Tag Archives: doctors

When the standard of care is bad medicine

When the standard of care is bad medicine – KevinMD.com – Myles Gart, MD | Physician | July 2019

This article explains that when you are in the hospital with acute pain, there’s a simple formula for prescribing pain medication (opioids) according to your stated pain level. No wonder so many patients inflate their numbers!

However, even though this article was published in July 2019, it assumes pain will be treated according to a patient’s report of their pain. That’s not what I’m hearing from pain patients who are sent home with aspirin or Tylenol even after major surgeries.

For the last three decades, the numeric pain score has been the go-to assessment for acute pain in the hospital setting. Since this methodology was developed for research purposes to see if drug “A” had an effect on patient “A,” its clinical utility is not just worthless but dangerous.

Continue reading

Rx Opioids: Culprits or Scapegoats?

Are Rx Opioids the Culprits or Scapegoats for Opioid Crisis? — Pain News Network – By Dr. Lynn Webster, PNN Columnist – Aug 2019

The Washington Post recently published a series of stories about the volume of opioid medication distributed over the past several years in the United States. Over 76 billion pills were distributed from 2002 through 2012.

That sounds like a huge amount, but it is difficult to know what the number means. What is clear is that the stories are meant to suggest the number of pills is excessive and responsible for the rise in opioid overdose deaths.

It sickens me to see how the media sensationalizes the huge numbers of individual pills without putting them into context.  Continue reading

Patient Abandonment as Malpractice: What You Need To Know

Patient Abandonment Cases: What You Need To Knowtheexpertinstitute.com – by  – 

This article is already over a year old, but the legal points it makes are still valid. It sure looks like many pain patients who were tossed out of practices have grounds to sue for malpractice.

The hard part might be finding a lawyer who hasn’t been gaslighted by the myth of “heroin pills” and is willing to fight for the patient in the midst of a whole society, including juries, believe this cleverly made-up story.

Patient abandonment is a serious, yet often overlooked, form of medical malpractice. Generally, patient abandonment occurs when a physician terminates medical treatment without a justifiable excuse or reasonable notice so that the patient can find a replacement physician.   Continue reading

Paltering: When the truth is used to deceive

Paltering: When the truth is used to deceive – by Shannon Casey, PA-C July 2019

One evening in the clinic’s bullpen provider office, a colleague of mine wondered aloud how to respond to a difficult question a patient asked via patient portal message.

A physician within earshot responded, “Just because someone asks you a question doesn’t mean you have to answer that question.” I tried to empathize with where the physician was coming from.

Some actions don’t require empathy as much as correction.  Continue reading

40% of doctors refuse new patients taking opioids

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids – Jama Network Open – July 2019

This JAMA study shows that 40% of doctors refuse a new patient if they are using opioids. Many refuse not just to manage their pain, but to manage any other aspect of their general health.

Findings  In this survey study of Michigan primary care clinics, 79 clinics contacted (40.7%) stated that their practitioners would not accept new patients receiving opioid therapy for pain. There was no difference based on insurance type.

Meaning  The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or poor management of other mental and physical comorbidities.   Continue reading

Ethical Responsibility to Manage Pain and Suffering

The Ethical Responsibility to Manage Pain and the Suffering It Causes – Position Statement of the American Nurses Association, Apr 2018 – Repost

I’m reposting this from last year because it’s such a good (and rare) example of a reasonable attitude toward opioids. The Nurses Association gets credit for standing up for patients a year earlier than others.

The purpose of this position statement is to provide ethical guidance and support to nurses as they fulfill their responsibility to provide optimal care to persons experiencing pain. 

The national debate on the appropriate use of opioids highlights the complexities of providing optimal management of pain and the suffering it causes.

In these first sentences, the difference between nurses and doctors shine through:

Nurses are much more concerned with suffering, while doctors nit-pick about what is painful and what isn’t, who is “really” hurting and who is “catastrophizing”.   Continue reading

Doctors Are Prescribing Fewer Opioids

Doctors Are Prescribing Fewer Opioids, but Not Always for the Right Reasons by Ed Cara – Gizmodo – Mar 2019

Doctors are starting to give out significantly fewer new opioid prescriptions to their patients, according to a study this week in the New England Journal of Medicine.

But some are continuing to prescribe Backgroundpossibly dangerous doses, while others have—perhaps unnecessarily—stopped prescribing opioids altogether.

when prescribing opioids to new patients…

I don’t understand why this stipulation (which was also stated in the CDC guideline) is completely ignored by everyone making rules for us and our pain treatment.    Continue reading

California’s probe of opioid deaths

Doctors call California’s probe of opioid deaths a ‘witch hunt’by Cheryl Clark – Jan 2019

The Medical Board of California has launched investigations into doctors who prescribed opioids to patients who suffered fatal overdoses, in some cases months or even years later.

The effort, dubbed “the Death Certificate Project,” has angered physicians in California and beyond, in part because the doctors being investigated did not necessarily write the prescriptions that led to a death.

That makes it the most comprehensive [and perverse] project of its kind in the country.   Continue reading

Structural Iatrogenesis leading to “Opioid Misuse”

Structural Iatrogenesis — A 43-Year-Old Man with “Opioid Misuse” – Scott Stonington, M.D., Ph.D., and Diana Coffa, M.D. – February 21, 2019

Here’s a quick summary of a terrifying story:

“When he gets tangled in new restrictive policies on opioid prescribing, a factory worker with severe rheumatoid arthritis, whose pain must be managed for him to perform his job, ends up buying oxycodone from a friend.”

(I’ve quoted almost all the text of this case study because the NEJM is now behind a paywall with only 3 free articles a month, suddenly restricting our access to what our doctors are reading and upon which they base our treatments – just another screw being tightened on patients.) Continue reading

Healthcare market model destroying healthcare professions

Why a market model is destroying the safeguards of the professions | Aeon Ideas – by Lisa Herzog – Jan 2019

The young doctor was desperate. ‘I need to talk to my patients,’ she said, ‘and give them time to ask questions. Some of them are foreign-born and struggle with the language, and all of them are in distress! But I hardly have the time to explain the essentials to them. There’s all the paperwork, and we’re constantly understaffed.’

Such grievances have become sadly familiar – not only in medicine, but also in education and care-work.

The imperatives of productivity, profitability, and the market rule.

These imperatives are all monetary with financial gain as the highest priority while ALL other outcomes are subsumed in the pursuit of profit.    Continue reading