Our facility has a "Corporate Medical Services" that treats facility employees when they are injured on the job. I screwed up my back last Monday pulling an airway box off the crash cart during a "mock" code. Filled out all the necessary paperwork and seen by the ER physician (because it was after corporate was closed) and then went in next day to see corporate physician. Told him what happened and how much pain I am in (an 8 at its worse). Gave me script for Flexeril at bedtime, 800mg ibuprofen TID with food, and Darvocet N100 every 8 hours as needed for pain. Well, these drugs are not touching my pain. Went back to corporate on Wednesday to be seen again, and told the doc I was in a lot of pain. He did script me 10 Vicoden. I told him I had to work 12 hour shifts Thursday and Friday and was put on a lift restriction. I definitely don't want to be taking the Vicoden and the Flexeril when I am suppose to be working, so that leaves the ibuprofen. I worked my 12 hours Thursday, but there was no way I could today. I called in. I just couldn't do another 12 hours. I even wore my husband's TENS unit yesterday which at least made my day bearable.

I don't think this doc in corporate wants to give out strong meds, and I am not one to usually ask for them. I have never been to corporate in the 7 years I worked at the hospital except for a needle-stick. I don't go to the ER either unless something dire is wrong. So, what's the deal with this guy not giving me adequate pain meds? I also want to know are divisions of hospitals such as this mandated by JCAHO regs requiring pain relief? Because I sure am not having my pain relieved. I know that when it comes to back pain it is really hard to discern whether the patient is truly hurting or are they trying to scam for drugs. But I thought you were suppose to treat the patient's reports of pain, not what you perceive it to be. The doc actually told me the 2nd time I was in there that he didn't know what else to do for me.

If anyone is well versed on JCAHO regs and such, I would love to hear from you (NRSKaren, hint hint :wink:). Anybody else is free to give an opinion too. Thanks.

JCAHO has nothing to do with it, except that the docs have to perform at the accepted "standard of care" required by their situation. If you're not getting what you need, go to the ER. IMHO.

deespoohbear - so sorry you are in pain - unfortunately, physicians do not have to comply with the JCAHO stuff we know.

I would suggest you see another MD. This one sounds like he/she has a pre-concieved notion of your pain management - so why see the MD? If you are forces to see MD D/T workmans comp or some other such issue, I would still see another MD, make the insensitive one aware, and take care of yourself. You only have one back, keep it in good shape. I might also mention physical therapy for stretching and exercise and muscle strengthening. Good Luck -frankie

Thanks for the tips. I have already been in PT because I was having back pain for a month. It was getting better, then I screwed it up Monday night.

If I am still in pain Monday, I will just call my own physician and pay for the visit myself. (It is only a $10 copay). I seen this MD because this is the one are facility says we have to see when we are injuried on the job. He definitely would not be my first choice.

frankie- What do you mean by "physicians do not have to comply with the JCAHO stuff we know." Our facility is always after the doctors about signing off their orders, their documentation and such. I am confused by your statement. Could you be more specific about it? Thanks.

despoohbear

MDs are not inspected by JACHO. They must comply with the orginazational policies of the institution that grants them privleges, but as far as I know, they themselves, in practice are not inspected. There was talk of doing this for MDs. I do not know when JCAHO can/will implement this. So the thing to know is an orginization pays JCAHO lots of money to come to the facility and give it accreditation. JCAHO is a private company. Without JCAHO accreitation, the orginization is limited by insurance providers, association, etc...that requirre JCAHO accreditation. However, MDs are reimbursed without accreditation. that is something to chew on! take care of your back - frankie

Frankie-If I understand this correctly the physician is suppose to comply with facility policies in which they have privileges but not their "way of practicing medicine at the facility?" The MD I am seeing is employed by our hospital, and the corporate med services are a part of our facility. So this physician is bound by facility policy regarding pain control in accordance to JCAHO, I think. Gee, it is too late for me to be thinking this hard. Thanks for explaining this too me.

PS-I don't like JCAHO! (unless I can use their rules to benefit my patient or me!! )

Sounds like this doctor needs some of my educational material

JCAHO: Take the Ouch Out of Pain Management Standards

http://www.jcaho.org/accredited+organizations/long+term+care/ltc+update/2001issue2/take+the+ouch+out+of+new+pain+management+standards.htm

http://www.jcaho.org/news+room/health+care+issues/jcaho+focuses+on+pain+management.htm

Tools for implimenting JCAHO standards

http://www.partnersagainstpain.com/html/profed/PM_Guide/pmg.htm

JCAHO Pain Standards: Strategies for the Case Manager

by Carol P. Curtiss, RN, MSN

http://www.jcaremanagement.com/html/pain__jcaho_pain_standards__st.html

PA Physican Newsletter , Winter 2002: Principles of Highly Effective Pain Managers--****MUST READ***

http://www.dos.state.pa.us/bpoa/LIB/bpoa/20/10/medbd-newsletter.pdf

Harvard Pain Mgmt:

http://www.hmcnet.harvard.edu/brighampain/therapy/

Brownson's Nursing Notes :Pain Management

http://diannebrownson.tripod.com/pain.html

Purdue Frederick pain resources

http://www.partnersagainstpain.com/html/inst/lit_stu.htm

NRSKarenRN,

Thanks for the info - I have been JACHO deprived for a few years and feel out of touch.

frankie