Question Why do some doctors are not able to prescribe pain meds?

[DandyDon]

Do you not have a family doctor/general practitioner that can serve your needs? I don't know how it works in the US.

I have a Physician's Assistant who fills my GP needs okay enough, but she can't prescribe pain meds.

My thought is that any doctor who can create such tremendous pain in procedures needs to be able to treat with pain meds. My follow-up is with the primary cardiologist I usually see and who I think can at least prescribe Tramadol which might be okay. If I learn that the other cardiologist who did my last procedure is liscensed for Tramadol but didn't use it when I was in tears, I'm going to want to know why!

 

[MB NZ]

My thought is that any doctor who can create such tremendous pain in procedures needs to be able to treat with pain meds. My follow-up is with the primary cardiologist I usually see and who I think can at least prescribe Tramadol which might be okay. If I learn that the other cardiologist who did my last procedure is liscensed for Tramadol but didn't use it when I was in tears, I'm going to want to know why!

Reasonable points. Any doctor here in NZ can prescribe virtually any medication. Some medications do require special authority from a specialist in the field, but that wouldn't include commonly used analgesics.

 

[JohnN]

I have a Physician's Assistant who fills my GP needs okay enough, but she can't prescribe pain meds.

My thought is that any doctor who can create such tremendous pain in procedures needs to be able to treat with pain meds. My follow-up is with the primary cardiologist I usually see and who I think can at least prescribe Tramadol which might be okay. If I learn that the other cardiologist who did my last procedure is liscensed for Tramadol but didn't use it when I was in tears, I'm going to want to know why!

Two bits:

One—“Physican Assistant “. Not “Assistant’s”

Two—Tramadol is a scheduled drug (Schedule 4) and requires a DEA license. That license allows the holder to prescribe Schedule 2–5 drugs

 

[DandyDon]

One—“Physican Assistant “. Not “Assistant’s”

And not Physician's Assistant as I typed. Thanks. I rarely type the title.

Two—Tramadol is a scheduled drug (Schedule 4) and requires a DEA license. That license allows the holder to prescribe Schedule 2–5 drugs

Well, Hydrocodone is a 2, and my preferred choice. So if he can prescribe one he can the other eh?

 

[DandyDon]

Ok, well, I got in for my follow-up today. My cardiologists are important people in my life and will be for the rest of it, so I am glad that the discussion went well. He was pleased with the improved circulation in my problematic leg, and we'll meet again in a couple of months for another visit and dopplers.

I expressed my gratitude for their work but explained that the post-procedure pain was tremendous, asking what could be done. He was not aware of this problem and expressed that he would take additional actions to alleviate the pain. I think that there had not been much communication between the nurses in post-procedure and the doctor on this, with the doctor moving on to his next patient and the nurses doing all they were authorized at the time. I'll look forward to improvements next time.

Two—Tramadol is a scheduled drug (Schedule 4) and requires a DEA license. That license allows the holder to prescribe Schedule 2–5 drugs

He advised that neither of my cardiologists is licensed to prescribe hydrocodone, but could give me tramadol. "Hydrocodone, a commonly prescribed opioid painkiller, is classified as a Schedule II," and "tramadol is classified as a Schedule IV controlled substance by the Drug Enforcement Administration," so I don't understand why they can give one but not the other, but I can accept that.

 

[Mrs. B]

I have never heard such a thing so I asked AI

Are you sure they were physicians and not PAs?

Maybe they were residents but that means their attending is responsible to write it as far as I know.

One isn’t a cardiologist until they finish residency and take their board.

 

[DandyDon]

Are you sure they were physicians and not PAs?

Oh, yes, they're board-certified cardiologists. Maybe they just don't want to register with the DEA to deal with Schedule II? I wouldn't.

 

[JohnN]

I have never heard such a thing so I asked AI

Are you sure they were physicians and not PAs?

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Maybe they were residents but that means their attending is responsible to write it as far as I know.

One isn’t a cardiologist until they finish residency and take their board.

"Who knew medicine could be so complicated" (I'll let you guess who said that)

It's a bit more nuanced than what ChatGPT might say. The ability to prescribe scheduled drugs varies by state, e.g. in Oregon a PA can prescribe Schedule II -- V drugs with no restriction on the specific setting.

 

[Mrs. B]

"Who knew medicine could be so complicated" (I'll let you guess who said that)

It's a bit more nuanced than what ChatGPT might say. The ability to prescribe scheduled drugs varies by state, e.g. in Oregon a PA can prescribe Schedule II -- V drugs with no restriction on the specific setting.

I put the query in for Texas because I thought that’s where it happened

I still find the situation unfamiliar to anything I have seen.
A cardiologist doing an invasive procedure but can’t prescribe Vicodin?

If that is accurate I would be asking a lot of questions prior to a procedure.

 

[Mrs. B]

Oh, yes, they're board-certified cardiologists. Maybe they just don't want to register with the DEA to deal with Schedule II? I wouldn't.

I just find that very surprising as they are doing invasive procedures. I’m not saying you are wrong, just that I am shocked. Think about all the things that can happen during a procedure in the cath lab etc