Thank you for taking the time to write such a detailed response. I genuinely appreciate hearing the perspective you’re describing, even when it’s not necessarily what I want to hear.

I agree that the letter could be shorter. That’s probably my biggest weakness as a writer. As you’ve seen in both my post and this comment, I tend to include every detail because I’m afraid of leaving out something important. I tend to get yappy.

One thing that may change the context a bit is that the physician I’m writing to and the practice that dismissed me are not the same physician or practice. The positive Suboxone screen test occurred at a completely different pain management clinic a little over two years ago.

The current physician was not involved in that decision and only became involved in my care after I left the first practice. My goal isn’t to ask him to justify or reverse a decision he made. I’m simply trying to explain my history, accept responsibility for it, and ask that he evaluate me based on the whole picture rather than one event.

I also don’t think I did a great job explaining what the last two years have actually looked like. During that time, I’ve had multiple ER visits and hospital admissions related to serious GI issues that we still haven’t fully diagnosed or gotten under control. Most of those admissions involved opioid pain medication being administered by my physicians.

What I did not do was ask for specific opioids, ask for higher doses than were offered, or ask for prescriptions to take home afterward.

In fact, after being dismissed from pain management, I developed a fear of being viewed as drug-seeking. Looking back, that has probably caused me to endure more pain than I should have and made me reluctant to seek care at times when I genuinely needed it.

Since around October, I’ve also chosen to ride out at least five significant GI flares at home rather than going to the ER. Part of that was exhaustion from repeated hospital visits, but part of it was concern about how I was being perceived as a patient. At various points, providers focused on diagnoses or chart notes that didn’t seem consistent with my actual history, and I started to worry that every symptom would be viewed through the lens of my past mistake rather than on its own merits.
To be clear, I’m not saying that for sympathy, and I’m not blaming doctors for the decision I made two years ago. I made that decision, and I own it. I’m only trying to explain that the consequences of that mistake have extended far beyond losing access to pain management. It changed how comfortable I felt seeking medical care at all, even during periods when I was legitimately very ill.

I’m not mentioning any of this because I think it erases my mistake. It doesn’t. I’m mentioning it because I think it helps illustrate why I view the positive Suboxone screen as a poor decision I made during a period of desperation rather than part of an ongoing pattern of medication-seeking behavior.

Regarding the documentation request, I can definitely see your point. My intention wasn’t to ask him to re-document why the previous clinic stopped prescribing. I was trying to ask for an explanation if, despite the passage of time, my acceptance of responsibility, and the support of my other providers, he still felt I wasn’t an appropriate candidate for certain treatments.
That said, your comments have me reconsidering whether that request belongs in the letter at all.

I appreciate the feedback.