Tag Archives: Pain

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The Story of “Doctor Pat”

pat and skeleton

In early 2000 I was toying with the idea of hosting a radio call-in show. Well, the show still hasn’t happened. But that didn’t deter my former college roomie, Phil Ward, from writing the theme song.

A few weeks after hearing of my intentions, he surprised me with “Doctor Pat.” The song was featured on his album “Easily Amused.”

easily amused

Now Phil has graciously given me permission to share “Doctor Pat” on YouTube.

you tube dr pat

(Disclaimer: It was very touching that my talented friend paid me such a tribute… However, the only part of the song I stand by is the FIRST LINE !!!)

“Doctor Pat” by Phil Ward

Chronic pain sufferers all is not lost,

Spinal stimulators at half my cost.

Nerve blocks, epidurals, everything must go,

I must be insane my prices are so low.

 

Take advantage of my craziness before they come and get me,

Doctor Pat, Doctor Pat.

I want to give it away but my wife won’t let me,

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

 

Morphine pumps, facet blocks, trigger point injections,

In flagrant violation of my bookkeeper’s directions.

May I just introduce one little concept at this juncture?

No payments ‘til 2002 on first time acupuncture.

 

And no money down on electronic implants with,

Doctor Pat, Doctor Pat.

Everybody get nuts and do a pain free dance with,

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

 

Take advantage of my craziness before they come and get me,

Doctor Pat, Doctor Pat

I want to give it away but my wife won’t let me,

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat.

ap trail pat and phil Phil and Pat, circa 1982

“Doctor Pat” was written by Phil Ward with a little help from Doctor Pat (P. Ward, J. Murphy) Copyright 2001, ASCAP.

Thanks to Stephen Bassett for helping me with my first ever attempt at posting a YouTube video.

Discover the genius of Phil Ward – entertainment’s true Renaissance Man – by exploring Phil’s website and visiting his Facebook page.

James Patrick Murphy, MD, MMM

jamespmurphymd.com

Twitter @jamespmurphymd

Doctor Pat on YouTube http://www.youtube.com/watch?v=6vuUpSnPXz0

Phil Ward’s Facebook page https://www.facebook.com/pages/Phil-Ward-Live/180936201939986

Download “Doctor Pat” from iTunes https://itunes.apple.com/us/album/easily-amused/id69823459

Phil Ward, Trough Records philwardmusic.com

Easily Amused http://www.rhapsody.com/artist/phil-ward/album/easily-amused/track/doctor-pat

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OPIOID EMAIL RECAP

Screen Shot 2014-02-10 at 10.14.19 PM

The premier offering of “Optimal Prescribing Is Our Inherent Duty” concluded on Sunday, February 9th.  I plan on having more to say… soon.

For now, I thought it worthwhile to share the three emails I sent to our staff, participants, and faculty each evening.

It was a sincere privilege to serve with the OPIOID team.

OPIOID picture

FEBRUARY 7, 2014 – DAY ONE

Dear all OPIOID’ers,

Well, day ONE was a great success. All ten participants were energetic and focused. Our GLMS staff was superb. After an overview by yours truly, Dr. Paul Sloan gave a thorough review of pharmacology and guidelines. Then Detective Beth Ruoff did a fantastic job explaining the diversion issues facing prescribers.  Dr. Boz Tabler educated us on the science behind addiction. Lastly, Dr. Heather Tluczek joined the team and facilitated two earnest and brutally honest Healing Place peer mentors offering a gut wrenching account of the toll addiction exacts.

hp

The staff of The Healing Place was great. The room was perfectly outfitted. And the food was delicious.  And we ran on time all day! Thanks to Dr. Mary Helen Davis and Dr. Mark Boswell for stopping by for support…  the day before they present.

Tomorrow (Saturday) we are at the Greater Louisville Medical Society headquarters for DAY TWO. More great lectures, discussions, and experiential learning!  It’s happening! More later…

– Pat

old school now

FEBRUARY 8 – DAY TWO

Dear Friends of OPIOID,

Day TWO has come and gone… and what a day it was!

mhd

We convened bright and early at the Old Medical School Building (GLMS headquarters). After some camaraderie and a hot breakfast, Dr. Mary Helen Davis took us through the inner workings of KASPER, the governmental process involved in making policies, and finished with a discussion on physician motivation in the age of regulatory expansion.

boz

We then had what, to the casual observer, must have looked like group therapy – led by Dr. Boswell Tabler.  I believe this was another major breakthrough moment in the course, as the participants began to open up with personal accounts. At the end, all seemed to be fully motivated to make the changes necessary to be successful.

boz and ken

Then Dr. Ken Kirsh gave an extremely thorough review of the interface between pain and psychological issues. This was followed by Dr. Tabler’s interactive discussion on psychiatric treatment strategies.

After breaking for lunch, Dr. Mark Boswell had us enthralled by his categorical run down of the different types of challenging pain patients. He followed this with a lecture on how to screen for psychological pathology in our patient population.

Then it was on to “Pain Management Meets Speed Dating.” Dr. Heather Tluczek, along with Dr. Patrick Myers and seven other gifted actors posed as various types of challenging pain patient – allowing the course participants private one-on-one mock interviews.  This was a fast-paced, exhausting, and enlightening experiential learning exercise. Everyone had a good time and learned something about themselves.

Tomorrow Dave Hopkins will get us up to speed on KASPER. Then I will be bringing it home with a thorough run down of Kentucky’s laws and regulations. We will conclude by getting familiar with some “tools” and memory aids in order to help the participants apply their new skills efficiently in their own practice setting.

This is going great! Our GLMS staff is fabulous. Our OPIOID faculty is superb. I almost don’t want it to end.

– Pat

really dave and boz

FEBRUARY 9 – DAY THREE

Dear OPIOID friends,

In May of 2012, just after Kentucky passed House Bill One on the last day of a Special Legislative Session, the thought of having a comprehensive educational course for prescribers took root. Well, today that sapling idea bore fruit.

The inaugural OPIOID course concluded today around 1:00 pm. It was three days packed with lectures, group dynamic work, testimonials, didactics, theatre, poetry, and focused engaged effort by ten pioneering participants.

dave K

Today we had breakfast together then nourished our minds with 90 minutes of Dave Kasper, err, I mean Dave Hopkins – the KASPER director. He loaded our heads with vital information about our state’s electronic prescription monitoring program. I then led a discussion on drug screens and compliance monitoring.  During our final two hours we poured over the Kentucky pain regulations in detail and learned strategies on how to incorporate the rules effectively into our daily practice routines.

What was most gratifying to me was seeing how our participants (now to be rightly known as our “partners”) remained focused and underwent a metamorphosis of sorts. But in reality, I don’t believe they were changed in any way by the course. Instead, I believe OPIOID may have rekindled a spark in each of them that was already there – only perhaps a bit beaten down by the regulatory grind. I know I was inspired by what happen over these past three days.

I am grateful to so many people and in the coming weeks I plan on communicating that message in other formats. For now, let me just say that everyone who participated – staff, volunteers, faculty, students, and even our impromptu professor GLMS security guard “Cory” felt something special had happened over the past three days.

…and something special has begun.

Yours in earnest gratitude,

– Pat

juggle dr m

*still juggling…

patient

practice

community

*P.S. You had to be there.

3 balls

 

James Patrick Murphy, MD, MMM  is President of the Greater Louisville Medical Society.

 

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OPIOID Possibilities are Limitless

65_doctor_saying_sto

“What am I supposed to do? I’m over the limit.”

Recently I was visited by a patient “warrior”. I hadn’t known her before, but she had read one of my articles online and wanted to meet me.  I was touched. There in the foyer of our surgical center, she motored up in her electric scooter and smiled the genuine smile of a person seeing a long lost friend.

Are there limits to friendship? No.
Are there limits to prescribing opioids for pain? Maybe.

At the vortex of misinformation swirling around pain regulations is the fact that no state has limited what physicians are allowed to prescribe, although some states make it unwieldy to treat legitimate pain patients compared to other states; some set unsubstantiated quantity limits while others require consultation to a pain specialist if a predetermined (yet not scientifically proven) “morphine equivalent dose is prescribed”.  Nevertheless, no states unilaterally prohibit a prescription at any dose if the regulations are followed.  However, requiring a pain specialist in some cases may become a logistical nightmare because in most instances there are not enough pain specialists to go around.

photo-stepping-over-the-line1

To be sure they have created thresholds above which physicians are required to do certain obligatory actions like: drug screens, re-evaluations, treatment agreements, and database queries. But these requirements do not represent ceilings to what can be prescribed – as long as it is medically necessary.

Are these regulatory obligations rational, reasonable, fair, or effective? That is a subject for another article. What is true now, however, is that prescribers are drowning.

“OPIOID” is the acronym used in an upcoming seminar that aims to rescue prescribers from the regulatory maelstrom.

OPIOID picture

“OPIOID” means Optimal Prescribing Is Our Inherent Duty. It is a seminar conceived by physicians, approved by Kentucky’s Medical Board, and produced by the Greater Louisville Medical Society in association with the University of Louisville – February 7 – 9, 2014.   The goal of “OPIOID” is to empower prescribers to optimally care for suffering patients and adhere to the governing regulations.  Clinicians and support staff can register by email: physician.education@glms.org or call: 502-736-6354 or visit online at https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).

My new friend, whose pain had confined her to her motorized chair, wasn’t quite convinced when I assured her that her state’s (Indiana) regulations did not limit what her doctor could prescribe. But in her friendly eyes I saw hope. And her hope gave me strength.

Am I strong enough to climb over the barriers created by these regulations? Are you?

As long as there are patients willing to fight the good fight, then so will I.  And courses like “OPIOID” provide us the tools we need to win. Together, the possibilities are limitless.

nolimits

James Patrick Murphy, MD, MMM

January 26, 2014

Note: This article was originally posted January 27, 2014 on Dr. Jeffrey Fudin’s blog http://paindr.com/opioid-possibilities-are-limitless-2

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The Urgent Need for OPIOID

two tangential universes: therapeutic and pathologic

tangential u darko

In the therapeutic universe suffering is relieved, lives are enhanced, and hope is restored. Central to this universe are the pain care needs of 100 million suffering Americans.

In the pathologic universe suffering is unleashed, lives are enslaved, and hope is shattered.  Ruler of this realm is drug abuse – now killing even more Americans than automobile accidents.

Common to both universes is the prescriber – and the tangent point is OPIOID.

OPIOID picture

OPIOID means Optimal Prescribing Is Our Inherent Duty – a seminar conceived by physicians, approved by the medical board, and produced by the Greater Louisville Medical Society in association with the University of Louisville – February 7, 8 & 9.

American Medical Association Board Chair (and Kentuckian) Steven J. Stack, MD says:

Physician education on responsible opioid prescribing is a critical element in addressing the epidemic of prescription drug abuse.

Todd Cook, MD, Chief Medical Officer of St. Elizabeth Physicians (Northern Kentucky) says:

This is one of the times when sending a responsible party proactively may provide a great return on the investment for all of us.

Participants in this two and a half day course will gain insight on how to: (a) best prescribe controlled substances for chronic pain, (b) minimize the risks of drug abuse, and (c) safeguard their communities. These goals are achieved through lectures, coaching sessions, and face-to-face interaction with individuals battling addiction.

louisville skyline

Louisville is a point shared by two states (Kentucky & Indiana) that, like many other states, have recently enacted laws to address prescription drug abuse. When such well-meaning laws give legitimate prescribers the chills, a dose of OPIOID is the right prescription.

Finally, an OPIOID epidemic we can all get behind.

Please make it contagious. Pass along this info, refer someone, or even better – sign up yourself.

OPIOID  February 7 – 9, 2014

Register by

Email: physician.education@glms.org

Or call: 502-736-6354

opioid tab

Or visit online at: https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).

 

enterprise

Boldly go where no prescriber has gone before.

Take back your universe.

take back universe

OPIOID

James Patrick Murphy, MD, MMM  is President of the Greater Louisville Medical Society.

rx and pen and pad

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Dr Gupta, Seriously?

04C No truth sign

On December 21, 2013 at 12:28 am, in response to a story on Anderson Cooper 360 by CNN’s Chief Medical Correspondent Dr. Sanjay Gupta, about Dr. Lynn Webster,  I posted the following comment. 

RE:
December 19th, 2013 10:00 PM ET

Pain doctor investigation

 
 
Dr. Gupta, seriously?

You know that treating chronic pain is challenging. There is no pain “thermometer” or lab test to measure, monitor, or prove pain.  It is inherently personal and subjective.  Your implied dismissal of a mode of therapy (i.e. opioids) just because it is not “proven,” smacks of hypocrisy.

You know physicians offer treatments every hour of every day that have not been proven by ivory tower standards (e.g. Many of the drugs used in Pediatrics have only been researched in adult studies and are not FDA approved for children).  Medicine is as much art as it is science. At the end of the day, it comes down to the caring personal connection between the physician and the patient – understanding that the outcome is not guaranteed.

My knowledge of Dr. Lynn Webster is indeed that of a caring, expert, and passionate physician. I wish he could have given his candid opinions, but (again, you know) when there is a lawsuit the doctor is advised to keep silent.

Your CNN piece was anecdotal, unconvincing, sensational, and seemed like “gotcha” to me. I expect better from CNN and you.

Opioid therapy for chronic pain is not without risks.  Dr. Webster has been part of the solution exponentially more than he has been part of the problem. One-sided stories (like yours) cause harm by keeping silently suffering pain patients in the shadows and by discouraging physicians (like Dr. Webster) from taking on the challenge of chronic pain care.

Dr. Gupta, you have such an influential platform. Don’t give in to sensationalism.

 

James Patrick Murphy, MD, MMM

Certified, American Board of Pain Medicine
Certified, American Board of Anesthesiology
Subspecialty Certified in Pain Management
Certified, American Board of Addiction Medicine

 
jamespmurphymd.com
@jamespmurphymd

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SEVEN DAYS UNTIL INDIANA’S “DRAMATIC” PAIN REGS GO INTO EFFECT

theatre_masks 

December 9, 2013 – Counting today there are seven days until Indiana’s Emergency Pain Regulations go into effect (on December 15, 2013).

The Painful Truth (my opinion) today examines section FOUR:

SECTION FOUR

This section deals with the Physician’s responsibility for performing the initial evaluation, including determination of level of risk.

It is clearly stated that the physician shall do the physician’s OWN evaluation and risk stratification of the patient by doing the following:

  1. Perform an APPROPRIATELY focused history and physical exam
  2. Obtain or order APPROPRIATE tests “as indicated”
  3. Make a DILIGENT effort to obtain and review records & document the effort.
  4. ASK the patient to complete an OBJECTIVE pain assessment tool
  5. Use a VALIDATED screening tool for mental health and substance abuse
  6. Establish a “working diagnosis”
  7. Tailor a plan with MEANINGFUL and FUNCTIONAL goals (to be reviewed “from time to time”)
  8. WHERE MEDICALLY APPROPRIATE use non-opioid options instead of or IN ADDITION TO prescribing opioids.

The Painful Truth believes the requirements of Section Four lend themselves to creating a checklist. Therefore, at the initial evaluation a Hoosier physician must be DRAMATIC.

o          D         diagnosis made (“working diagnosis”)

o          R         records obtained (a diligent effort made to obtain & review)

o          A          assessment of pain

o          M         mental health (and substance abuse) screen

o          A          activity goals established

o          T          tests ordered if indicated

o          I           instead of opioids, use non-opioid options

o          C         conduct focused history and physical

The Painful Truth notes that the terms “appropriate,” “as indicated,” “diligent,” “meaningful,” and “from time to time” are subjective. Physicians are advised to be able to defend his or her interpretation of these terms.

The Painful Truth believes it is acceptable for a prescribing physician use historical information obtained by sources other than the prescribing physician (i.e., office staff) as long as the physician personally verifies the information with the patient.

The Painful Truth points out that the initial physical exam must be done by the prescribing physician and cannot be delegated.

The Painful Truth notes that a truly “objective pain assessment tool” does not exist, as pain is personal and subjective. Nevertheless, at minimum, a visual analog scale (i.e., 0 to 10) or similar documentation aid should be employed in order to satisfy the regulatory requirement.

The Painful Truth believes that only in rare circumstances would a non-opioid treatment option fail to exist.

acting