First visit with Nurse Case Manager

[hurt back]

Well my first visit with my nurse case manager did not go as I had hoped / planned for it. I informed her I did not want her back in the exam room with me, so she sat outside of the exam room on a bench. I then heard the Dr. and her whispering something for a while, then the dr. came into the room. Asked a/b how the epidural injection went. I explained how I was sick and so on for 4 days after the injection. He said well we won't do another one then.. Checked my reflexes and the states he is going to order an EMG test to check my nerves. I stated ok but what a/b my lower back pain... He said well right now I am ordering this then I will have you do an ( FCE ? ) and we will go from there. I said I feel worse now than before. I then asked a/b pain medicine and he stated I would have to see a pain management Dr due to the regulation in TN after the first of the year. So all he prescribed was just some muscle relaxers.

I feel as if my case manager is "forcing" him into not prescribing me pain meds ( due to pain management ). Once he got done examining me he went outside the room, him and her were whispering things 4 a/b 10 minutes then he said ok we are done. They will contact you if they approve the EMG..

I have contacted my attorney to see if there is anything he can do a/b the Dr and case manager talking in private. I was under the assumption they cannot talk a/b my care w/o me present? And also this Dr. is always short and sweet. Is there a way to change? I was refered to him by my orthropediac surgeon whom wanted to try alternatives before surgery..

Thanks in advance for the replies..

[1171]

it's difficult to have it both ways:
to want to be present when nurse and doctor talk and yet not want nurse to be present when you and doctor are together.

the employer, carrier, nurse will want to influence the medical outcome just as patient does; tough for one to exclude the other
workers comp has joint and shared responsibility for the injury even though either might not like it.

like two people at the steering wheel: often develops control issues with neither side wanting to work with the other and each acting like the other has too much say so. comp is a difficult system to manage.

[hurt back]

My main thing is though that if I am in pain why can't he send me to the pain management instead of giving me a bunch of medicine that isn't going to do anything and is probably costing them more?

I mean I just want to get better and get to work. My previous employer fired me due to I could not get the Dr to release me to come to work and then 4 months later i get this case manager.

Workers Comp. is a different world. Whatever happen to worrying a/b someones health and being able they can get back to as normal as possible? That was her exact wording on our meeting, is that my job is to get you back to as normal as possible..

Can I refuse to have the case manager? ( In Tennessee )

[AQA]

I mean no offense, but I don't know any other way to address this

quote " My main thing is though that if I am in pain why can't he send me to the pain management instead of giving me a bunch of medicine that isn't going to do anything and is probably costing them more? ".

1) any dr. worth thier weight is going to take the most conservative route possible and the move on from there. There are only so many testes that can be done. I think I have had them all. That reminds me, I have a sc scan on 4 weeks, but that in reference to having two balloons put in my nose.

2) What do you think that a PM dr. is going to do??? After all, the name says it all. There are only three things that I can think off that a PM dr. can do, other than a bunch of pain meds.. 1) tens unit, 2) SCS, 3) epidural injections. I forget what your symptoms are, so all of the three may not be an option.

Take Care

[hurt back]

AQA - I'm not sure if he could do anything, besides the medicine.. My diagnosis are as follows: L4-L5 degenerative disc, herniated L4-L5 disc, spinal stenosis, and osteoarthritis.

But the dr before this one wanted to try conservative treatments and this current dr just makes me feel like I'm a waste of his time, especially since I have the nurse case manager..

I don't know what to do, I am feared that they will cancel my benefits and I have yet to even find a job to accomediate my restrictions due to can't sit for long time, or stand and walk with a cane, and lifting anything is just painful.

[bronco54501]

Ah yes, the ncm can and will power your dr, if there is somw whispering going on then you might want to change your mind and let her in durring the visits.. This way you will know what is being talked about...... The emg tests will. help in determining where the pinched nerves are..... There aint hardly any dr out there that will perscribe pain meds without the standard steps they follow....


If you are in severe pain, go to the er, afew trips there might influence your dr to get you on some type of pain med...

[hurt back]

Bronco - I've asked a/b the Er thing b/c somenights I'm in extreme pain in the fetal position in the floor almost crying. And she stated the only Dr they will pay to treat me is my current. That is it.....

Sounds fishy to me.

---

My other question I guess would be, what if the EMG comes back normal / no results found? From what I've read there are both false positives / false negatives...

I just want to find the root cause of my pain. Even though its mainly in my back but right now they are focusing on my left leg more than anything? I guess just standard procedure but I just don't understand how a muscle relaxer is going to take pain away from something that feels like is "grinding" when I bend over.. He didn't seem too worried a/b that??

I' just confused as crap.. If this was a regular insurance claim I wonder where I would be by now? Instead of a month at a time between appts. and the whole case manager that dictates your treatment that is being hired by the I/C? I mean its my body not hers to decide what to do right? What would he do different w/o her there ?

[Woodlawn]

You can refuse the case manager being in the room, but you cannot stop her from communicating with the physician.

As far as advice that you should go to the ER a few times and maybe that will convince them to move you to pain management, that is a terrible idea. A few times going to the ER asking for pain meds is going to do nothing other than make you look like a drug seeker, and the I/C will jump all over that.

A pain management doctor is going to follow a script. You'll sign a contract, get some medications. Next, they'll want to do an EMG and/or and epidural injection, the latter you've already said made you worse. If that's the case, maybe they'll try a facet injection instead. If that helps, they may try medial branch blocks and further, a rhizotomy.

If the facet injection doesn't work, they might recommend a spinal cord stimulator. With your MRI, no way does it get approved. I still think it would be worthwhile for them to run some testing on your sacroiliac joint. Not testing like MRI's etc, but a manual exam and maybe a diagnostic injection. If the SI joint injection helps, you may have found the pain generator.

[bronco54501]

Hurt back, it does sound fishy to me, I have done it and wc did pay for it.... What does your lawyer have to say on this.....?

I have had the same senerio, low back pain and left leg pain, I had always asked them to concentrate on my back but after 18 esi injuections and a total of 5 rfa's it still remains the same.. emg test came back abnormal, surgeon says he can help with the leg pain by fusing l4-l5---l5-s1 but it will not help with my back pain... I said no to surgery .......


Woodlawn------ not all pain drs work the same and if pain is to bad there is nothing wrong with going to the er,, it doesnt make you look like a abuser unless its every other day...

[hurt back]

Bronco - I've been told the EMG can give both false positives / false negatives.. So if mine did come back as a "no problem". Then what would I do a/b the pain. Do they base all facts on this one test? Plus my "main" pain in my lower back and kind of radiates to the hips..
And yes she told me they would not pay for any other dr outside of Dr. treating me now.. Maybe I should call my attorney and ask b/c sometimes i'm in the floor in the fetal position it hurts so bad.


Woodlawn - They can look at my medical history and see that I'm not a "pill junkie" I NEVER go to the Dr. until now since I got injured. And if I did go before for a cut finger i had to have stitched I never even filled the pain meds then.. I am / was always healthy and want to get back to as normal as possible.. The thing that tisses me off is he didn't even offer the pain management just mentioned it and walked out...

I just think he's in love with that blonde hair, blue eyed case manager of mine, plus that were on a first name basis ( which scares me tells me shes a regular )