Why I don’t treat chronic pain: “. . . doctors have been sued for undertreating pain and jailed for overtreating it.”

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  • Anonymous

    But in my ER, it’s ALWAYS the Drug Seekers with 100 previous visits who tell me they’re going to sue me when I won’t give them Demerol.

  • Dr Epicurus, in Oz

    You’re kidding…right ? If one of your patients say, has a spinal fracture, or severe OA…you’ll boot them out the door ??

    I presume that was tongue in cheek :)

    Here in Oz we have a ‘drugseeker hotline’ accessible only to docs, who want to check a patients prescription history from ANY docs in ANY state even.

    The privacy issue is debatable, though.

  • Anonymous

    I’m not sure you read the first post. Here in the States we get patients signing in to the ER for “Med refills” who say “I was pissing in the toilet when my bottle of oxycontin fell in and all the pills got flushed” I kick those patients out. I’m not sure what that has to do with Acute Spinal Fractures. We can’t share information about drugseekers, it’s called a “HIPAA Violation”. We could get sued.

  • Dr Epicurus, in Oz

    I did read the first post, “anonymous” ;)

    It was one sentence “WHY I DON’T TREAT CHRONIC PAIN..etc”, with a link to an article about the difficulties, in the US, associated with opiod prescription.

    Obviously the laws are different here, which is why I raised the topic, in terms of your situation there. The ‘drugseeker hotline’ thingy here is highly contentious. Mind you, we’re not as litigious as you Americans :)

    No idiot would dispense a full script in an ED, but presumably you still objectively assess for withdrawal SIGNS and provide cover for 24 hrs if they’re evident ?

  • Dr Epicurus, in Oz

    Sounds difficult. Defensive medicine. Lawyers getting in the way of best practice again.

    And if it’s a known abuser, I agree it’s a different story to someone you suspect..

  • Nicolas Martin

    God forbid that Amercan doctors would speak out forthrightly against the drug prohibition responsible for this horrific state, or in favor of restoring the traditional right to self-medicate. To aggrandize themselves physicians have been willing to sacrifice medical integrity and their patients.

    In the past few days the Supreme Court has given physicians the green light to kill patients, and a report from the UK finds that doctors subjected almost 2000 patients to “non-voluntary euthanasia,” a euphemism for murder, despite the fact that euthanasia is illegal there.

    The Nazification of medical care gives physicians ever-expanding authority as de facto agents of the state. In this circumstance, it is becoming more acceptable for them to kill even “non-voluntary” patients than to properly treat them, or for people to treat themselves.

    Meanwhile, physicians have lobbied for control of “suicide prevention.” If a doctor elects to kill you it is “compassionate” medicine, but if you want to kill yourself you will likely be given a psychiatric diagnosis and administred “non-voluntary” treatment.

    It is unfortunate that physicians are being pestered and prosecuted for prescribing opiates, but it is the inevitable consequence of physicians eschewing autonomy for themselves and their patients, prefering to become gatekeepers for the therapeutic state.

    If American physicians think they are immune to the extant ethical failures of legal Dutch and illegal British euthanasia (if one considers murder an ethical failure), they can be referred to contrary 20th Century evidence, including the imprisonment of epileptics and sterilization of “idiots.” also approved by the Supreme Court.

  • Jeff

    Thanks, Nick Martin, for proving Godwin’s Law (“According to Godwin’s Law, an Internet discussion-group dictum that long predates blogging, when one side in an argument invokes Hitler, it proves he’s lost.”)

  • Nicolas Martin

    Let us then gather up the volumes that consider the lessons of Nazi Germany and set them ablaze. We can learn nothing from the eugenic trail that leads from American medicine to Germany, and on to the gas chambers. We are bound by a rule: all references to Nazi history are discredited by those that are ill-founded. That is, it is now impermissible to look at the genesis of German or American euthanasia because some people called Ronald Reagan a Nazi.

    Jeff’s is a common and often effective anti-intellectual tactic. It’s much easier than proving why a Nazi analogy is incorrect. Why bother when there is a rule against thinking?

    The fact remains that the U.S. has an ugly eugenic history which influenced the Nazis. The fact remains that the U.S. is just the third country since WWII to authorize euthanasia. So, I’m content with my selective reference to the Nazis.

    Perhaps if history has revealed favorable aspects of officially-sanctioned euthanasia and American eugenics, Jeff would trouble himself to describe them.