First appointment with the pain specialist


I had my first appointment with a pain specialist yesterday even though I've been on opioid treatment for almost a year now. Up until now my neurologist has been treating me, but he wanted me to see this specialist in hopes of maximizing my pain control. The appointment didn't go quite as I had imagined it would. I thought that we would discuss my history, he'd maybe conduct an exam, and then he'd suggest a course of treatment. Sounds reasonable, right?

Apparently not.

It's a long trip to this doctors' office for me–at least an hour each way by bus and train. It costs me about $10 round trip. I had to wait for 2 hours in the waiting room and when I finally got in to see the doctor we discussed my history. He said he might keep me on my current medication (oxycontin) but change the dosing to every 8hrs instead of every 12, or perhaps switch to methadone. So far things sound ok. Then he told me that he would do a phsyical exam and look at taking over prescribing for me at the next appointment.

Why would I need another appointment I asked–I'm right here. He told me that there is no billing code for "chronic pain". That the amount he could bill MSP for the office visit wasn't sufficient to cover the "2 and a half hour work-up" he says he needs for each new patient, so he has them come back several times instead. I was just livid. Now it's going to cost me at least $30 and 3 full afternoons for what should be one doctor's appointment. I wasn't sure who I was angrier at–the doctor, or the Province. So I started researching on the net today.

It's hard to find any indepth information about this or the billing practices of the Ministry of Health, but I was able to find something quite disturbing documenting that the Ministry of Health has determined that chronic pain services are not considered an essential medical service under the Canada Health Act. The Canada Health Act aims to "ensure that all eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without direct charges at the point of service for such services." The key phrase here would be "insured health services".

Insured health services are medically necessary hospital, physician and surgical-dental services provided to insured persons. Here in Canada when you need to go see your family doctor or go to the emergency room, you just go and give your personal health care number and all billing is taken care of. We pay monthly premiums for our provincial health plans based on our income. Apparently, chronic pain is not one of these insured services, at least not in British Columbia?

I can't even believe that's possible when I read it back. I've tried finding more information about it but it's very difficult. I've written letters to both the Provincial and Federal ministers of health and am eager to see what kind of response I get. Hopefully they'll tell me I'm very wrong, but I'm worried. Our health care system has been slowly eroding over the years, and is in danger–we all know that. But to think that this may not be considered medically necessary right now, today, floors me.

I've been thinking all this time that the lack of doctors who specialize in chronic pain here in Canada was due to a reluctance to prescribe opioids. Perhaps part of the reason may be because it's just not at all a viable specialty here.


5 Responses to “First appointment with the pain specialist”

  1. Hi! I just found your blog via Wind Lost, it’s nice to see another Canadian out there, although I’m sorry about your pain.

    My biggest frustration in seeing doctors is feeling like a jinkie when I ask for me medication. I hate that I feel guilty when I ask for something stronger. It’s not because I WANT it, it’s because I NEED it.

    Good luck with the new doctor, hopefully the next few visits will go smoothly!

  2. 2 katy

    Hi Jackie 🙂 I know how you feel. It’s been a while since I’ve been made to feel that way by a Dr so I feel fortunate in that regard. I do avoid the ER at all costs though that’s for sure.

    Thanks for the good luck wishes–I’m not sure what direction things will take but hopefully things will go well.

  3. 3 Jacques Dussault

    This is rediculous that a person with chronic pain as to suffer. It has been a battle for me and I am getting to the point that whish that my dotor to fell my pain for a day maybe he would understant what I go through in a day I am sure this is the whish of everyone that is living with pain

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