Case Management Focus: You're 'Fired!' Now What?


Sarasota, FL ( -- I recently talked to a young man looking for an advocate/independent case manager to help him. He said he was a chronic pain patient after having undergone two unsuccessful back surgeries for chronic back pain.

As we talked, I found him to be calm, articulate, and nervous. He was worried and in pain and said he did not know how to handle a situation that had recently come up and wanted to see if having an advocate could help. The situation he found himself in was that he was "fired" by his pain doctor for not following this plan of care. He now has no doctor, is running out of medication, and does not know where to turn.

I never had this experience and tried to think about what to advise him. As the man was in another state, I could not take on his case but referred him to a few colleagues in his area who could help him. I gave him a few commonsense suggestions, one being to see if he could repair the situation with his former doctor.

In speaking to my colleagues, I found that being "fired" by a doctor, especially in pain medicine, was becoming more and more common. Also, because so many of the systems are interconnected, knowing what happened in one setting was shared with others. For example, a patient who gets pain medication filled at one pharmacy is listed in a shared system, so all the pharmacies know what was ordered, when and if it should be renewed, and the doctors involved.

Also, most pain management practices know each other, so if a patient is fired from one practice, he is not likely to find another practice to take the case.

I was shocked at this. What happens to the patient? What are they to do? Someone who is on large amounts and various types of medications for pain is very vulnerable. I know the opioid crisis is to blame for much of this, but it is still eye-opening.

Also, as I spoke with my colleagues, I was reminded that I had only heard one side of the story, so I should refrain from jumping to conclusions based on this. Both colleagues I spoke to said I could have the man reach out to them and they would see if they could help him.

I communicated this to the man and have not heard back from the patient, but I hope he finds an advocate/independent case manager to help him with his situation and get the treatment he needs.

For those who work in pain management, I would like to explore this topic more in future columns. Have you ever experienced a patient being fired from their doctor? Please email me if you have expertise in this area and would like to share your knowledge in a future column. We all can learn from each other!

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