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, 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 others have—perhaps unnecessarily—stopped prescribing opioids altogether.possibly dangerous doses, while
…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
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 — 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
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
Can a Nice Doctor Make Treatments More Effective? – By Lauren C. Howe and Kari Leibowitz – Jan 2019
Here’s proof that a doctor’s demeanor and empathy for the patient has powerful effects on the results of their care.
Our research in the psychology department at Stanford University suggests that having a doctor who is warm and reassuring actually improves your health.
The simple things a doctor says and does to connect with patients can make a difference for health outcomes. Even a brief reassurance to a patient from a doctor might relieve the patient’s symptoms faster.
Yet the titans of the healthcare industry are doing their very best to make doctors just another generic and interchangeable piece of equipment in their money-making enterprises. Continue reading
Chronic pain management in medical education: a disastrous omission: Postgraduate Medicine: Vol 129, No 3 – John D. Loeser & Michael E. Schatman – Feb 2017
First, a quote from almost 4 decades ago is proven over and over again in this “opioid restriction crisis” and the “uncontrolled pain crisis”:
“The relief of suffering, it would appear, is considered one of the primary ends of medicine by patients and lay persons, but not by the medical profession.”
-Eric Cassell. The nature of suffering and the goals of medicine. N Engl J Med. 1982
The “war on drugs” has urged all kinds of non-medical self-appointed experts to target pain patients (they are much easier prey than illicit drug cartels and dealers). Continue reading
4 disturbing trends in health care – Praveen Suthrum | KevinMD | Aug 2018
I agree with the author that health care is changing dramatically and not necessarily in a good direction. This article points out some fundamental issues that must be addressed before any “progress” can be made.
It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.
Here are four trends that are changing health care but on the surface are too unsexy for us to care about. Continue reading
Authorities’ Use of Big Data May Harm—or Help—Your Chances of Investigation – By Efrem M. Grail – September 12, 2018
A former prosecutor and current defense lawyer shares strategies to help protect your practice.
This is what it has come to: lawyers are advising doctors how to practice medicine without ending up in jail.
As pain practitioners well know, two recent developments – one federal, one state – have combined to increase the risk of providers being investigated for prescribing opioids for their patients. Continue reading
Are doctors cutting back on opioids too much and too quickly? – Healthy Debate – Author: Paul Taylor – Date: March 27, 2018
I suffer from a rare and very painful genetic disorder.
For a decade, my family physician has prescribed opioid drugs to me to ease the pain. But he recently retired and I had to find another doctor.
Well, any pain patient knows what’s coming next. There are very few doctors taking new pain patients and continuing their opioid therapy, no matter how well it has worked or for how long. Continue reading