Saturday, November 27, 2010

When Physician Accuses Patient of Being "Drug Seeker"

The relationship between a physician and a patient is based on trust.  It is a two-way street.  Patients are expected to be honest.  Physicians are expected to likewise be honest.

As soon as the physician walks through the exam room doors, the professional must put aside every preconceived prejudice about the patient - or he should ask another doc to walk through the door.   The physician must put the patient's life and health first and foremost.  The physician must properly examine and provide the best possible care and treatment for the patient.

So what happens if the doctor has a preconceived notion that the patient is a malingerer or narcotic drug seeker.  Should the doctor ever bully the patient to prove his point?  No.  At that point, the trust relationship is fractured.

If the doctor is correct and the doc does nothing more than yell and bully, then the patient could become even more vulnerable and fragile.  The patient may be desperate enough to hurt himself or herself.  An unfortunate outcome.

If the doctor is incorrect and the doc is not listening to the patient's complaints of pain, he misses a diagnosis or causes the patient to undergo unnecessary pain (miss sleep, create anxiety/depression, delay healing ---- vicious cycle).  Another unfortunate outcome.

Physicians are human.  They get tired, they have errands to run the day before Thanksgiving.  But that is never ever an excuse to mistreat patients.  

Fortunately, medical boards and speciality boards provide guidance for physicians to deal with difficult situations.  Take a deep breathe, physicians.  Call a "time out" and consult the web-sites provided as guidance for sticky situations.

As I tried to explain to Duke Medical's Dr Raymond Wase on Thanksgiving eve 2010, there is both a written position statement and a procedure for dealing with patients that are believed to be "doctor shopping" drug seekers:

  • Do’s and Don’ts for Prescribers and Dispensers Using the NC Controlled Substances Reporting System
  • Check the database prior to prescribing or dispensing a controlled substance. 
  • Discuss any findings of concern directly with your patients but don’t give them a copy, have them contact us). 
  • Listen to your patients when they say the system is in error, and contact us to help verify if there are questions. 
  • Notify your patients that you use the system.
  • Learn about SBIRT (Screening, Brief Intervention and Referral for Treatment) and use with your patients.
  • Use behavioral contracts with patients where appropriate. 
  • Report forgeries to law enforcement. 
  • Inform us of non-reporting pharmacies.
  • Use the CSRS to exclude potential patients prior to engaging them. 
  • Discharge patients without intervening and attempting to refer for substance abuse treatment or pain management.
  • Have office people check the CSRS for you.
  • Refer suspected “Dr. Shoppers” to police (you may call us) where your only source of data is the CSRS. 
  • Give information to law enforcement from the CSRS (except for forgeries). 
  • Believe information from the CSRS is the gospel truth. There can be errors. CSRS is a TOOL.

The North Carolina Medical Board (NCMB) also provides physicians with a "position statement" for pain management issues.

Dr Raymond Wase classified my pain as "chronic pain."  According to the NCMB's definition, "chronic pain" is defined as:

Chronic Pain- Chronic pain is a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years.
As such and presuming Dr Wase understood the meaning of "chronic pain," Dr Raymond Wase must believe that my osteomyelitis has healed?  Huh?  Odd since I still have dead bone and a draining sinus and open sore that probes to the tibia. Also odd since I told Dr Raymond Wase that I was preparing for orthopedic surgery at Cleveland Clinic.

And remember that Duke proudly declares that Dr Wase is trained as an "orthopedic surgeon."  Weird.

What else does the NCMB position statement relate to North Carolina physicians and surgeons?

Policy for the use of controlled substances for the treatment of pain

Created: Sep 26, 1996
Redone July 2005 based on the Federation of State Medical Board's "Model Policy for the Use of Controlled Substances for the Treatment of Pain," as amended by the FSMB in 2004. Amended September 2008

  • Appropriate treatment of chronic pain may include both pharmacologic and non-pharmacologic modalities. The Board realizes that controlled substances, including opioid analgesics, may be an essential part of the treatment regimen.
  • All prescribing of controlled substances must comply with applicable state and federal law.
  • Guidelines for treatment include: (a) complete patient evaluation, (b) establishment of a treatment plan (contract), (c) informed consent, (d) periodic review, and (e) consultation with specialists in various treatment modalities as appropriate.
  • Deviation from these guidelines will be considered on an individual basis for appropriateness.
Section I: Preamble
The North Carolina Medical Board recognizes that principles of quality medical practice dictate that the people of the State of North Carolina have access to appropriate and effective pain relief. The appropriate application of up-to-date knowledge and treatment modalities can serve to improve the quality of life for those patients who suffer from pain as well as reduce the morbidity and costs associated with untreated or inappropriately treated pain. For the purposes of this policy, the inappropriate treatment of pain includes nontreatment, undertreatment, overtreatment, and the continued use of ineffective treatments.

The diagnosis and treatment of pain is integral to the practice of medicine. The Board encourages physicians to view pain management as a part of quality medical practice for all patients with pain, acute or chronic, and it is especially urgent for patients who experience pain as a result of terminal illness. All physicians should become knowledgeable about assessing patients’ pain and effective methods of pain treatment, as well as statutory requirements for prescribing controlled substances. Accordingly, this policy have been developed to clarify the Board’s position on pain control, particularly as related to the use of controlled substances, to alleviate physician uncertainty and to encourage better pain management.
Inappropriate pain treatment may result from physicians’ lack of knowledge about pain management. Fears of investigation or sanction by federal, state and local agencies may also result in inappropriate treatment of pain. Appropriate pain management is the treating physician’s responsibility. As such, the Board will consider the inappropriate treatment of pain to be a departure from standards of practice and will investigate such allegations, recognizing that some types of pain cannot be completely relieved, and taking into account whether the treatment is appropriate for the diagnosis.
The Board recognizes that controlled substances including opioid analgesics may be essential in the treatment of acute pain due to trauma or surgery and chronic pain, whether due to cancer or non-cancer origins. The Board will refer to current clinical practice guidelines and expert review in approaching cases involving management of pain. The medical management of pain should consider current clinical knowledge and scientific research and the use of pharmacologic and non-pharmacologic modalities according to the judgment of the physician. Pain should be assessed and treated promptly, and the quantity and frequency of doses should be adjusted according to the intensity, duration of the pain, and treatment outcomes. Physicians should recognize that tolerance and physical dependence are normal consequences of sustained use of opioid analgesics and are not the same as addiction.
The North Carolina Medical Board is obligated under the laws of the State of North Carolina to protect the public health and safety. The Board recognizes that the use of opioid analgesics for other than legitimate medical purposes pose a threat to the individual and society and that the inappropriate prescribing of controlled substances, including opioid analgesics, may lead to drug diversion and abuse by individuals who seek them for other than legitimate medical use. Accordingly, the Board expects that physicians incorporate safeguards into their practices to minimize the potential for the abuse and diversion of controlled substances.
Physicians should not fear disciplinary action from the Board for ordering, prescribing, dispensing or administering controlled substances, including opioid analgesics, for a legitimate medical purpose and in the course of professional practice. The Board will consider prescribing, ordering, dispensing or administering controlled substances for pain to be for a legitimate medical purpose if based on sound clinical judgment. All such prescribing must be based on clear documentation of unrelieved pain. To be within the usual course of professional practice, a physician-patient relationship must exist and the prescribing should be based on a diagnosis and documentation of unrelieved pain. Compliance with applicable state or federal law is required.
The Board will judge the validity of the physician’s treatment of the patient based on available documentation, rather than solely on the quantity and duration of medication administration. The goal is to control the patient’s pain while effectively addressing other aspects of the patient’s functioning, including physical, psychological, social and work-related factors.
Allegations of inappropriate pain management will be evaluated on an individual basis. The Board will not take disciplinary action against a physician for deviating from this policy when contemporaneous medical records document reasonable cause for deviation. The physician’s conduct will be evaluated to a great extent by the outcome of pain treatment, recognizing that some types of pain cannot be completely relieved, and by taking into account whether the drug used is appropriate for the diagnosis, as well as improvement in patient functioning and/or quality of life.
Section II: Guidelines 
The Board has adopted the following criteria when evaluating the physician’s treatment of pain, including the use of controlled substances:

Evaluation of the Patient - A medical history and physical examination must be obtained, evaluated, and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance.
Treatment Plan - The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of each patient. Other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment.
Informed Consent and Agreement for Treatment - The physician should discuss the risks and benefits of the use of controlled substances with the patient, persons designated by the patient or with the patient’s surrogate or guardian if the patient is without medical decision-making capacity. The patient should receive prescriptions from one physician and one pharmacy whenever possible. If the patient is at high risk for medication abuse or has a history of substance abuse, the physician should consider the use of a written agreement between physician and
  • patient outlining patient responsibilities, including
  • urine/serum medication levels screening when requested;
  • number and frequency of all prescription refills; and
  • reasons for which drug therapy may be discontinued (e.g., violation of agreement); and
  • the North Carolina Controlled Substance Reporting Service can be accessed and its results used to make treatment decisions.
Periodic Review - The physician should periodically review the course of pain treatment and any new information about the etiology of the pain or the patient’s state of health. Continuation or modification of controlled substances for pain management therapy depends on the physician’s evaluation of progress toward treatment objectives. Satisfactory response to treatment may be indicated by the patient’s decreased pain, increased level of function, or improved quality of life. Objective evidence of improved or diminished function should be monitored and information from family members or other caregivers should be considered in determining the patient’s response to treatment. If the patient’s progress is unsatisfactory, the physician should assess the appropriateness of continued use of the current treatment plan and consider the use of other therapeutic modalities.  Reviewing the North Carolina Controlled Substance Reporting Service should be considered if inappropriate medication usage is suspected and intermittently on all patients.
Consultation - The physician should be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention should be given to those patients with pain who are at risk for medication misuse, abuse or diversion. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder may require extra care, monitoring, documentation and consultation with or referral to an expert in the management of such patients.
Medical Records - The physician should keep accurate and complete records to include
  • the medical history and physical examination,
  • diagnostic, therapeutic and laboratory results,
  • evaluations and consultations,
  • treatment objectives,
  • discussion of risks and benefits,
  • informed consent,
  • treatments,
  • medications (including date, type, dosage and quantity prescribed),
  • instructions and agreements, and
  • periodic reviews including potential review of the North Carolina Controlled Substance Reporting Service.
Records should remain current and be maintained in an accessible manner and readily available for review.
Compliance With Controlled Substances Laws and Regulations- To prescribe, dispense or administer controlled substances, the physician must be licensed in the state and comply with applicable federal and state regulations. Physicians are referred to the Physicians Manual of the U.S. Drug Enforcement Administration and any relevant documents issued by the state of North Carolina for specific rules governing controlled substances as well as applicable state regulations.
Section III: Definitions 
For the purposes of these guidelines, the following terms are defined as follows: 
Acute Pain- Acute pain is the normal, predicted physiological response to a noxious chemical, thermal or mechanical stimulus and typically is associated with invasive procedures, trauma and disease. It is generally time-limited.

Addiction- Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include the following: impaired control over drug use, craving, compulsive use, and continued use despite harm. Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and are not the same as addiction.
Chronic Pain- Chronic pain is a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years.
Pain- An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Physical Dependence- Physical dependence is a state of adaptation that is manifested by drug class-specific signs and symptoms that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Physical dependence, by itself, does not equate with addiction.
Pseudoaddiction- The iatrogenic syndrome resulting from the misinterpretation of relief seeking behaviors as though they are drug-seeking behaviors that are commonly seen with addiction. The relief seeking behaviors resolve upon institution of effective analgesic therapy.
Substance Abuse- Substance abuse is the use of any substance(s) for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed.
Tolerance- Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce a specific effect, or a reduced effect is observed with a constant dose over time. Tolerance may or may not be evident during opioid treatment and does not equate with addiction.
Physicians need not label patients and call patients names .... at least not straight away to our face.  Patients would be well advised to use the resources available for them and do not presume that every pain patient is faking or malingering.

Case in point:  Sick, pre-surgical patients (such as myself) have elderly widowed moms that we care for and we must schedule even medical trips (in my case from NC to Cleveland) to coordinate with other family members.  

That means I suffer with pain and disability longer before I can have surgery.  

I don't seek accolades. I certainly don't expect criticism.

I am not a martyr. But I am also certainly not a malingerer.  

I just ask that that physicians please refrain from treating patients in situations like mine as drug seekers without any factual basis.  I trust physicians when I make the appointment and write a check for the co-pay.  

Abandoning me and mistreating me hurts my feelings and makes it more difficult for me to trust the next doctor.

Friday, November 26, 2010

Who is Duke Medical's Dr. Raymond Wase & Why Does He Hate Patients?

Duke University Medical is holding Dr. Raymond Wase out to be a trained orthopedic surgeon.  Specifically, Duke University Medical implies that Dr. Raymond Edward Wase completed a surgical residency in orthopedic surgery. 

Is this another example (as with former Duke University researcher Anil Potti, MD) that Duke University Medical fails to properly check credentials of professional employment applicants?  Perhaps Duke University Medical is focusing so desperately on growing in size that they need warm bodies and it doesn't have time to check each applicant's credentials.  

If Dr. Raymond Wase has the professional experience and training he claims:

1.  Why didn't he seem to know anything about progression of the bone infection osteomyelitis?  [bone infection seems like orthopedics 101]

2.  Why on Earth would a trained orthopedic surgeon such as Dr. Raymond Wase  think that my pain was "chronic" like fibromyalgia?  [I presented with an open surgical wound and told Dr. Wase I was doing preop tests for surgery]

3.  Why couldn't Dr Raymond Wase know that I would be in pain with osteomyelitis?  [again, bone pain with this infection is like orthopedics 101]

4.  Why didn't he know or even have an impulse to care about an orthopedic patient (such as me) and bandage my wound? [IMHO either incompetent or does not give a damn about patients.  Either way, run, crawl or call about from Dr. Raymond Wase.]

5.  And why is there a gap in Dr. Raymond Wase's brief curriculum vitae presented on Duke University Medical's own web-site?  [Gaps in employment are always a good employment interview question.  Hmm.]

    Dr. Wase claims to be a Fellow in American College of Emergency Medicine.  Remember that we should also be sure to check whether our physicians are "board certified."  That will include Dr. Raymond Wase for me.  American Board of Medical Specialties   

    Older board certifications don't ever have to be renewed.  Newer certifications require "re-certification" (or "maintenance of certification"). 

    The reference to Dr. Raymond Wase being trained as an orthopedic surgeon  during a residency is repeated throughout the Internet (one of a number of examples includes:)

    Primary specialty - 
    Internal Medicine 

    Gender - 

    School - 
    Univ Of Fl Coll Of Med, Gainesville Fl 32610

    Training - 
    Carolinas Med Ctr, Internal Medicine; Carolinas Med Ctr, Orthopedic Surgery; Carolinas Med Ctr, General Surgery

    Major - 
    Office Based Practice

    Accepts new patients - 

    Certification - 
    Emergency Medicine

    First name


    Middle name


    Last name


    Thursday, November 25, 2010

    Is there a billing code for physician threatening patient?

    After having processed the verbal assault from Duke Medical's Dr. Raymond Wase, the question comes to my mind: What precisely constitutes an "office visit" with a physician?

    I first met Dr Raymond Wase on Saturday November 6, 2010, because the pain and wound were becoming unmanageable.  I was still waiting for the pre-op appointments to be scheduled by my Duke Medical primary care physician.

    Dr Wase wanted me to go the Duke University Hospital Emergency Department and be admitted to the hospital.  That seemed a bit drastic since I was in the "pre-op" phase, did not have a fever or any other evidence of acute systemic infection.  He did not provide any pain or wound care at the 11-6-2010 appointment.

    I did agree to speak with Duke Medical Infectious Disease on Tuesday November 9, 2010.  It was at that visit that I was firm in my resolution that Duke Orthopedics was not equipped to deal with my infection.  I continued with the pre-op for the surgery to be performed at Cleveland Clinic.

    Duke Medical has plenty of patients.  Why on Earth were Duke physicians so insistent on my having the second osteomyelitis surgery at Duke University Hospital?

    Fast forward to Wednesday November 24, 2010.  
    • I was unable to complete the pre-op bone scan because of debilitating pain associated with the bone infection.  
    • Thanksgiving is just my mom and myself.  
    • Dad died 1/15/2010 while being treated by Duke Medical (Orthopedics and Infectious Disease) for bone infection.
    • I thought that my (newly widowed) mom deserved for me to not be bed-riddened on Thanksgiving.  Mom deserved to have her family not be suffering at this first holiday season without her husband of over 55 years.
    I sat in the room waiting on Wednesday November 24, 2010, for Dr Raymond Wase for about 15 minutes.  The door hardly shut behind Dr Wase before he said "you again" and asked me "what is going on"?  Before Wase could allow me to answer, he proclaimed that I could not expect to come into "his clinic" and get pain medication.

    I tried to explain that I was in the process of having pre-op procedures so that I could have surgery.  He asked me for the date of the surgery. I said it was not yet scheduled.  

    Before I could explain that Duke Medical primary care physician was not cooperative in scheduling the pre-op, Dr Wase just shook his head and smirked. He looked at me as though I was lying about having a surgeon at Cleveland Clinic and lying about going to Cleveland Clinic for the bone scan next week.

    Dr Wase never looked at my wound.  In fact, Dr Wase made a concerted effort to not look at my wound or examine me in anyway.  

    Dr Wase never moved from the area of the exam room door.  When I tried leave with my walker, Dr Wase moved his body to block my exit.  Dr Wase wanted me to go to the Duke University Hospital ED "so that we can determine the cause of the pain."   

    When I insisted to Dr Wase that I just wanted to go home since no one would help me with the pain, Dr Wase actually threatened me.  Dr Wase stuck out his chest and ego and stated "if you leave now then I will chart that you were here to get narcotics and everyone will know you were drug seeking."  

    I'm sorry, doc.  I didn't catch that.  You are going to chart what exactly?  Will that affect me getting into the college of my choice.  And, Dr Wase who exactly is "everyone"?

    I have an idea, doc.  Why don't you chart how you had no intention of ever examining me, treating me, communicating with me or in any other conceivable way using any skill beyond that of a street thug or fifth grade school bully?  Then give me back the $20 copay you took under false pretenses at the front desk.

    Wednesday, November 24, 2010

    When (Duke) physicians insult patients - Dr. Raymond Wase

    This post could apply to any medical facility.  

    There is never ever ever a reason for a physician to insult a patient.  I have been insulted by Duke University physicians so many times that I begin to wonder why I even keep trying.

    I do not trust Duke University Orthopedics and Duke Infectious Disease in terms of medical implants, joint replacements, metal fixators because there is a real possibility of bone infection (osteomyelitis).  Those two Duke Medical Departments put my dad through a living Hell  for one and one-half years before he died with severe osteomyelitis in January 2010.

    By sheer coincidence I developed osteomyelitis in September 2010.  Duke Orthopedics tried to surgically resolve the infection on 9-13-2010.  The surgeon was Dr Michael Bolognesi and the surgery failed.  I was discharged with a completely open wound (and no explanation of why the surgery for  osteomyelitis failed) on 9-18-2010.

    I communicated with Duke physicians (including Dr Bolognesi and the attending infectious disease physician) about additional treatment.  I received no sense of confidence that Duke University Medical could resolve my osteomyelitis any more effectively than they resolved my dad's osteomyelitis.  And I knew what dad's outcome was - death.

    I traveled to Cleveland Clinic and met with a terrific surgeon who knew immediately what he would do.  The Cleveland Clinic orthopedic surgeon immediately made referrals for a plastic surgeon and infectious disease consult.  For the first time in many years I felt completely safe and confident with a surgeon as I faced a life threatening condition.

    Cleveland Clinic expects to work with Duke.  The problem is that Duke physicians generally have way too big egos (except for one phenomenal cardiologist that keeps me at Duke) to play well with others.

    I thought that it would be most appropriate if I obtained pain medications at Duke Medical in North Carolina since they had an established relationship with me since 1985.  They would know that I did not abuse narcotics/pain medications.

    Now something odd is going on.  Duke Medical has no intention of alleviating my pain.  Today (the day before Thanksgiving 2010),  I broke down and went to Urgent Care at Duke Medical.  The doctor (Dr Raymond Wase) had seen me previously as I was still talking to Duke physicians about where I would have the surgery.

    Dr Raymond Wase is an urgent care physician at Duke Medical in Morrisville, NC. During the abbreviated "appointment" I tried to explain to Wase that I had pre-op appointments yesterday at Duke and I am going to Cleveland next week for additional pre-op appointments.

    Dr Wase was hostile towards me and certainly not interested in providing medical care.  He blocked the door so that I could not move my walker out of the office.  He said "You cannot just come into this office and expect pain medications."  I tried to explain that I was getting all of the pre-op work done and that I was having surgery in Cleveland.  Crickets.  

    Duke's Dr Raymond Wase told me that I was told I could go to Duke Orthopedics anytime.  I told this doctor who obviously wasn't listening to me that I did not trust Duke Orthopedics.  I told him that I spoke with Dr Robert Wolfe at Duke Infectious Disease and that there was not a plan in place that I felt comfortable with.

    Dr Wase then told me that I have "chronic pain." Really?  I have osteomyelitis.  I have dead tibia bone and tremendous pain in my legs and back that effective keep me bed-ridden.  The pain is not really "chronic."  If I don't have the surgery, I will die from this.  

    Dr Wase told me "even good people with chronic pain can become addicted to pain medication."  Really?  I did not even get a script for pain medication on 9-18-2010 when I was discharged with the open wound!  It has been over 2 months since the discharge.  

    I have never received pain medication from you.  In fact, I have only received 30+15+8 pain control pills since 9-18-2010 and those pills were prn 1-2 pills taken every 4-6 hours.  Dr Raymond Wase . . . is that really an indication that I am heading down the dangerous road of narcotic drug dependency?

    Dr Wase told me that he was going to call Dr Wolfe and ask whether Wolfe thought my receiving additional pain medication was appropriate.  Okay.  Then Dr Wase left me in the room alone where I felt more and more like a criminal than a patient. 

    I walked out in pain and tears about 15 minutes later.  Dr Wase was still on the phone "checking me out."

    Dr Wase's comments to me were beyond insensitive.  

    The comments were insulting.  Dr Wase was effectively telling me that he did not believe that I was in pain.  Either (1) Dr Wase thought  I was lying about being in pain or (2) Dr Wase is ignorant about the pain caused by osteomyelitis.  

    Either way, Dr Wase is (IMHO) a poor clinician.

    Monday, November 22, 2010

    When Duke Physicians Refuse to Treat Pain

    I have done my best to deal with the pain of osteomyelitis and orthopedic injuries.  In a word, I *suck* it up.

    I have a hole in my leg today (as I have had since 7-30-2010).  And, yes, it hurts.  I tell Duke physicians that I am bed-ridden with pain since the 9-13-2010 Duke surgery to resolve the bone infection failed.  Crickets.

    Duke Orthopedic Resident (Level 2) Jonathan C. Riboh, MD worked with orthopedic surgeon (and Zimmer Orthopedic medical device surgical adviser) Michael Bolognesi, MD on the failed surgery.  Neither of them explained the surgery, acknowledged the failure at discharge or the increase in pain.

    Maybe Duke Orthopedics, infectious disease and primary care in general don't understand the North Carolina Medical Board's Position Statement on pain management.

    The NC Medical Board does not want patients to be in pain.

    In my situation, the refusal of Duke to alleviate the pain results in my not being able to get a bone scan to determine the extent of the bone necrosis (death) beyond the bone death already confirmed by Cleveland Clinic.

    Bone infection (osteomyelitis) causes pain.  And, as Duke knows, the pain has spread to my back, thigh and contra lateral leg.  

    My dad had osteomyelitis last year (died 1-15-2010) and he rarely received pain medication.


    1.  Duke Orthopedics and Duke Infectious Disease physicians really do not believe that bone infections involving open draining wounds that probe to bone are painful or

    2.  Duke Orthopedics and Duke Infectious Disease physicians do not care whether their patients are in debilitating pain.

    Wow.  Quite a choice.

    Saturday, November 20, 2010

    Spoiler: Nothing to be thankful for this year

    It is bad enough that dad died unexpectedly in January 2010 while being treated at Duke Medical.  (Two days before his death I wanted dad's oncologist to see him but the office said he was fine.)

    Fast forward to November 20, 2010:

    1.  Duke Orthopedics's Michael Bolognesi, MD admits me in hospital at 11:55 pm on a Friday 9-10-2010 with a bone infection and then does zero to treat me until Monday 9-13-2010.  I just sat in the hospital room reading my Kindle.  Thereafter, Dr. Bolognesi ignores my reports that the wound is reopening, I am vomiting daily, the wound is wide open, the wound is wide open at discharge and I am in severe pain.  I am discharged with no physician looking at the open wound and discharged without pain medications.

    2.   The Duke Infectious Disease meets with me while I am in severe pain.  I report I am in severe pain and have difficult walking.  The Duke ID physician knows that I can not lie flat on a table.  The Duke ID physician does not prescribe any pain medications.

    3.  I visit my Duke Primary Care Physician several times after the 9-18-2010 discharge while I am in severe pain.  His office actually refuses to ever prescribe pain medications!  I call the pcp's office on Thursday 9-17-2010 and explain that I have pre-op appointments on 9-23-2010 among which include a bone scan.  I am bed-ridden in pain and cannot lie still for a bone scan.  The nurse said I must come in for an office visit.  Not physically possible.

    4.  I will get a ride to the pre-op tests scheduled by Duke on Tuesday 9-23-2010.  But, I wont be able to undergo the bone scan or the MRI because I am in too much pain to lie still.  I have explained that fact repeatedly to Duke physicians.

    5.  I am unclear why Duke Medical is requiring that I continue to be bedridden in pain. It is bad enough that I am bedridden with pain (bone infection, dead tibia bone and severe lower and mid back pain with vomiting) on days when I do not have necessary medical tests.  

    Duke evidently does not care that I suffer every day.  Fine.  I get it.  They did that with day.

    But now Duke is forcing me to forego pre-op tests that would allow another surgeon at Cleveland Clinic to help me by maintaining me in a state of debilitating pain.  


    I have nothing to be grateful for this holiday season.  Last year I was advocating for dad.  Now I do not even have the strength to advocate for me.  And my worn out mom must be ready to just give up.

    This is the first year of my life that I don't care anymore ... I don't expect anything to better.  The professionals that I always admired and trusted (medical) have changed and are no longer motivated by helping others.

    Query what motivates these medical professionals (physicians, surgeons) -- money?

    Saturday, November 13, 2010

    Why does my Duke University orthopedic surgeon practice medicine?

    I am no fan of Obama Care.  I am a firm believer that every responsible person should have some sort of medical insurance.  It is responsible.  There should not be a "pre existing" issue because people should not ever be without insurance.

    And this comes from a person with a history of cancer and orthopedic issues.

    At this moment, I have osteomyelitis in my left tibia.  I had surgery to clean out the bone infection on 9-13-2010.  Sadly, the surgery was not a success.  

    The reason for the surgery's failure is less important than the fact that no one in the hospital listened to me when I mentioned that the wound was opening two days after the surgery or that the wound was wide open on the day of discharge.  

    My surgeon (who is featured on the video) never explained the surgery to me, never scheduled a follow up appointment with me.  And why should he?  He earns much more money as the surgical advisor for:

    1.  Speakers Bureau: Zimmer Orthopedics 
    2.  Consultant:  Zimmer Orthopedics 
    3.  Consultant:  Biomet
    4.  Consultant:  Total Joint Orthopedic
    5.  Consultant:  Amedica Corporation
    6.  Research Funding:  United States Federal Clinical Trials (NIH, Pfizer)
    7.  Stockholder:  Amedica Corporation
    8.  Stockholder:  Total Joint Orthopedic
    9.  Research Support:  Zimmer, DePuy, Johnson & Johnson, Wright Medical 

    [  as reference for above]

    I begrudge no one making money.  I am a capitalist.  The problem I have is that joint replacements are becoming a money maker ---- like cosmetic Botox injections being given by dentists.  

    I want my orthopedic surgeon to be first and foremost a surgeon with his fiduciary duty to me, the patient.  I become concerned when the orthopedic surgeon ignores me.  When I then learn that he is not first and foremost interested in patient care, I become concerned about the practice of physicians becoming too involved with the suppliers who provide significant income to the surgeon and his facility.

    Then I begin to wonder how an orthopedic surgeon (Dr. Michael Bolognesi) with so few years experience can become the Director of Adult Reconstruction Orthopedic Surgery at Duke University.  

    There are many more experienced orthopedic surgeons at Duke.  Perhaps those more experienced orthopedic surgeons at don't have the corporate contacts. 

    Regardless of experience, even orthopedic "surgical advisers" like Dr. Bolognesi doesn't know how to prevent, diagnose, treat osteomyelitis (a bone infection which is common for immune compromised patients who have foreign metal objects placed in their body).

    My orthopedic surgeon had no intention of following my care and everyone knew the wound was open when I discharged from the hospital. Dr. Michael Bolognesi scheduled the first post op for a day he was in surgery!

    What if I was 75 years old, rehabbing from a hip replacement and in a nursing home?  Chances would be heightened that I would have a complicated wound issue.  

    My metal was placed in December 2004 and hurt everyday until it was removed in July 2010.  The infection did not become obvious until the metal was removed.  And, it is very difficult to locate a surgeon that can properly treat the bone infection.

    Ask questions before agreeing to have metal (especially joint replacement) placed in your body.  Is your orthopedic surgeon a surgeon or a sales rep for an orthopedic device company?

    By the way, thanks Dr. Chris Dangles (Carle Clinic in Urbana, Illinois) for performing the unnecessary surgeries in 2000 & 2001 that started the last 10 years of nightmare.

    And of course thanks to the orthopedic doctors who knew what Dr. Dangles did (and the fact that he stated under oath "I don't know why I performed the surgery" and "I think Cheryl fell down a lot because she had a drinking problem") - Dr. Mark Easley and Dr. Armen Kelikian.  Protecting bad doctors corrupts your profession.  

    Please -  remember first do no harm and always remember the patient comes first.