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
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
Artificial Intelligence and Black‐Box Medical Decisions: Accuracy versus Explainability – by Alex John London – February 2019
This article explores a big problem with “AI”, one that’s fundamental to its design and function, one that presents thorny philosophical issues that must be confronted and decided before technology decides them for us by default, allow the technology to direct us instead of us directing the technology.
I suspect this is already starting to happen as more medical records are digitized and become available to be processed by an algorithm instead of a person, preferably one with medical knowledge, but these days more commonly a bureaucratic administrator following a procedural “algorithm” of their own. Continue reading
No Shortcuts to Safer Opioid Prescribing | NEJM – Deborah Dowell, M.D., M.P.H., Tamara Haegerich, Ph.D., and Roger Chou, M.D. [!!!] – Apr 2019
This article is astonishing because Dr. Roger Chou has been one of the most influential anti-opioid crusaders. I’m thrilled that he’s finally understanding (or at least noticing) the problems (torture) caused by the CDC Guideline that he helped write.
Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016, the medical and health policy communities have largely embraced its recommendations.
Although outpatient opioid prescribing had been declining since 2012, accelerated decreases — including in high-risk prescribing — followed the guideline’s release.
“Accelerated decreases” is a deliberately innocuous term when referring to the brutal, suicide-inducing, drastic forced opioid tapers pain patients have had to endure. Continue reading
Voice-recognition system aims to automate data entry by doctors – STAT – By Casey Ross @caseymross – March 4, 2019
I think artificial intelligence (AI) in healthcare simply must happen with so many people’s care sprawling over so many healthcare services (and billing companies). Using AI learning systems in healthcare makes a mockery of any kind of patient or doctor privacy. Even worse, they are dangerously prone to undetectable errors (people have died).
Still, we need these systems to cope with the ever-increasing amounts of data and knowledge, but we need them to serve humans, not to replace them.
Hands down, the one task doctors complain about most is filling out the electronic health record during and after patient visits. It is disruptive and time-consuming, and patients don’t like being talked to over the doctor’s shoulder. Continue reading
What Are Important Ethical Implications of Using Facial Recognition Technology in Health Care? – AMA Journal of Ethics – Nicole Martinez-Martin, JD, PhD
Applications of facial recognition technology (FRT) in health care settings have been developed to identify and monitor patients as well as to diagnose genetic, medical, and behavioral conditions.
The use of FRT in health care suggests the importance of informed consent, data input and analysis quality, effective communication about incidental findings, and potential influence on patient-clinician relationships.
Privacy and data protection are thought to present challenges for the use of FRT for health applications. Continue reading
Ethical Issues in the Design and Implementation of Population Health Programs – free full-text /PMC5834965/ – J Gen Intern Med. – 2018 Mar
When a single doctor is supposed to work both for a “population” and an “individual”, ethical problems are inevitable. I doubt any patient wants to be treated as just a standard member of a “population”.
This is the current problem that pain patients are having: because we need a drug that is also used illicitly (by others), we are treated as though we were members of the “population” of “illicit drug users”.
Instead of receiving treatments that are effective for our pain and tailored to our individual needs, we are literally treated like “people with addiction” instead of “people with pain”.
…specific population health activities may not be in every patient’s best interest in every circumstance, which can create ethical tensions for individual physicians and other health care professionals.
Patient Care and Population Health: Goals, Roles and Costs – free full-text /PMC4207028/ – Aug 2014
We should welcome efforts that encourage clinicians to avoid tests and treatments that do not improve health and thereby waste valuable resources
But we should critically evaluate proposals that assign clinicians the direct double responsibility of
- meeting the medical needs of patients while
- simultaneously meeting the economic needs of populations.
Why should we be sceptical? For two reasons. Continue reading
I stumbled across this interesting publication that’s dedicated to reporting on the “cheating” that goes on as our country moves to privatize more and more services
Tarbell uncovers how powerful people and companies use their influence to shape a system that works for them, not you. We highlight solutions to pressing problems.
This puts our lives in the hands of corporations whose “moral imperative” is to make money for their shareholders, while all other goals and concerns (like patient outcomes) exist only in service of this “prime directive”. Continue reading
60 Minutes Fails to Represent Pain Patient Perspective – By Laura Mills, Kate M. Nicholson, and Lindsay Baran – Mar 2019
CBS heaved out another stigmatizing and inaccurate media “story” (didn’t qualify to be called a “report”) about opioids and those who must take them. Here is the response, which points out the “pain” side of opioids (instead of just the “addiction” side).
In a Feb. 24 segment, CBS’s 60 Minutes accused the Food and Drug Administration (FDA) of igniting the overdose epidemic in the United States with its “illegal approval of opioids for the treatment of chronic pain.”
While the program highlighted the adverse consequences of misleading pharmaceutical marketing and lax government oversight, this segment failed to consider the perspective of patients who legitimately use opioids for pain, stigmatized them as drug-seekers, and propagated misconceptions about the overdose crisis, such as the idea that opioid treatment for chronic pain is indisputably illegitimate and is driving overdose deaths in the US. Continue reading