Juan Carlos Roman, MD on Arkansas Medical News Inc.

Juan Carlos Roman, MD

By: LYNNE JETER

LITTLE ROCK—Juan Carlos Roman, MD, almost got his career in medicine off-track at an early age.

Unchallenged in school, he had considered making money through weight training means. After all, as the youngest of three boys born less than four years apart, he had frequently been on the losing end of sibling games and a few fist fights, and had been motivated from adolescence to focus on body strength and discipline.

"I learned more from losing and getting a good beat-down than I ever did winning something," said Roman (pronounced Ro-MAWN), director of pain management for St. Vincent Infirmary and Arkansas Specialty Pain, and vice chief of Little Rock Anesthesia Services. "Losing is truly underrated."

Roman's parents—Juan, a surgeon, and Mary, an equestrian—met when his dad was stationed at Columbus Air Force Base in Mississippi. Roman was born in New Orleans in 1968, when folks in Bayou Country were still chattering about how the JFK assassination attempt was rumored to have initially been planned in the Crescent City, President Kennedy's last stop before the ill-fated Dallas trip.

When he was toddler, Roman's parents moved the family to Little Rock, Ark., after his dad completed residency at Tulane University.

"My parents purchased a couple of hundred acres of land to support my mother's horse habit," said Roman. "Having boys also fit the bill for my mother's horse habit … manual labor crew to build fences, haul hay, build barns, and feed the horses. I had two loving parents who were not afraid to put their boys to work."

Overworked Physicians Sometimes Misled by Drug-Seeking Patients

As chairman of the Arkansas State Medical Board's Pain Management Review Committee, Juan Carlos Roman, MD, has noted common trends that "usually fall in line with what we learned in that 30-minute Wednesday afternoon lecture during our sophomore year in medical school."

"Recommendations … vary from 'no violations found' to recommending an emergency order of suspension of a physician's license," said Roman, who was recommended to serve on the 5-member volunteer board at its conception by John Wilson, MD, then president of the Arkansas Medical Society, and appointed to lead the committee in 2009. "We sometimes send a letter to a physician and ask them to review ASMB regulations. We'll on some occasions invite a physician to appear before our committee to better clarify a situation. Our physician meetings usually reveal an overworked physician who was misled by a drug-seeking patient."

To help Arkansas physicians better spot patients with drug misuse issues, Roman said these patients tend to reveal themselves by:

Making frequent calls to the doctor's office for drug refills (often citing lost prescriptions);
Visiting emergency rooms frequently;
Being of young age;
Having a psychiatric history;
Having a family history of drug abuse;
Having a personal history of substance abuse;
Having mild or no objective clinical disease;
Drug-screening positive for non-prescribed drugs of abuse;
Drug-screening negative for prescription drugs prescribed (indicating the patient is selling drugs, not taking them);
Using multiple pharmacies;
Visiting multiple doctors;
Having a motor vehicle accident under the influence of drugs;
Having a record of a prior drug overdose;
Having family members concerned over drug use; and
Not returning to work.

"Doctors often do not put these signs together," observed Roman. "A busy clinician can miss a lot of these signs. Many times, the signs are subtle and only in hindsight does it seem obvious. Many physicians have difficulty saying no or confronting a patient, especially because we doctors are trained to make patients better and sometimes want to please everyone. Sometimes, we simply get fooled! We can build strong patient-doctor relationships; we truly care for our patients. It can be a difficult task for even the best pain management physicians to determine who might have an addiction … who's diverting drugs, who's pseudo-addicted, who's abusing or sharing their drugs."

Editor's Note: The February 2010 edition of Medical News of Arkansas will provide in-depth information on the Arkansas State Medical Board's Pain Management Review Committee, including the key regulations that guide advisory board recommendations.

A turning point in his childhood came when Roman's father forced him to go to a Catholic school.

"At 14, I wasn't challenged academically and entered the halls of Catholic High and Father Tribou," he said. "I learned what homework was and how to study. The last 'C' I ever made was my first semester (there)."

Roman's study ethics impacted his tenure at Tulane University. He graduated in three years instead of the usual four.

"I originally went to college to become a lawyer," he said. "I was a perpetual 'B' student in English and an 'A' student in math and science. As frequently occurs in life, you choose what you're good at over what you want to do. So after my freshman year at Tulane, I declared biology as my major and applied to medical school."

After graduating from Tulane in 1990, Roman studied at the University of Arkansas College of Medicine, and spent his senior rotation at Royal Perth Hospital in Australia. He chose to specialize in anesthesia during his final year of medical school because, as he explained, even though he enjoyed being in the operating room like his dad, he wanted a specialty that didn't obligate him "every day and night of the week."

"My father being a surgeon, I had vivid memories of him working at the most inopportune times," said Roman, who completed an internship at UAMS in 1995, and an anesthesiology residency at Tulane in 1998. "He missed a lot of things caring for his patients; he never complained. In anesthesia, the 70-hour workweek isn't unusual, but at least I know which weekends I have to work, and which ones I have free."

In his role as chairman of the Pain Management Review Committee of the Arkansas State Medical Board, Roman has been diligently working statewide to develop a greater sense of awareness of regulations affecting prescription drugs.

"I'd like to see a physician education program that makes a clear distinction between the chronic pain patient with a terminal illness and the non-terminally ill chronic pain patient, emphasizing the prescribing of narcotics to avoid of narcotic dependency and iatrogenic drug addiction," he explained. "The education currently emphasizes a titrate to effect philosophy that leaves too many patients physically dependent on narcotics and at higher risk to develop an addiction to narcotics. The physically dependent patient takes medications for pain and to avoid symptoms of drug withdrawal."

Fortunately, Roman didn't pursue a career involving weight training. "At one time, I wanted to make a living as a gym owner," he said. "A reality check kept me in school."

He still enjoys a good workout session in the gym, and loves a good horse race—he's considered owning a stakes-winning racehorse in partnership with his mom—yet most of his spare time gravitates to events involving his wife, Christie, and their daughter, Sofia, 3. The family dog, Belle, is usually nearby.

"I see people every day at work with real problems and I know how lucky I am," he said. "The greatest challenge in my life simply comes with never taking anything or anyone for granted."