Primary Care and Pain

Here is an article that basically summarizes a recent lecture done in Palm Springs, California about chronic pain.   Usually I blow by these things when I get the journal in the mail but a few things struck me about the piece.   I always find it laughable when pain specialists complain about their referrals.   The pain doctors in my small community are some of the richest people around.  One guy makes almost a million dollars a year.  How?  Well, he puts a needle in almost everyone he sees.  Reading that “the best people to take care of most pain problems are primary care doctors” feels like someone is putting a needle in my eye.   Let’s be honest.  The pain specialists want only the most perfect specimens coming their way so that they can really hone in on doing more procedures and making more money.  That’s calling a spade a spade.   Now I will be honest with you.  If they don’t take the bad (managing the chronic pain people who just get meds) then they don’t get the good (a new summer house and boat).  That is why this article is a waste of my time.   But the saddest part was the dude doing the lecture.  Dr. McCarberg, who is a family doc and pain specialist ,is an absolute sellout not only on the pain issue but also on how he states he treats his patients. Just look at this quote from the article:

In his pain practice, Dr. McCarberg can see a patient for 45 minutes to deal with a single problem – but in his primary care practice, a patient typically arrives with a list of problems for a 15-minute visit.  “I get paid according to the hemoglobin A1c – whether or not we’re controlling diabetes. That’s part of where my salary comes from,” he said. “If I have blood pressure control,” other financial incentives kick in. There are no similar metrics for pain management, he added.

Dr. McCarberg is an example of what is wrong in primary care as well.  Do you see how he has bought in the quality metrics philosophy?   He treats it like it is standard of care or dogma.  He cares about getting PAID according to blood pressure and blood sugar measurements.  Are you kidding me?  How sad is that.  Hey, doc, what about the patient?
Lastly, Dr. McCarberg reported that he is an advisor for Endo Pharmaceuticals, Forest Laboratories, PriCara, a division of Ortho-McNeil-Janssen Pharmaceuticals, and NeurogesX.
So, let’s summarize.  Dr. McCarberg is the founder of the Chronic Pain Management Program at Kaiser Permanente and wants family docs to do the pain control while he can do the procedures.   He treats patients as numbers and not people.   And he is getting paid by Big Pharma.   I shed a tear for our profession.
13770cookie-checkPrimary Care and Pain