Do opioid contracts harm the doctor-patient relationship? – KevinMD – Michael Kirsch, MD | October 10, 2018
Dr. Kirsch brings up a couple of points I hadn’t considered:
- “Decent people” don’t need contracts to “enforce” decent behavior.
- If some patients have to follow these general rules about adhering to their treatment instructions, why don’t all?
A contract is an agreement stipulating the rights and obligations of the signatories. In general, decent people resolve differences in the old-fashioned way utilizing the twin arcane legal techniques of reasonableness and compromise. Remember them? Yes, it is possible to settle disputes without consulting an attorney.
I learned recently about the existence of opioid contracts (OCs), an “agreement” between a patient and a physician regarding the use of opioids.
I have read through various OC templates and, although I have no law degree, they seem extremely lopsided in that one party seems coerced to accept numerous stipulations while the other — the doctor — serves as the enforcer.
I’ve been complaining about these coerced contracts since 2013:
- Little Evidence That Pain Contracts Work
- Opioid contracts can harm patients
- The downside of opioid agreements and pain contracts
- Opioid Contracts and Trust
Although many of these agreements require both the patient and the physician to sign and date the forms, there really are no requirements of the doctor, except to provide the prescription.
The agreements basically catalog a very long list of required behaviors that patients must agree to and be prepared to document. Here’s a sampling.
- I will agree to random drug testing.
- I will agree to cancel any office visit at least 24 hours in advance.
- Only 1 lost opioid prescription will be replaced annually.
- I will agree to psychiatric care and counseling, if necessary.
- I will treat the office staff respectfully.
- I will store my medicines safely.
- I agree to waive any right to privacy or confidentiality if any law enforcement agency is investigating alleged misuse of my opioid medicines.
To begin, it is not clear to me why “agreeing to cancel any office visit at least 24 hours in advance” or treating “the office staff with respect” is so unique to opioid users that it is included in some OCs. Explain to me please the relevance with respect to the opioid issue. Why shouldn’t these terms apply to all patients?
If these medical diktats are truly necessary for opioid users, then why shouldn’t every patient sign an agreement promising to take all medicines as prescribed, never arrive to the office late, refrain from disparaging the practice, never request a refill on a night or a weekend and limit their phone calls to the office to one per month. How would patients react to this?
One advantage of this approach is that it would clear out doctors’ crowded waiting rooms.
Author: Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.