Future Docs Give USA Fair Warning about Pain…
Future Docs Give USA Fair Warning - We Get the Doctoring We Deserve; Alexander DeLuca; War on Doctors/Pain Crisis; 2007-06-19.
God Bless John Tierney.
Tina Rosenberg wrote an article in the June 17, 2007 NYTimes Sunday Magazine entitled “When is a Pain Doctor a Drug Pusher?” which is already unavailable, free, from that bastion of the free press, the New York Times. Sheesh! (Don’t worry, I’ve got it - stay tuned). If it weren’t for a few wonderful authors and human beings like Tierney and Rosenberg the NYT would be entirely irrelevant; if it isn’t already, anyway.
But I digress. Tina wrote the mostly very excellent article (which I cannot link you to, today, courtesy of the idiot bean-counters at the NYT), which people like myself will be dissecting for some months to come. But it fell to Mr. Tierney to create the virtual space for The Public, lowly little US, to have a say. Tierney Rocks! The Pain Relief advocacy community loves and thanks John Tierney!; ’nuff said.
OK, so what? So Tierney blogs Rosenberg and in the process creates the space for wonderful commentary. This guy gets the best Comments, as I have previously noted in regards to his Hurwitz printed and blogged coverage. [See: Collection of Observation and Analysis of the Retrial of Dr. William Hurwitz]
Allow me to share with you, Future-Americans-In-Pain (and yes my dear 20 to 40-somethings, that means YOU), how your physicians-to-be are reacting to our glorious national policy of blaming pain-treating physicians for ‘the prescription drug problem,’ whatever the hell that actually is. Here are your future physicians, dear fellow citizens, telling you very, very clearly, exactly how it’s going to be, for YOU:
Comment #8; posted by S.K.:
I am a 2nd year medical student, and to read [Tina Rosenberg's article] was extremely disheartening. Basic definitions for physical tolerance vs addiction are included in very clear terms in my pharmacology textbook, and still I read that many physicians and most drug law enforcement agents do not understand the significant difference…
The writer is absolutely right - my friends and I in medical school find the pain pathways and significance of pain in illness and treatment terribly interesting, but I can almost guarantee that none of us will ever consider pain management as a specialty for fear of unfair litigation and the government taking away our licenses (and dreams).
Yeah, it’s called: The Chilling Effect - get used to it, America. Here is another future M.D. weighing in on the War on Doctors in reaction to the Dr. McIver case:
Comment #16; posted by B.McE.:
As a medical student, I can say that this is a horrifying story and that if policies like this continue, there will continue to be a shortage of pain docs. Imagine working so hard to become a physician and then being imprisoned for THIRTY YEARS plus because you kept bad records. That is not doing anyone any good.
This man [Dr. Ronald McIver] was not a threat to society, simply take his license away and the problem is solved. Why put him in prison, who benefits from that? It ends up costing society an enormous amount. Believe me, taking away a physician’s license to practice is an enormous punishment, akin to cutting off A-Rod’s arm.
It is absolutely unbelievable to me how the police received a letter from him, ignored the problem, then used the fact that he raised concern about these patients against him. Is there some equivalent to malpractice in police work? Is there an online listing of detectives, prosecutors and judges who have committed crimes or been imprisoned because they may have done there jobs outside the guidelines?
Equally unbelievable is the fact that the very people who defrauded the doctor into prescribing the meds are now suing him for prescribing them. Shouldn’t the con artists, who defrauded the doc and sold the pills illegally be the ones on trial? Why is the government targeting doctors like this, it’s not like they are mafia bosses or something? This story makes me so angry!
Well, my fellow Americans, looks like we’ve royally scared and pissed-off’ed YOUR future physicians. Show of hands, friends: Who thinks turning medical students away from the compassionate treatment of chronic pain is a really good Public Health idea?
You know, it’s been said that “we get the government we deserve”. Here is the corollary: You get the medical care you deserve, too.
Doctors can’t fix this for you, America. YOU, The People, are going to have to fix YOUR government. YOU, The People, are going to have to get YOUR government off OUR (physicians’) backs. Or. We. Simply. Will. Not. Be. There. For. You. Period.
I am so not kidding. Fair Warning Fairly Given.
OK comrades, here we are. Now, what are YOU going to do about this? I will make it very simply for you. Choose: you can have the drug war for 18 BILLION dollars a year, OR, you can have medical-standard-of-care pain treatment. You may NOT have both. CHOOSE!
Oh, What a Lovely Drug War! Are we so damn rich we can afford to lose another entire generation of potential physicians willing to treat our collective pain? It’s your choice, America. Rein in your cops, or lose us docs. That’s where it’s at, Jim.
Are you starting to get this, America?
[END]
Tags: author=deluca, chilling effect, drug policy, Ondcp, pain crisis, persecuted physicians, prescription drug abuse, public health, statistics, substance abuse
Comment by James Stacks
In this culture, we are trained from childhood to see physicians as being slightly above human — near gods. We accept their advice and comply (adhere) when it does not cause too much discomfort or cost. When we fail to comply, we usually feel stupid or guilty. We do not ask questions. We are taught to believe that we don’t and can’t understand science, and that physicians know best about every aspect of our lives at all times. This myth carries on despite every possible kind of evidence to the contrary. We believe this even though we can clearly see the limits on what physicians know and what they can do. We somehow think that the physician’s advice and comments are the best advice on living we could possibly obtain, even though we can clearly see that the physician could not possibly have enough information about us to have such answers. We believe it even though we can clearly see that we obtain far less attention from the physician than would be required to know anything about our condition, and that there are obvious limits on the amount of information that can be processed and weighed within that time — by anyone. We even continue to believe it when they forget our names, or they forget what we came in for, or they forget extremely important details that define our reasons for seeing them. We continue to believe it although we know the advice we get at times is insincere and canned. The assistant and the nurse don’t have the inclination or the skill to deceive, and they give you away when you don’t care. Some of us have even been inside the beast. We know about…billing! We know about…units! The point is, we believe you are superhuman. I don’t think you are going to be able to change our delusions in that area. They are too deeply embedded in the cultural psyche. Medicine has accomplished that goal much better than many others!
Many of us are trying to do something about our government. For instance, we elected Al Gore in 2000. Some of us understand the issues and history surrounding opiates. Some of us have scientific training, and we know what opiates are (which, from my understanding of the rules, makes us “suspect” for having “uncommon” knowledge about controlled substances). We also understand opiates have been around longer than physicians, and we also understand some things about the role opiates play in the world economy.
Now that we are being faced with this evil “drug war” force (which I believe comes from commercial pharmaceutical interests), I would like to also ask that we are not abandoned by our physician/gods. We treat you like gods. We give you tremendous amounts of creature comforts and wealth. We never ask why or show contempt for your fortunes. We never question your knowledge. After all, you are our gods. Like we always say, it must be the insurance companies, or the government, or someone else that that is causing the problems. Our physicians would not do this to us.
We didn’t send those cops to get you. They are after us too. They work for huge corporate interests that are controlling huge markets at levels of the economy that very few people in the world know about or understand. After all, we elected Al gore, not George Bush and Alberto Gonzales!
We Americans would be glad to do something, but we don’t know what to do. The reason we don’t know what to do is because we are so far removed from any position of relevance in our own health care that we can not make any defensible arguments to our elected officials about health care, and especially about any particular pharmaceutical. Many of us would do a lot to help ourselves, but we are going to look like criminals and idiots unless we have physicians behind us. We need some support and guidance on what to do, and we need “a note from the doctor” to legitimize us. We clearly don’t have the ability or authority to “call off cops”. They will arrest us, and we will do a lot more time than a doctor would.
There are plenty of us who would be more effective if we had clear help from more doctors in our efforts. Tell us what we can do to get this message out, and also get the message out to physicians to stop sidestepping and start telling the simple truth to patients. There is a responsibility to carry this message at the level of the health provider, also. We need more physicians who will handle consults in something similar to the following way:
“I can not do anything for you, but I wish I could. I am going to tell you the reason I can not do anything for you, so please listen carefully:
You do not meet the requirements under the drug laws, as I understand them, to receive pain medication. The type of pain medication I would give you is a narcotic. It probably would not be dangerous for you to take this medication, and it would help with your pain. However, I do not have enough evidence that you need this medication to avoid possible prosecution for giving it to you. The reason I can not do it is because the laws that have been passed in support of the War on Drugs have gone too far in limiting how physicians treat pain. I could very easily lose my medical license and my career — and perhaps face criminal charges — by writing a prescription for your pain. You should write your congressional representatives and tell them what I have told you. Here is a letter from me explaining the facts I have told you about. I can refer you to a clinic that might be able to help you cope with your pain, but largely you are going to have to come to terms with it, or move to another country where you can obtain reasonable amounts of the medication you need. I am sorry. I feel bad about this, but there is nothing I can do.”
That is what I would expect a god to tell me. Wouldn’t that be more ethical than scribbling “drug seeking behavior” in a chart? What would the physician have to lose?