Over the last few years, I have noticed that the Department of Health, Office of Professional Medical Conduct, OPMC, is systematically searching for doctors who, in the eyes of OPMC, are “treating” pain with nothing but the use of narcotics day after day, week after week, year after year. OPMC absolutely wants to put a stop to this practice and they are going to punish doctors who are operating in this fashion.
The fundamental issue is that OPMC wants doctors to try methods of treatment to deal with pain other than the never ending prescription of narcotics. They want to see that you as the primary care physician, or the pain management specialist, are constantly looking for other answers to this pain issue. The questions OPMC will be asking are, at least in part, the following:
Have you obtained a complete and accurate history from the patient regarding past narcotic usage?
Have there been radiology evaluations looking for the source of the pain?
Has the patient undergone physical therapy to improve the pain situation?
Has there been EMG testing looking for nerve issues?
Were opinions from surgeons regarding whether surgery might be the answer to alleviate the patient’s pain obtained in the past, etc?
If none of the above has been done in the past, you should direct the patient to have these tests and evaluations. Do not simply re-order the same narcotics visit after visit.
I believe that OPMC feels that a great deal of the patients are simply seeking drugs and therefore the doctor has to do the proper testing to see if the pain is real and, if so, are there ways to address it other than a lifetime use of narcotics. If, at the end of the day, the patient is simply addicted to drugs then there should be a referral to a professional who is experienced in that area.
The object lesson to be learned by you, the physician, is that you must stop giving narcotics to patients without any indication in your records that you are actively searching for an alternative method of treatment. If you fail to do this, then you might well become the object of an OPMC inquiry and that will be expensive, time consuming and might end up with a mark against your license or, at worst, the revocation of your license. Do not let this happen to you.