks to their selves, what’s the big deal? Well here it is: Even if a patient understands you do not take an insurance, they will still try to weasel their way in for an office visit and hope that your adeptness to the understanding of insurances fall short. In part I hope they do these acts intentionally because I believe it is almost impossible that at least 90% of the people whose insurance changed that fall between the ages of 20 and 55 do not understand how it happened. I also like to think their stages of handling the situation is likewise for other doctors and other institutions that have the pleasure of gracing even the slightest time of these people. That's just wishful thinking.

There is a pattern to the response of these people. I usually prepare myself on the phone; give some alternative even before they get a word in. Usually that works in pain management, give the most ethical, kind response you can think before anyone can speak. I usually insist they change their insurance, here’s a list that we do accept! I do this in hopes of ending the phone call shortly so I can inform the next 10 people of their dismay. Nobody wants to hear that his or her pain management doctor cannot see them for their office visit. They’ve probably been out of pain medicine for weeks. Usually this approach works for the first phone call but they will call back.

After I give them my oration they get extremely angry. (Most of the time this is a matter with Medicaid. You would think having government funded insurance that you had to pay no more than 2 dollars as a copay – no premiums, no deductible – that you would keep up with it right?) They tell me they have regular Medicaid. They deny they have an HMO, although I am looking at their DCF profile online. They go on to say Medicaid MUST pay for my office visit. Politely, and with all my gathered patience for this day I state to them their insurance changed to an HMO, we do not accept it and go on to give them alternatives.

Afterwards they thwart their attention to the DCF/Medicaid office. I love this part because I can only imagine the things they say to the representatives there. How they’re entitled to pay everything, how could you change my insurance, blah blah blah. I’m not off the hook yet and now I have involved everyone in the office and they do not even know it yet. Soon enough the girls up front and even in the back will be inundated with phone calls, from the same 5-10 people I called this morning, trying to repeat the conversation but in much different tones. Most will call back, screaming, yelling, tells us the manager of Medicaid said that we must see them. Some call back and try to guilt us, they cry, they mope on the phone; none of them take No for an answer. Eventually they will call and then proceed to hang up on us. We cannot do anything, unfortunately.

So today I came in bright and early. A couple of patients have been nagging me the month before to check their insurances although the insurance does not change until the next month with medicaid. I decided to check one patient first because him and his girlfriend call about once a day to swear up and down Medicaid has changed his insurance. Then he tells me I need to check the insurance by 8:00 because of his appointment time. Apparently I have a new boss, and he isn’t paying me anything… Well his insurance was compatible with our office so I called him. It went straight to voicemail. An image of him ran across my mind, him lying around, probably not even up yet.

Anyway, I call my first insurance changed patient. At first she is pleasant, but eventually she followed through with every phase I have mentioned above. She put a twist on it though. She said that we hated her, that we were racist and this is why we would not see her. No matter what we said, we were racist and then she would hang up. The last time she called she even stated her disdain for her previous office visit, how the doctor wouldn’t give her what she wanted and how long the wait was etc. etc. You know what would have put the icing on the cake? If she would have said she was going to report us to Medicaid for not giving her the blue pills she wanted, I’ve heard that a couple times. Instead she just called us a couple more times and by 10 AM she was done. I mean that’s a lot of work to persistently harass a group of girls for more close to two hours.

I unjustly did not mention the 10% of the patients who’s insurance changed and they graciously fixed the situation without yelling at my first. I applaud them for taking the time and responsibility to understand their insurance, regardless of what kind of insurance it is. You go glen coco.