Are you a victim of patient profiling?

Are you a victim of patient profiling?

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences.

For the first time, people share their stories:

Are you a victim of patient profiling?

“I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider

Are you a victim of patient profiling?

“In 1986 I was in a motorcycle accident. I tore up my face on the road. I was taken to the ER and treated like crap because I had no insurance. They cauterized my facial wounds rather than stitch me up, and then dumped me on the sidewalk with amnesia. I still have distinct black scars; people think they’re tattoos. I went into collections and it took years to pay that one off. Six weeks ago, I fell while trimming a tree. When the ER found the insurance card in my wallet, I was treated like gold.” ~ James Cummings

Are you a victim of patient profiling?

“I was pressured by our doctor from my son’s birth all the way through grade school. I kept telling him no vaccines whatsoever, zero, nada. I was hassled, shamed, talked down to, and more. Not a fun experience, whatsoever. I was profiled as a bad mother.” ~ Sheri Ricker

Are you a victim of patient profiling?

“As a teen, I fractured my nose. Many sinus issues later, I consulted an ENT specialist. He insisted that I damaged my sinus passages by using cocaine. His assumptions caused me pain, humiliation, confusion, and anger. I repeatedly assured him that I wasn’t a user. Two surgeries later, my septum was removed. Afterwards, he was so cruel as to continue his tirade about my cocaine use. As the gauze was being removed from my nose, I fainted. When I was roused, he insisted that I leave immediately showing no concern about whether I could even make it home safely.” ~ Lonnie Stoner

Are you a victim of patient profiling?

“It was 1975. I was 23 and I’d been on the pill for 4 years, but I became concerned about potential negative side effects of long-term hormonal manipulation.  So I researched other contraceptives and felt the diaphragm was the simplest and safest option for me. When I went to the county clinic to get fitted, I explained what I’d researched to the doctor. He scoffed at my concerns, urged me to stay on the pill, and disputed any potential negative consequences. He reminded me that taking a pill each day was SO much easier than having to be responsible for using the diaphragm properly. It was clear he thought I was too young and clueless to make this decision about my own reproductive health care. Although he tried to dissuade me from switching to a diaphragm, I insisted that’s what I wanted, and he finally fitted me for it. After he left the room, the nurse said, ‘Don’t worry, dear; it’s quite easy to use. I’ve been using one for years with no problems. It’s a good choice for you to make!’ It was clear she didn’t approve of his patronizing attitude either.” ~ Patsy Raney

Are you a victim of patient profiling?

“I injured my back at work. I couldn’t get time off, so my family doc prescribed pain meds so I could get through the day and Xanax for sleep. I returned every six months for two years and he always accused me of taking more than I was prescribed. He got progressively more rude and angry. I brought my wife with me to see if I was imagining it. She witnessed it too, so we searched for another doctor. I asked my new doctor to taper me off of the pain meds and Xanax so I could try medical marijuana instead. He was skeptical. He told me to go to the pain clinic. I’d gone there once before and was treated like a criminal. I didn’t want to go there!  So he wrote up a contract that said I would agree to take pain meds and Xanax and I’d be drug tested monthly to make sure that I wasn’t using medical marijuana. When I told him I wouldn’t sign the contract, he told me to find another doctor. This was at a critical time when I needed real help and was worried about taking the meds for over two years.” ~ Carl Williams

I’ve been a doctor for 20 years. I thought I’d seen it all. Drug addicts have altered my prescriptions, even forged my name. Patients have lied to me. Many haven’t followed my treatment plans. Some have died as a result. Still, I try to treat everyone fairly and with respect. But now I’m wondering, “Have I ever profiled a patient?” I bet I have. So on behalf of my colleagues and myself, I’ve got a message for any patient who has ever been misjudged or mistreated:

Are you a victim of patient profiling?

Are you a doctor who has profiled a patient? Have you ever been profiled by your doctor? I’d love to hear your story.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • EmilyAnon

    If any of my doctors read my comments here I wonder if I would be profiled. Good thing I’m anonymous. .;-)

    • DoubtfulGuest

      Oh, I think you’d be alright. You’re respectful and bring up lots of good points to think about. *Supposedly*, most doctors don’t want us to be intimidated. ;)

      • PamelaWibleMD

        Docs want to help – not hurt – their patients, We are humanitarian idealists at heart, <3

        • SarahJ89

          Sadly, not all, Pamela. But most, yes I do believe most front-line people in every profession I’ve seen really do their best. I just posted my experience above and the power the few bad apples have is unsettling.

  • Anthony D

    My doctors already know I post on kevinmd!

  • CSPrf

    The pediatrician who decided that the woman who refused to allow any vaccines for her child was a bad mother wasn’t profiling. She just made an accurate judgement that the woman was endangering her child and the pediatrician’s patient.

    • guest

      Yep, that was the one instance of “profiling” here that I thought was appropriate.

      • DoubtfulGuest

        I wouldn’t call her a “bad mother” because that’s getting ad hominem. Otherwise, I agree with you docs on the vaccine example.

        • guest

          Loving mom, bad judgment (IMO)

    • PamelaWibleMD

      There may be a more compassionate way to disagree.

      • DoubtfulGuest

        Yes, just give this woman information. Calmly and objectively. It will either work or it won’t. Shaming people just makes them dig their heels in even more.

        • CSPrf
          • DoubtfulGuest

            Yesterday, there was discussion about what ‘shaming’ means, and what actually occurred. I don’t have a problem with a physician declining to take on or keep patients who don’t vaccinate. If there was a verbal tirade of some sort, that’s another matter. If the doctor is going to talk to her about it at all (docere = to teach, and all that), it should be to convey factual information.

            I fell into that trap of “if you ask any questions, it means you don’t trust me” with my own uncommon (not rare) diagnosis, so I can’t quite agree with that general premise about the doctor/patient relationship. Depending on the situation, there may be lots of reasons for a patient to say “I trust you AND I need you to consider some additional information”. Not with the vax issue, in particular. Just other stuff.

          • SarahJ89

            But Doubtful, refusing to see children whose parents don’t vaccinate them only means they now have no medical care. I lived through the polio epidemic and saw what the Salk vaccine accomplished. But I have friends who don’t vaccinate their kids. Refusing to treat those kids teaches the parents absolutely nothing (worse than nothing, really) and means the kids are now without a doctor. How does that help?

          • DoubtfulGuest

            Yeah, I agree that is a problem. What information sources do your friends use to decide? Would they be receptive to any kind of education from their doctors? I was thinking mainly from the perspective that unvaccinated kids in the office could be dangerous for that doctor’s other patients, e.g. an immunocompromised child.

          • SarahJ89

            I honestly don’t know the answer to that question. When I was a child everyone got mumps, measles and chicken pox and it wasn’t a big deal. No one ever went to the doctor for them so being in a waiting room wasn’t an issue.

            But I do know that having kids with no doctor at all isn’t a great idea. I wonder if parents who don’t want to vaccinate would be willing to keep their kids home if they get sick with these childhood diseases. It’s not as if you can do much to treat them, really. Bed rest, fever reduction. I remember with measles the window shades were drawn to keep the house dark to guard against problems with the eyes. It actually served to make the environment more conducive to rest.

            I don’t have the answer to that but getting on high horses on either side helps no one and adds nothing to finding a solution.

          • SarahJ89

            My friends used a variety of sources, some (IMO) more reliable than others. Part of what I see going on is that people approach the whole issue as being monolithic and it really isn’t. I lived through the polio epidemics so I’m a big fan of polio vaccinations. But I also grew up in a time when *everyone* got chicken pox so I think it’s beyond silly to be vaccinating kids for that. I would want to postpone or stretch out the timing of several vaccinations instead of doing so many at once and yes, I would not be wanting to vaccinate against chicken pox, mumps and measles until much later if the child didn’t get them in early childhood because they’re pretty miserable in adulthood. I would put HPV vaccination in the same category as seeing to it you got reliable birth control *before* you became sexually active and would impress that responsibility upon my child instead of doing it earlier.

            But if I was dealing with a doctor who got huffy the minute I brought this up… well, you can see it wouldn’t go well.

            My friends have run into doctors who were unreasonable jerks the moment the topic came up. And, after a period of several years of no care or ER only they found a doctor willing to work with them. And… they ended up eventually doing some vaccinations. I was certainly nipping at their heels about polio vaccinations.

            I have other friends who are equally huffy as some docs. They just end up painting themselves in a corner. Huffy simply doesn’t help in a situation that’s really more complicated than people want to think it is.

          • rbthe4th2

            How does it hurt the kids who can’t be vaccinated due to age or the like, when someone comes in and gets them sick? What happens when a parent loses a child or they suffer sickness or a disability because the doctor accepted non vaccinated patients?

      • ninguem

        My little Oregon town, I had reason to walk through the town cemetery a while ago. A remarkable number of children’s graves, all with year of death 1952. I lost count at about a dozen, quite a number for a little rural town.

        What do you think? Whooping cough or polio?

        My guess is polio. Epidemic in USA in ’40 and ’52.

        Am I being less-than-compassionate by pointing out the gravestones they drove by, on the way to my office?

        • DoubtfulGuest

          Absolutely not. That’s factual information that patients can use to make good decisions. Even if you’re making an educated guess between two diseases. That doesn’t count as “shaming” in my book.

          • ninguem

            How about pointing out that the research on which recent vaccine objections are based, is not only wrong, but fraudulent (Wakefield)?

            And that we’re seeing incidence of these diseases back at 1952 levels (whooping cough), with deaths, in the Pacific Northwest?

            With vaccine “exemption” rates approaching 30-40% in metro Seattle schools, all in the more “yuppie” parts of town.

            Not in my area, which is more blue collar and immigrant. The immigrants don’t refuse vaccines, they know bloody well what the disease can do, having seen it personally in the old country.

            I suppose the shaming comes with the suggestion that the American-born exhibit the same common sense as an immigrant Somalian peasant in this country.

          • DoubtfulGuest

            IF I was a vaccine-avoider, which I’m not, I’d surely be convinced by now. I wonder what “shaming” meant to the patient? Objective information is always the way to go. If I were that patient, I’d listen to you.

          • ninguem

            “Shaming” usually means the physician declining to sign the exemption forms.

          • DoubtfulGuest

            Haha, okay. Again, I have no experience with these particular kinds of examples. I did have a specialist who had been “doing this” for 32 years, decide I was faking my rather serious illness with no objective evidence of deception on my part.

          • SarahJ89

            No, some doctors get really “red flag with a bull” nasty when there’s any attempt at discussion. As do some parents. Neither helps, nor does your painting of everyone with the same brush.

        • PamelaWibleMD

          That is a great example to share with patients. It really comes down to the level of trust a patent has in the physician. Adversarial relationships with patients are part of the problem here.

    • Grimm

      While I don’t agree with you about vaccinating, the mother should have found a pediatrician who had the same views and values she had to avoid profiling.

      We delayed vaccinations for my daughter. We screened a few doctors before she was born to find one that wasn’t just going to medicate our child if there was something wrong rather than get to the root of the problem and treat THAT. Our pediatrician delayed vaccines for her own children and was willing to discuss any and all our options before any treatments are offered.

      Going with a doctor without talking to them about their practices first is just plan uneducated! The pediatrician was right in thinking this mom was dumb.

  • PoliticallyIncorrectMD

    For 10+ years of training each physician is continuously taught to recognize patterns of “appearance, race, gender and … other observable characteristics”. Now we have to apologize for it? There are other ways to increase your patient satisfaction scores than trying to paint the medical community in unfavorable way!

    • DoubtfulGuest

      I can see both sides. The stakes are quite high for the patient. It does make sense that you have to use diagnostic algorithms. I’ve had many situations in which it seemed that I was profiled, that ultimately led to a series of misdiagnoses. They were not so straightforward as some of the ones here. The apparent labeling was indirect and there were more variables involved. It’s a very strange feeling for the patient…at times I actually looked back over my shoulder to see if the doctor was talking to someone else! Patients might realize that medicine is extremely challenging and you have to look for patterns. What matters more to me is that doctors are careful not to ‘anchor’ the perceptions and filter out important information.

      • PoliticallyIncorrectMD

        All people profile whether we want to admit it or not. That is how our brain works. Profiling is not designed to replace conclusions based on facts. It allows our brain to make a snap judgement when information is incomplete or time is limited. As additional facts come in, the initial impression based on profiling would be corrected based on what we learn.

        • DoubtfulGuest

          You’re right, I profile people, too. I try to constantly question myself. Would be nice to see a post sometime about ‘anchoring errors’. I think that’s what really ends up harming patients in these situations.

          Oh, wait, that’s already been done.

          http://www.kevinmd.com/blog/2012/11/teach-anchoring-error-avoid.html

          A favorite topic of mine, all the same.

    • PamelaWibleMD

      Not trying to “paint the medical community in a an unfavorable way.” I do believe sometimes we make snap judgments about patients that may not be correct. Our subjective analysis then follows them around in something called a medical record and that legal document may continue to paint the patient in an unfavorable way. I just think we can do better. I know I can.

      • Harriet

        It seems like it does not matter what a patient does. . .it’s always wrong and always right there in the medical record that will follow us wherever we go. Go to the doctor with lots of questions or a different idea? Patient has a knowledge deficit. Still having the same problem and it’s not getting any better? Exaggerating symptoms. Can’t take the medication because it’s too expensive or the side effects make it impossible for you to work at
        your job? Non-compliant. Don’t go to the doctor very often for financial or other reasons? Patient has a history of refusing care. Ask a question about what to take for pain? Drug seeking behavior. The labels and pigeon holes are endless.
        I can honestly say I truly regret anything I have ever told a doctor or nurse beyond objective factual statements because I know it’s all right there to be judged by every doctor that I have no choice but to go to for the rest of my life. It seems like the best thing a patient can do now is offer a few basic medical facts and not interject any references to anything about their feelings about their treatment or their personal circumstances, even if these things do have a significant impact on their health and well being. Sad state of affairs when your labels and rush to judgment make us not be honest with you. But honestly,
        what choice do we really have?

        • southerndoc1

          Switch to a doc in a small private practice who doesn’t share her records with the entire world and can only release them at your request.

          • DoubtfulGuest

            Okay, but when does switching become “doctor shopping”?

          • PamelaWibleMD

            Find the right doc and you won’t have to worry about labels and doctor shopping. Some of these terms are thrown around by doctors who are under immense pressure and they don’t even have time to eat lunch or take a bathroom break. It is hard to care for patients this way. I tried. 10 years. It wore me out.

          • DoubtfulGuest

            Oh, I’m all set now, thanks. I share your concern about the working conditions of most doctors. Just noticing a pattern on this blog of “Having a problem with your doc? Find a new one!” and at the same time, “Doctor shoppers…the bane of our existence. What, they think they can go through us like Kleenex?”

            I just wondered if, say, changing docs more than once becomes suspicious? More than twice? Three times? You’re right, that the right doc will not worry about it. They’re always the last place you look…

          • PamelaWibleMD

            Good idea.

          • SarahJ89

            How I wish. That option simply does not exist in my area. The hospital has bought them all up. My own PCP fought for years but EHR finally did him in and now he, too, is owned.

        • PamelaWibleMD

          Some of these snap judgments may be the result of high volume practices forcing docs to see WAY too many patients in brief slots. In a 5-10 minute visit, we are trying to assess and manage really complicated physical, emotional, and social problems. This is not how most docs imagined caring for people.

        • SarahJ89

          “I can honestly say I truly regret anything I have ever told a doctor or
          nurse beyond objective factual statements because I know it’s all right
          there to be judged by every doctor that I have no choice but to go to
          for the rest of my life. ”
          This. I wish I could like it 1000 times.

      • PoliticallyIncorrectMD

        Whether you are trying or not, your posts frequently resemble well-designed PR campaign focusing on how you are more fair, sensitive, understanding, inclusive … (fill the blank) … than other providers. I was just pointing out that it may not be the right thing to do (for patients of course).

        • DoubtfulGuest

          I’ve expressed this same concern elsewhere. Although it looks to me like an unintended side effect. I think a crucial aspect of promoting physician welfare is for patients to learn to appreciate a wider variety of doc personalities and approaches to care. I have a great respect for Dr. Wible’s work. I do see problems with some of her public statements vis a vis widespread “quality measures”, patient satisfaction surveys, and online reviews. Much of this is out of any individual’s hands, but should be considered when crafting one’s message to the public about what doctors and patients need to do.

          • SarahJ89

            Want to make patient satisfaction more meaningful? Stop hiding the very information we need to make reasoned evaluation. At the moment we have your personality and the nice curtains in your office to go on, not much more really. So yes, the results are shallow.

        • PamelaWibleMD

          I do not feel I am better or worse than anyone else. I am just trying to be me. I do tend to address taboo topics that are not polite dinner conversation – miscarriages, doc suicide, patient profiling. I think people are hungry for real conversation on these difficult topics. How can we solve a problem unless it is named and claimed as a problem?

          • DoubtfulGuest

            Your addressing taboo topics is one of the things I admire most, Dr. Wible. You have the ability to reach a wide audience and a tremendous opportunity here. Many patients love your style of doctoring and you are also doing a lot to re-humanize medicine. How great it would be if patients would just treat their doctors as human beings. On the other hand, you can only take care of so many patients. I would like to see a wider variety of doctor and patient personalities learn to get along and work together. It seems feasible to promote your own style — and at the same time encourage all patients to appreciate the skilled surgeon who’s not much of a talker, a PCP who’s a bit nerdy and shy, or a cardiologist who is gruff and snappish but does great work and cares in her own way. I think this would make a significant impact on quality of life for all physicians, which I know is one of your most treasured goals. I think of these doctors who are tired after a long day, have skipped lunch, then find that they’ve gotten another poor online rating or low patient satisfaction scores, with a negative impact on their pay. Or yet more bad popular press about doctors in general? Just something to consider, as a possible opportunity to make an even more positive impact.

          • PamelaWibleMD

            Yes. Kindness and mutual respect go a long way in healing both parties. Doctors are essentially perfectionists working in an imperfect system. There is a lot to admire in their dedication – much of it selfless.

    • buzzkillersmith

      Yep. Initial impression, then continuous Bayesian updating. That is, make a hypothesis and then change it as new information is brought to light. Like working up abnormal liver function tests, or abdominal pain, or headache, or a rash, or leukopenia, or anemia, or chest pain, or shortness of breath, or insomnia, or an abdominal bruit, or crying spells, or ear pain, or facial asymmetry, or chronic vomiting, or hematochezia, or melena, or vertigo, or acute lower extremity weakness.

      Would you believe it, they do it science–and engineering, Officers do it in battle. Farmers do it. Meteorologists do it. The guy at the bus stop does it when he looks you in the eye as you drive up.

      Ignoring potentially useful information is no way to practice medicine, or, indeed, to live life, Dr. Wible. You should know this by now.

      Hypothesis, then Bayesian updating resulting in a new hypothesis, then repeat until this process converges to a steady state.

      Next case.

      • DoubtfulGuest

        Dr. buzzkillersmith, Sir? I think there’s disagreement over what “profile” means. I suggest that *failure to update* is what actually harms patients. I wonder why there’s not been more discussion about that? I would also expect doctors to disagree with one another in a more collegial way than I often see happening here. Why so dismissive?

        • buzzkillersmith

          1. Failure to update is not much discussed because most physicians have the statistical sophistication of schoolchildren. As a mathy guy I kid myself I’m more skilled in that area. Not to demean MDs–we just have other things to learn and not much time to do it. I would submit that the average MD has 15 IQ points on the average psychology PhDs( I know quite a few–nice folks, not geniuses), yet the shrinks know more stats.

          2. Dismissiveness is part of my charm. Hence the moniker. Feel free to be as rude to me as you wish. I am nice to people who know who I really am. But you don’t have to believe that.

          3. I am proud to be an XY.

          • DoubtfulGuest

            1. Okay…I’m just not sure what the point of the discussion was then? Nobody wants to admit mistakes in judging a patient, where the patient was harmed as a result? Line forms to the right…
            2. I didn’t assume you’re not nice. I appreciate many of your comments. Cloying politeness is part of my charm. If I may be less charming for a sec, I feel that there’s a lot of back-patting among physicians here, about the patient assessment process. Like yep, we always do a great job. Yep, yep…but it looked to me like people got stuck at the definition of “profiling” and picking apart the examples (some of which I agree were problematic, and boy did I learn a lot about prescription drug abuse and how it affects you all). It’s an odd mix of dismissiveness and back-patting. The dynamic doesn’t make sense to me.
            3. Okay, thank you for your time, Sir.

          • buzzkillersmith

            Again, the key point is the process. Initial impression->new information-> second impression->repeat until stability.

            This is how physicians and other rational observers of nature should think. Denying your own initial impression, an impression based on experience and worldly wisdom, might be politically correct, but it is suboptimal from the standpont of decision making. Dr. W. know this. She is being disingenuous so as to brownnose and I am calling her on it.

            I will monitor her future posts closely and might not be so polite in the future.

          • DoubtfulGuest

            Well…

            We agree on what the process “is” or rather, should be. Patients here have described many instances in which doctors got stuck at step 1. We all know about risk management, blah blah…no one expects any of you to relate in detail a case in which you screwed up. If you guys would simply acknowledge the problem that would be a big step.

            Two possible definitions of “profile”:

            1) The initial impression
            2) *Maintenance of* that initial unflattering impression regardless of new information

            Seems like you doctors think she’s saying it’s #1, but I (and other patients here) took it as #2. I didn’t think she suggested that physicians should deny their initial impressions or circumvent the process. I’m aware that many of you take issue with some of Dr. Wible’s statements in different posts. I understand those points of contention. I haven’t been around long enough to know how much is communication snafu vs. actual differences in philosophy. It certainly is interesting.

        • buzzkillersmith

          Just one more thing. If you want to see a lack of collegiality, spend a little time in a medical case presentation at one of our better universities, say UCSF. The goal is to make one another look like dogmeat. I loved it.

  • DoubtfulGuest

    Also, this is a great topic, Dr. Wible. Thank You. And it is nice to see a physician who is not afraid to say those two words.

  • guest

    I “profile” regularly. Most of the time my “profiling” or assessment is pretty accurate. However, that does not change how I treat patients or families. I treat them as well as I’d like to be treated in their situation, regardless of their “baggage.” As PIMD pointed out it is our job to size people up based on what we see and what we sense about them and then go from there.

    • DoubtfulGuest

      How much training do you all get in sensing a patient’s personality or character? I mean any doctors who aren’t psychiatrists. What I have trouble with is the apparent idea that patients are supposed to be perfectly relaxed, sort of ‘blank slates’ for the doctor to judge. We can feel that we’re being sized up and it’s pretty hard to take. The medical environment is alien and uncomfortable for most people, which can lead to all kinds of misunderstandings.

      • PamelaWibleMD

        Yet we want people to feel comfortable in something we created called a “medical home.” Do patients really feel comfortable in medical homes designed by docs, consultants, and experts? I think we need to be more patient-centric and understand what the person is feeling in front of us.

      • PamelaWibleMD

        I’m not sure we get training in intuiting who a person is?

      • guest

        Good question. I don’t know what my colleagues do but I certainly process patient anxiety into my assessment. It’s amazing the different way patients emote their fears. Some won’t make eye contact, some answer tersely, others do not stop talking. Some are rude or dismissive, others tearful and apologetic. Despite anxiety you can still (after many years of experience) get a sense of the patient underneath. The times I’ve been surprised it’s been pleasantly so.

        • DoubtfulGuest

          Nice, compassionate response. Thank you. I wish all doctors would take this approach. I do think people-reading skills take practice, for all of us.

    • PamelaWibleMD

      Profiling is (in a way) part of our job, We assess – sometimes accurately, sometimes inaccurately – who the patient is in front of us. The problem arises when our care of the person suffers as a result of our personal prejudices. We all make prejudgments don’t we?

  • PamelaWibleMD

    I have always heard that doctors are the lowest utilizers of health care services (such as the flu vaccine).

  • ninguem

    Who used the word “addict”?

    The doctors, or “Carl Williams”?

    • DoubtfulGuest

      A reasonable question. I’d like to know, too. On the other hand, many doctors are very smooth about talking *around* the negative labels. The consequences for patients are just as bad. Then it’s hard to even have a discussion about it later because, you know, “the doctor never actually called you that”.

      • ninguem

        Well, to start with, assuming quotes are accurate, he refused the opiate “agreement” or “contract” whatever you want to call it, he refused monthly visits, he refused drug testing,

        So……..he “needed real help”…….his words……..and he refused it. Concerned he was taking medicines for two years……and I agree, opiates (“pain meds”) and Xanax are a bad choice, and frankly I virtually never prescribe Xanax for any reason

        But marijuana was OK.

        Perhaps “treated like a criminal”, meant making the effort to physically recondition, to get weight down to Earth (the man pictured looks to be pushing 300-lbs), stop smoking if applicable.

        • DoubtfulGuest

          Fair enough. I’m thinking of my own experience and the problem in general, not these specific examples. Some are…better examples of profiling than others, to say the least. I wondered about that contract, too. I have almost zero experience with pain meds so I don’t really have a reference point. I’m just pointing out that patients can be harmed if a doctors mislabels, whether or not the doctor uses that label directly. To see how skilled you all are at talking around the labels for defensive medicine purposes, makes it even harder to take. Yes, patients can get defensive and misunderstand things. It’s no fun, all around.

          • Suzi Q 38

            Some times, I “dress up” for a physician appointment. If I don’t want the standard “brush off,” I wear nicer clothes.

            My friend is an NP. She commented once that her SIL always wore shorts, flip flops, and a tank top in the summer to her physician appointments. She also wore loose sweat pants and a sweatshirt in the winter. She told me that her SIL was not going to get taken seriously by the physician.

            I had previously thought that the physician didn’t care what we wore.

            I now make sure to dress for the “occasion.”

            If the doctor is checking my knee, I wear shorts or a dress.

            If the neurologist is checking my gait while I walk, I try to wear a dress so that she can see my legs without a problem.

            For the GYN, it doesn’t matter.

          • DoubtfulGuest

            I think this is often true. For me, it actually backfired, believe it or not. The doctor who said I was faking based on no evidence was at a fancy teaching hospital in a large city. The other doctor I keep mentioning was the referring physician for that visit, and he turned against me after he saw the other doc’s opinion. Anyway, for Big City doctor visit day, I stupidly got some nice-ish new clothes. Everything else I had were student clothes…my research involves being outside and getting dirty, so I had mostly worn out things by then. I put on this nice-but-not-lavish sweater, pants, and shoes for the doctor visit, and the doctor who said I was a faker actually commented on my shoes! “And Oh Yes, those are VERY nice little shoes, but you’ll have to KICK those off for me to examine you…”

            ????????

            I also wore nice pants that could be easily rolled up so the doctor could check my muscles…given that I had proximal weakness this was kind of important. He didn’t look at them, though. With the disease I have, muscles can take on kind of a spongy appearance, and the muscle bulk is decreased. He never even checked that stuff.

            Good point, though.

          • Suzi Q 38

            Thanks.

          • PamelaWibleMD

            For gyn exam wear a skirt. easier than a gown.

          • ninguem

            I tried that Pam, the patient ran off screaming.

          • SarahJ89

            I really am laughing out loud here. Thanks.

        • PamelaWibleMD

          The guy is about 160. he is wearing a large coat and did not wanted to remain anonymous so thus the card over his face, He is the only person in the story who did not want to use his real name. All stories shared are direct quotes from the patients sent to me by email.

          • ninguem

            Fair enough.

            Just because they were direct quotes does not mean that the events described have any relation to reality.

            I’ve been lied to about histories of major trauma, multiple sclerosis, and HIV, among others. The stories always end in requests for narcotics and marijuana. “Spinal tumors” that turned out to be 2-mm incidential hemangiomas.

            “But I was NEVER TOLD…..” [that there was no HIV or MS, etc].

            http://www.youtube.com/watch?v=_QMCtVRMzUo

            The “second opinion” scene in The Sopranos.

            My response, same as the psychiatrist at 3:40 in the clip.

          • PamelaWibleMD

            Human psychology is full of land mines.

          • ninguem

            Actually, forget about the 3:40 part, see the whole clip. The psychiatrist was quite judgmental, and for good reason. Sometimes the patient needs to be told the hard truth. Of course, had Carmela Soprano done what the doc had advised, there would have been no series.

            Or the psychiatrist would have been killed. Actually, the actor who played that role, passed away not long after doing that scene.

            “One thing you can’t say…..that you haven’t been told.”

            I’ve told some patients, that I know for a fact went on to other docs with the same story.

            “Nobody ever told you that you have HIV, no one ever told you that you have MS……etc.,…….I went to the trouble to find your old records from out-of-state, fifteen years ago (one time twenty-five years ago). There would often be a mention that the disease was considered and ruled-out.

          • DoubtfulGuest

            “…passed away not long after doing that scene.” So weird when those things happen in show business.

            Always enjoy your videos, ninguem. A little hard to watch, though, because so many doctors view themselves in this flattering light — ethical role models, doing the right thing. But it doesn’t always go quite like that.

          • Suzi Q 38

            I like ninguem’s videos too.
            Some have been memorable.

          • DoubtfulGuest

            There are more Cops In [name of small town in WA state] videos on YouTube. Highly recommended.

          • ninguem

            Then here’s a video of great educational value.

            Notice the premise of the comedy is a pharmacy that can make no money except by selling liquor, and a customer that sides up to the soda fountain, knowing full well he can get liquor by asking for “the prescription stuff”.

            You can’t premise a comedy on something an audience is not familiar with, or understand. The comedy works because the idea was quite familiar to an audience of the mid-1930′s…….actually Prohibition had just been repealed when this short came out.

            http://www.dailymotion.com/video/xjm4eb_pardon-my-scotch_shortfilms

          • DoubtfulGuest

            Shoot, I was trying to edit and pressed the wrong button. Of course you are helping patients when you refuse to help support their drug habit. Even if they hate you for it. In my experience (just a counter-example of stuff that can happen), there were no drugs to save me from. No psych assistance offered, either. This doctor just wanted to rescue my referring physician from my…diabolical machinations? I don’t have a problem with anything you all are saying, I only ask that you continue to question yourselves…at least get *objective* evidence.

          • Suzi Q 38

            Are you saying that I need to bring the MRI of my cervical spine with me?
            I don’t make a habit of asking my PCP for an RX for narcotics.
            I save that question (if needed) for my neurologist or neurosurgeon.

          • ninguem

            Little thought into the medicinal value of alcoholic drinks. In fact, in World War one times, the AMA took the position that alcoholic drinks had no medicinal value.

            Then Prohibition took effect, what……1920 as I recall……and all of a sudden, all sorts of thought went into the medical value of alcohol, especially when it became clear that doctors could profit from it by writing prescriptions, and various pharmacies could make money selling it. Remember that’s how The Great Gatsby made his money, taking over pharmacies and making the soda fountain a little more……interesting…….by prescription.

            This cartoon came out in 1921.

            http://nursingclio.files.wordpress.com/2013/06/medicinal-beer-cartoon1.jpg

          • PamelaWibleMD

            Worked in a gyn office during residency. Studied some older books in his office from the 1970s. Treatment for premature labor: Alcohol. Imagine a ward full of drunk women in labor.

          • ninguem

            They might have given it intravenously, I know I saw it done as late as the mid-1980′s.

            And rotating cuffs for congestive heart failure.

            That whole hospital was an antique.

            Actually, they still had the full leather restraints needed for laboring women under the influence of “twilight sleep”. If you’ve ever seen someone react badly to scopolamine…………..

            “Twilight sleep” was long gone, but the restraints were still there as late as the 1980′s.

            Every so often they came in handy……..

            Ya gotta remember, maybe no more scopolamine around, but sometimes pregnant women found stuff just as good for making themselves go wild when those labor pains hit.

          • SarahJ89

            I believe it was one ounce per hour. I remember those days from working in a hospital.

            The old social worker texts from the 1930s were hair raising. Things really can change a lot in our lifetime. Getting old is an experience of ongoing culture shock.

          • SarahJ89

            My family is Irish. We always kept a bottle of whiskey in the house for medicinal purposes. Whiskey was for coughs (and it works) and brandy was for the heart (not so effective). The theory was that brandy is a stimulant, whilst whiskey had the opposite effect. Not true, of course, as both are depressants.

            Considering the people who raised me were born in a rural area of a third world country in 1875 it makes sense. I never questioned it, but my husband was certainly shocked when I made sure we had a bottle of whiskey on hand “for medicinal purposes.” He thought I was joking, but I wasn’t.

            I still will make a hot toddy for URI. But brandy is now for eggnog, not my heart.

        • PamelaWibleMD

          Medical marijuana is legal in Oregon. As you know some people feel that they would rather use “natural” or “herbal” treatments rather than big Pharma-style therapies. That is a personal choice. I try to respect what patients feel is a congruent with their life philosophy. Local. Sustainable. Organic. Ya know . . . Don’t you live in Oregon?

          • ninguem

            Of course I am aware of it. Beer is legal too, you don’t give it to an alcoholic.

            I am also aware that “medical marijuana” is about as fraudulent as “medical alcohol” was in the 1920′s.

            It was prescribed for the same reason, which is to get around the legal prohibitions.

            I don’t care if someone wants to smoke marijuana.

            I **DO** care if someone wants me to sign off on it.

          • Suzi Q 38

            So what.
            My good friend has breast cancer.
            She asked her oncologist if he would write her an RX for medical marijuana.
            He said “No.”
            I don’t know what the big deal is.
            If it helps with her pain, why not?
            At least her request is legitimate.

            I told her that I would take her to the wrong side of town to get a bit of it. Heck, all she would have to do would be to take off her hat and show the clerk her shaved head.

            I told her to try it once, just to see if it worked.
            I am open to this because I grew up in the 60′s and 70′s.

            You don’t even have to smoke it, you can mix it in brownie batter and bake it.

          • ninguem

            Here is a prescription pad for “medical” alcohol from the 1920′s.
            http://rosemelnickmuseum.files.wordpress.com/2010/04/p1000781.jpg

            Here’s a doctor’s log book, filled with all the people the doc felt would “benefit” from “medical” alcohol.
            http://rosemelnickmuseum.files.wordpress.com/2010/04/p10007891.jpg

            The interest in “medical” alcohol instantly disappeared with the repeal of Prohibition.

            Watch Washington and Colorado, see the “medical marijuana clinics” evaporate now that the drug has become kinda-sorta legal.

            Nobody was interested in the plant’s medical value. Too bad, as there probably is some benefit to individual cannabinoids.

            They were interested in getting high, nothing more, nothing less.

            Not that there’s anything wrong with that.

            Just don’t claim that anything medical is being done.

          • Suzi Q 38

            I like the picture.
            Good “show and tell.”
            Now alcohol is legal.
            Were all those people fakes, liars, and druggies?

          • ninguem

            Do you think they were helped by alcohol?
            Or more to the point, when alcohol was made legal again, did any interest remain in “medicinal” alcohol?

            Were they fakes and liars? They were engaging in a fiction to circumvent the law. Their medical condition vanished when Prohibition was overturned.

            Were they “druggies”?

            No…….but some were alcoholics.

          • querywoman

            I personally despise marijuana and don’t believe it’s harmless.

      • PamelaWibleMD

        Yes. Exactly. Our thoughts matter just as much as our words and labels. And can be just as dangerous.

    • PamelaWibleMD

      Carl, I believe.

      • PamelaWibleMD

        Not in medical records as “addict.”

        Do our profiling thoughts that do not end up in the medical record count?

        • DoubtfulGuest

          They count when they lead to actions that harm the patient.

  • ninguem

    I just filed a police complaint two weeks ago on someone passing forged prescriptions in my name.

    Had another just this past Friday.

    • Suzi Q 38

      This happens.
      Does your pharmacist call you with every RX of a restricted narcotic?

    • querywoman

      Ninguem, gee, I like you; gee, I do.

      I’m sorry that you are being victimized here, but glad you are staying on it.
      Do you have any idea how this started?

      • ninguem

        I have a medical license. I have a primary care practice, but a significant amount of my work is medical pain management, and addiction treatment.

        A doctor’s license number is a public document. A doctor’s DEA number is sort of “semi-public”, it can easily be found.

        Nothing personal I’m sure, the people caught so far had no connection to my practice. They have my numbers and they got their hands on the prescription blank paper with the “tamper-resistant” features that was supposed to prevent fraud. In fact, the paper is expensive, and does nothing to prevent fraud.

        And health care is that much more expensive without any increase in quality or safety. The prescription paper is rather expensive.

        Well, someone gets hold of the paper, prints a prescription on the paper using a simple word processor, uses a throwaway cell phone as my number so the pharmacy calls the cell and gets voice mail which they have programmed with “you have reached the office of doctor ninguem, we are taking care of patients, please leave a message” in case the pharmacist calls.

        The pharmacist sees the prescription is on real “tamper-resistant” paper prescribed by law, and may blindly and mechanically go ahead and fill the prescription.

        “It must have been ok because it was on the official paper and had your DEA on it”

        never mind that the prescription read oxycontin 80 mg every 3 hours prn #300, one refill, passed to a 24-hour Walgreen’s 100 miles away at 3-AM, it was the right paper so it must have been OK

        And healthcare is that much more expensive, and fraud continues unabated.

        I check the phone number on the prescription, sometimes I get nosy and call the number a couple months later, it will be “you have reached the office of doctor joe blow please leave a message”

        in other words, they rotate the targeted doctors. I’m one of many.

        The DEA knows this, I have a regular pen pal with a couple of agents, and they try to work with the Pharmacy Board to exercise some common sense.

        Like…….don’t fill the oxycontin prescription as I described above, and then call me two days later and ask me, after the fact, if it’s a legitimate prescription.

        I’m not making this up. I’ve had pharmacists do exactly that.

        The state controlled drugs database DOES make a difference, if the physician actually takes the time to use it. I’m appalled how many people don’t even bother to look.

        • querywoman

          Well, well, well. You told the world how to do it. But they already know how.
          All you can really do is stay on top of it as best as you can.

        • DoubtfulGuest

          Thank you for explaining all this. I had no idea. I understand your position a bit better.

        • SarahJ89

          It’s so not fun when the Feds come to visit. Sorry to hear this, especially to anyone wiling to treat people with chronic pain.

  • ninguem

    Automobile/motorcycle insurance has coverage for bodily injury.

    So an injured driver is usually not “uninsured”.

    Unless, of course, that person is driving without insurance.

    In which case, the word “deadbeat” might be a fairly accurate assessment.

  • PamelaWibleMD

    So many elderly people have told me that they have felt discounted. My very mobile and energetic mom who is hard of hearing asked for help at the airport. They put her in a wheelchair and rolled her on to the plane.

    • SarahJ89

      I used to go out for lunch with my blind friend in her forties. I cannot tell you how often wait staff would ask ME what she wanted to eat. It astounded me.

  • Suzi Q 38

    I remember when I had to interview people who wanted to rent one of our small offices in the city. A man made an appointment and I planned to meet with him the next day.
    He walked in and I was only a bit surprised as he had numerous tatoos all over his arms, neck, and legs (he wore shorts).

    After talking to him for about 20 minutes, I was observant of his gentle nature. He was so polite and fairly educated.

    After checking his references, I went ahead with the lease.

    I didn’t know it at the time, but he was a fairly popular singer/musician.
    He handed me his CD and encouraged me to listen to his music.

    I actually liked his music, and my son (21 at the time) recognized his songs immediately.

    He ended up renting the office space for about 5 years without a problem with him, his music or the rent.

    • PamelaWibleMD

      Xenophobia? Fear of people who may be different from how we look. Suzi Q – I guess it’s great that you took a chance on this sweet man.

  • Suzi Q 38

    Ditto for my father in law, R.I.P.
    He had had 3 major strokes and was aphasic.
    He understood everything people said, but had difficulty speaking. One doctor wrote that he was in a “chronic, vegetative-like state,” which allowed our stepmother (his wife of 4 years) to almost gain control of all his assets and his person. Good thing she dumped him shortly afterwards and left him for dead.
    This way, we had time to hire better and more attentive doctors to reevaluate him and restore his rights and assets.

    I will say that the nurses knew that he was lucid.
    They wrote what he understood and conveyed every day and every shift. They saved him from a very bad situation.

  • querywoman

    Hmm, I must get on to this and self-identify! Try having chronic skin disease! We’re always told we caused it and made it worse by picking at it!
    I have layer after layer of atopic eczema falling off me constantly. As it peels, it forms into these “nodules” that look worse.
    I fight this in my own doctor’s office.
    I showed a hard flake of a scab sticking up on my arm to a young derm resident recently. He blamed it on “scratching.”
    What do they expect it to look like? That’s what I told the senior derm.
    However, I liked this young derm so much that I want him to be my derm when the other one retires.
    It’s a crime if I peel a scab off my own skin! Why?

    • PamelaWibleMD

      Some people do have neurodermatitis. But I hear ya. You want to be taken seriously and not brushed off as a scab peeler.

      • querywoman

        What’s wrong with being a “scab peeler?” My lesions HAVE to come off for it to get better.
        The last time I went to the derm I asked him if my eczema is the human equivalent to animal dander. “Yes, that’s exactly what it is.” Is it normal scab tissue gone wild? “Yes, that’s exactly what it is.”
        To not understand the process is to not understand it all.

        One derm resident tried to get me to take the doxepin every night several months ago. I told her that was just going to keep me sleepy and not make them go away.

        • PamelaWibleMD

          Nothing wrong.

          • ninguem
          • querywoman

            I argue with my own derm about this. He’s approachable, but sometimes the younger residents don’t quite get it.
            In the years the stuff was forming, I might have been in an itch and scratch and form new stuff cycles, but not while I’ve been seeing him, a little over 5 years now. It’s been slowly flaking off, and I have not had a recurrence.
            If it didn’t itch in the first place, it never would have happened.
            As more peels off, I understand it even better. I see strange lesions that I remember from the past. And now I understand that they didn’t go away, that my body formed more tissue to cushion it.
            My doctor is a silvery maturing activist for his patients.
            I keep hoping that I will find the right young dermatology to be an activist for my own atopic eczema.
            How’s that for positive thinking? I don’t need kudos.

  • DoubtfulGuest

    Good points. I never had strong feelings either way about marijuana, but you’ve convinced me. I just never imagined all these different scenarios. Why the emphasis on drug-seeking, though? People get over-profiled or accused of faking for all kinds of reasons. It seems like only the examples that doctors can easily refute (anti-vax mom, drug seekers) are being addressed here?

    • ninguem

      Oxycodone sells for a dollar a mg on the street

      15 mg regular oxycodone. Take it, say four times a day for pain.

      Or, claim you do, but it’s all diverted.

      15 x 4 = 60
      Sixty dollars a day street value

      Thirty days in a month 60 x 30 $1800 a month

      Twelve months in a year
      $1800 x 12 = $21,600 income for one prescription.

      Scam half a dozen doctors……..and I’ve seen that in my area, now easily a six-figure cash income.

      Scam larger doses of oxycodone, they make far higher strengths, or add Xanax or the usual in the mix, the revenue goes far higher.

      • DoubtfulGuest

        I believe you…I have no personal experience with that. I’ve only taken pain meds stronger than NSAIDS within a few days of recovery from surgeries. Actually, after my TLH/BSO, I took only Naproxen or Ibuprofen after I left the recovery room. I have a mitochondrial disease and some pain meds are contraindicated anyway. It ain’t worth the side effects. I recognize drug-seeking as a problem, but as a Patient Who Never Asks For Pain Meds, I think there are other factors to be examined here.

      • Suzi Q 38

        Interesting facts.
        I wouldn’t know.
        When I was recovering from my cervical spine surgery, hysterectomy, and knee surgery, I got Norco or Vicodin.
        The doctors prescribed these drugs to me freely and were very generous.

        I remember having a full bottle on my kitchen counter. I am not sure how many were in the tall bottle. Anyway, my friend said that I could sell it easily. I had only used it sparingly, as i knew how addicting the drugs could be.

        I realized that I needed to keep meds like that hidden from now on.

        • querywoman

          When my mother was in my home dying of lung cancer, a neighbor asked me if I had any pain pills like hydrocodone. Of course, we had a stash.
          I told her, “no,” and warned my mother about these questions.
          I fill a prescription for 90 hydrocodone about once a year, and they are not for sale.

          • PamelaWibleMD

            Smart. I am attending a opiate CME this am at the Hilton in about an hour. They drive home the point that patients should NOT be sharing these meds. Good girl.

          • querywoman

            There are no absolute in life, Pamela. She did share a few with me, when my skin lesions were painful.
            When I write about being a light user of hydrocodone, it also means I have no problem getting my one prescription per year.
            My mother was not good about taking her paid med. A minister talked to her about that once.
            I get a hydrocodone script for 750 dose, which I start halving promptly.
            During her last illness, we talked about in front of her lung doctor. I encourage her to take 1/2, a full tab, 1 1/2 tab, or 2 full tabs according to her needs.
            We agreed that she would get it from him. He wrote her pain med up, making sure that the had the scored tablets.

            I used to have a friend who got about 180 hydrocodone per month. Sometimes, he would sell them, although he is a smart guy.
            He grew up with a mother who was a heroin addict. All the children went to rehab with her as children. She doesn’t do heroin anymore. She has a pain problem and won’t talk to her doctor about it.
            So he gives her 30 or 40 hydrocodone per month. Wrong!

          • ninguem

            I had an old man with cancer. He kept complaining of pain as I was increasing his opiate pain medication. Oxy-contin.

            I was at, I forget, about 40 mg four times a day or some fairly substantial dose, I ran a urine drug test.

            Negative for oxycodone, which was what I was giving him.

            Turns out his caregiver……..who was the old man’s SON, by the way, was stealing every single narcotic pill I was prescribing, and selling it.

            Oxy-Contin is a dollar a mg on the street.

            So, the scumbag son, stealing his cancer-ridden father’s pain medicines, was clearing

            $ 40 a pill, four times daily, 365 days a year

            40 x 4 x 365 = $58,400

            Potential of nearly sixty grand a year doing this to his father.

            And yes, I called the police and adult protective services.

          • querywoman

            Wow! The truth shall set us all free, Ninguem!
            Good thing you shared this. Some other doctors can get the idea to do this!
            Can’t click “like” on this, because the content is so offensive!

          • DoubtfulGuest

            I “liked” it, but I know what you mean. Main advantage of up-votes is people will see/read it sooner if they start from the top. Lots of unlikable, horrible things to discuss…Well, we like the way ninguem handled it.

          • querywoman

            The absolute strength here is that the blog provided him a means to share.
            Adult Protective Services usually can’t do anything, because the parent won’t cooperate.

          • DoubtfulGuest

            I hadn’t thought about that. Grrrrr…(at APS, not you)

          • querywoman

            I learned about that when I first went to work for the Texas Department of Human Services. Trust me, it’s the same in all states.
            Financial abuse is when adult children take all of their parents’ SS checks.
            I hope the police did something about Ninguem’s patient. It’s hard without proof.

          • EmilyAnon

            I so admire what you did for your patient.

            Lots of stories in the news about lowlifes guilty of causing unnessary suffering to patients.. In addition to family members, nurses in hospitals and nursing homes have been jailed for switching patient’s pain pills with something benign.

            And even addicted anesthesiolists diluting syringes of pain medication meant for patients during surgery. And this was only discovered because he OD’d in the hospital bathroom.

          • querywoman

            Dr. Ninguem has good instincts.

          • ninguem

            The anesthesiologists are often capable of coming up with a different anesthetic plan, allowing for more of one drug, and less of another (the one they want to divert), so the patient does not suffer. Excessive pain would attract attention.

            The addicted anesthesiologist often looks good in the hospital, very helpful, hard worker, of course because it allows more access to drug.

            That is why, all too often, the addicted anesthesiologist or CRNA may not be suspected until the poor soul is found dead in a bathroom in the operating suite.

          • PamelaWibleMD

            Just went to a CME on this. Yes, indeed. Oregon ranks #1 on non-medical uses of prescription opioids among teens. We have a HUGE problem on the streets. Oxycontin sells for 50 cents per miliigram. Thus $40 for 80 mg pill.

          • ninguem

            FIFTY CENTS a milligram is cheap. Most of the country, it’s a dollar or more a milligram, especially since there is, finally, a crackdown on excessive prescribing, and tamper-resistant formulations.

          • querywoman

            I hope you got him in nursing home hospice!

          • ninguem

            Adult protective, and police.

            Oh, and this being a small town, it turns out adult protective AND police actually knew the situation better than I. “Yeah, I know old Joe Blow, he has cancer, poor guy, and his son is a caregiver and a scumbag who deals drugs and I wouldn’t be surprised if he’s stealing his father’s drugs.”

            I got that same line from both adult protective and the police. Amazing. I had to sleuth it out on my own. I was the new doc in small town.

            What one knows to be true, and what one can bring to court to prosecute as a criminal matter, are of course two completely different things.

            So, yes, old man was set up in a better caregiver situation.

            But if you think there was any punishment for the son who could make fifty grand cash by letting his father suffer cancer pain……..not in this world.

            Justice from Karma, perhaps, but not a court of law.

          • querywoman

            You had cooperation because they knew the situation. I don’t suppose you can explain the instinct that told you do a drug test on this old man.

          • SarahJ89

            I could have paid my mortgage with the scrips I threw away. Scrips I neither asked for nor wanted but were obviously routine in the ER.

      • Deceased MD

        i think Big Pharma plays a role in that as well. They don’t want any investigations into opiates they sell.

        • PamelaWibleMD

          Interesting. . .

          LOVE your name – “Deceased MD”

          • SarahJ89

            Yeah, he does pretty well for a dead guy.

          • DoubtfulGuest

            Oh, snap — Maybe that’s why he didn’t answer my question? j/k

      • SarahJ89

        My experience has been that doctors seriously overprescribe Oxy and vicodin. I threw away my last two prescriptions without filling them. We were still awash in the stuff from the first half-filled prescription from my husband’s surgery.

        What’s up with that? How is it that doctors prescribe 20 or 30 of the things without bothering to ask if there’s any history of addiction/alcoholism or even if the patient wants or needs them? Then they complain about drug seekers.

        My neighbour is now a prescription drug addict but it seems to me that getting actual medical care for her initial shoulder injury would have been far more helpful. She had no insurance so now she has two problems–chronic pain and drug addiction. And yes, she’s a pain in the butt. But she was not an addict before injuring her shoulder.

        • DoubtfulGuest

          I don’t understand this either. I like my surgeon, NP and everyone who works with them. It was a strange experience, though, when I called after the first surgery to report a non-pain related symptom just to find out if it was normal/okay at that point in recovery. “Do you need more pain medicine?” “No, thanks, I only took it (Vicodin) for 3 days. I couldn’t sleep from itching and irregular heart beat so I decided to do without.” I asked if it was an allergy, and she said it’s not. Well, that’s fine, codeine goes on my list as “Pt. states she is very sensitive to this medication”. I hope they notice I never asked for anything stronger. The next surgery — NSAIDs only, on my own initiative. But they do seem to make narcotics readily available, and sort of test your interest in getting more. Very awkward.

  • DoubtfulGuest

    Weird timing, yes…there are many reports of that kind of thing with horror movies. I didn’t actually follow that show, but knew the basic premise. It was a weird feeling to watch the clip. Like patients are *always* morally weak, and need to be told things. I’m a scientist, and I don’t ask doctors to do anything I don’t do myself, in terms of frequently checking my own assumptions. It stinks to be lied to. Patients get lied to as well. Despite my frustration with doctors, I am sympathetic.

    • ninguem

      Do you know the series? Tony Soprano is a mobster, he kills people, sometimes his associates and his associates girlfriends. That was his wife. She knows full well what he does, she puts up with it. The psychiatrist knows full well who she is, more to the point who her husband is. The beginning of the scene in that clip, the guy on the golf course, was another doctor Tony had just threatened.

      The psychiatrist is saying Carmela Soprano is married to a mobster, a killer, an amoral monster, and the only way she will feel good about herself is to leave him, take the kids, with nothing but the clothes on their backs. Separate herself, and the children, from the blood money, same as the psychiatrist refuses her money.

      The story is not about the psychiatrist, he did a bit part, it’s about Mrs. Soprano, who **IS** in fact, morally weak, now that you mention it.

      • DoubtfulGuest

        I’m not much of a TV watcher. But I knew there was a mobster who kills lots of people, and filled in the rest when I saw the clip. I get it. I’ve had the opposite experience with a doctor who lied to me about his mistake. I’m not perfect, but you would be hard pressed to find many similarities between me and Mrs. Soprano. But that is how patients get portrayed. A lot. It’s an okay example for the point you wanted to make. But if we’re talking about patient profiling, anchoring errors, whatever you want to call it, there’s much more to the story of what can go wrong. I just have a hard time understanding why doctors want to help people, if they see most as depraved, manipulative, stupid, and irresponsible. What’s the point? You could just withhold care and “decrease the surplus population”, you know? The doctor who referred me to the one who said I was faking based on no evidence whatsoever, had been trying hard to figure out what was wrong with me. He’s a good doctor. But from the beginning when he did his assessment of me, he was really jumpy and ready to assume the worst at every turn. I think you all should have a healthy degree of suspicion, since there are a lot of shady people in the world, whether or not they go to the doctor. But you’ve got to rein it in and check yourselves so innocent people don’t get run over.

      • Suzi Q 38

        I never watched this.
        I was too scared.

        • SarahJ89

          Suzi,
          I have a friend who is very Italian. She gave me a cookbook. Which was written by a guy who drove and cooked for a Mafioso. I ended up getting rid of it because it creeped me out to be following a recipe prefaced by a description of the occasion for which it was created–the meeting of several mafia heads at which a hit was ordered. The premise of recipes created by a mafia chef was cute, until I realized this wasn’t fiction.

  • Suzi Q 38

    There is no problem, as my pain is not so intense as to require such drugs.
    I have never had a narcotic given to me by a PCP.
    My step mother in law was different. She lied to several doctors.
    I think she had at least 3 going at the same time.
    One pharmacy, though.
    It amazed me that the pharmacy did not tell any one of her doctors about her addiction to pain killers.
    I think that the pharmacy did not let any of the doctors know because they enjoyed the revenue.
    She paid with a personal check.

    • SarahJ89

      I once had a client in her 80′s who would take the bus from up near the Canadian border to Boston to score on street corners. In the end her doctor son in Syracuse kept her supplied. It was actually safer that way. There was nothing anyone was going to do about the addiction but at least she wasn’t in danger of being mugged on Boyleston Street.

  • Suzi Q 38

    I understand your viewpoint.
    What if it did work for her, though?

    Making brownies doesn’t mean that children are around anymore in our household.

    When the medical marijuana passed in California, I could not believe it. I figured if it is allowed for pain that there might be something to that.

    Not everyone is a “druggie.”

    • ninguem

      What makes you think it will?

      Like Laetrile? That was the stuff in the 1970′s that was supposed to cure cancer. I remember the protests, the evil doctors suppressing the miracle cure.

      Oh, and before that, it was Krebiozen in the late 1950′s to early 1960′s, the other miracle cure that the doctors were suppressing. Here’s a protest in front of the White House.
      http://www.professorwalter.com/2011/10/the-finest-alternative-cancer-treatment-from-yugoslavia.html

      Before that, I suppose Twilight Sleep in obstetrics, scopolamine and morphine in obstetrics. See the McClure’s article in 1914.
      http://www.hektoeninternational.org/images/Painless-childbirth_Crop-web.jpg

      Evil ignorant American doctors suppressed that one too. Then Frances Carmody, of the National Twilight Sleep Association (there was once, such an organization) who had for years pressured doctors to use twilight sleep, had herself received twilight sleep…….and died from it.

      Shall we say…..interest faded.

    • ninguem

      Does it work…….for what? Be precise about “works”. What do you mean by that?

      Cures cancer?

      It gets rid of unwanted facial hair, it gets rid of embarrassing age spots,
      It delivers a pizza, and it lengthens, and it strengthens
      And it finds that slipper that’s been at large
      under the chaise lounge for several weeks
      It makes excuses for unwanted lipstick on your collar
      And it’s only a dollar, step right up, it’s only a dollar, step right up

      Change your shorts, change your life, change your life
      Change into a nine-year-old Hindu boy, get rid of your wife,

      And it walks your dog, and it doubles on sax
      Doubles on sax, you can jump back Jack, see you later alligator
      See you later alligator
      And it steals your car
      It gets rid of your gambling debts, it quits smoking

      Well it takes weights off hips, bust, thighs, chin, midriff,
      Gives you dandruff, and it finds you a job, it is a job
      Gets rid of blackheads, the heartbreak of psoriasis,

      ‘Cause it’s effective, it’s defective, it creates household odors,
      It disinfects, it sanitizes for your protection
      It gives you an erection, it wins the election

      Step right up…………

      Sorry I was backstage with Tom Waits in 1976 when I was in college.
      Flashback. OK I’m back now.

      http://www.youtube.com/watch?v=Rdqh0GsXMII

      • Suzi Q 38

        My question was :Does Marijuana relieve pain for cancer patients?

        You don’t have to answer that.
        I would rather listen to Tom Waits…..

        • JR

          Marijuana does have uses for cancer patients on chemotherapy who have so much nausea they are considering stopping their chemotherapy. It makes people hungry, blocks the nausea, and for some people makes chemotherapy completely bearable. I’m not sure about it’s pain properties.

          I know someone who refused to go through chemotherapy a second time when their cancer returned. I couldn’t help but wish Marijuana had been legal… maybe she’d have been more willing to try it again. Then, I don’t know the details of her disease; maybe she really wasn’t considered treatable when it returned.

          • Suzi Q 38

            Thank you.

          • querywoman

            I always agree there’s a maybe.
            I have been researching coca tea. Shame it’s not available in the US.

          • ninguem

            The dose makes the poison.

            The Peruvian peasant, chewing a leaf or two every day, or making tea out of that leaf or two, could probably live to 90 and die a ripe old age.

            When we learned to concentrate the drug however……..

            Mrs. Ninguem’s father, RIP, was a surgeon. I have one of his pre-DEA narcotic order forms. I have it in front of me.

            “United States Official Order Forms For Opium, Coca Leaves, Opiates, etc.”

            So yes, as late as the late 1960′s, maybe early 1970′s, it was anticipated that a doctor could order coca leaves for patient use. Date on the pad is year 1969.

          • querywoman

            Thanks for the info. Supposedly, we might could order by mail from a South American country.
            I’ve just been reading, yuck, about a young girl sacrificed in Chile who was fed maize beer and coca in the year before her death.
            The trouble in the US is that that the druggies exist, and will find a way to make cocaine.

            I got on a coca thread by researching how to make my own soft drinks at home.
            I just hate marijuana. I was raised a 2nd hand smoke addict. My mother was a champion smoker. I never tried tobacco.
            A few times in my early 20s, I tried smoking marijuana. My lungs filled with that awful smoke, when I’d already inhaled plenty of 2nd hand tobacco smoke.

  • PamelaWibleMD

    Good to make sure we are all on the same page. So reviewing records every once is a while is a great idea. I think.

  • Suzi Q 38

    Like I said, Step mother in law had 3 doctor prescribing scheduled drugs for her at the same time. When I found that out and pointed it out to her lawyer, (long story) she was so hooked that she wanted to settle the divorce case with my FIL early. She didn’t want her doctors and her family to find out.

  • DoubtfulGuest

    Good question. I look at my records. Most of the ‘profiling’ has been either not written down at all or it’s been put in more vague terms. ‘Secondary gain’ was the worst I ever got. Well, that is pretty bad…especially since there was no evidence of it, but most of what I thought was profiling was unofficial, off the record stuff.

  • islandnp

    seriously? Yes, I profile. And not based on tattoos. I run a state drug report on everyone and trust no one. My partner and I keep a book too. I just had a very nice lady dragging in her pre-teen child who should have been at school plus a sheaf on medical records and MRIs telling me she had just moved to the area- when I showed her the state report showing she had been here for months and had seen multiple providers including the pain clinic she cursed me out as “one of those d—doctors that think only of themselves” and left without paying. I work in a very nice urgent care clinic and never prescribe narcotics for chronic pain and very limited amounts for certain acute conditions. The DEA will come for the provider not the user.

    • PamelaWibleMD

      Good work.

    • querywoman

      Very good.

  • PamelaWibleMD

    Wow.

  • DoubtfulGuest

    I hope you will be okay. This is the worst example yet, IMO. So sorry you went through that.

  • Deceased MD

    couldn’t have said it better on MJ. Making MD’s into enablers.
    Interesting no one profiles students on ADHD drugs also getting high for the purposes of studying for exams say. What is it something like 10 percent of HS students are prescribed it? Sorry Pam did not mean to hijack your blog!

    • DoubtfulGuest

      Could you, and maybe a few others, give some more number estimates here, please? I don’t think I’ve ever taken oxycodone, unless it was given to me right after surgery. I wonder what ~ % of your patients request these drugs? use these drugs? have a problem with these drugs? And about how much of your day? effort? mental energy? does it take to deal with all the paperwork, DEA visits, and whatever else that I can’t really picture since I know little about this? I agree it’s a very serious issue, and appreciate the perspective from you, ninguem, and others. I’m just a bit disappointed to see so much rush to justification by doctors instead of a more critical analysis of all sides of the “profiling” topic. Others have pointed out that you’re all not given time to think. Completely agree. I just think there’s more to consider. Thanks for your time.

      • PamelaWibleMD

        Also consider the price of a DEA license – which all docs pretty much have to get —> now at $731. Used to be under $100. Price increase over the years:

        $70 —> 131 —> 390 —> 551 —> 731

        Apparently DEA using the $ to deal with “diversion control activities.”

        Thoughts?

        • DoubtfulGuest

          That’s a lot of money! And too much responsibility being heaped onto physicians. Still can’t picture the day-to-day effect on docs, although I take very seriously everything you all say about this. I would like to understand more. I just have had a completely different experience.

        • ninguem

          They’re using the dollars to support their own bureaucracy.

          And all too often, the regulatory agencies, State Boards, etc., get caught raking in more money from overcharging physicians, than the budget of that agency.

          The surplus becomes the Governor’s slush fund.

          Complain, and all you get is a supercilious “the doctors can afford it” attitude.

          And medical care just becomes that much more expensive.

          • PamelaWibleMD

            Argh!!!

          • PamelaWibleMD

            I’ve got one word for that: DISINTERMEDIATION

    • PamelaWibleMD

      Yes, Ninguem, please continue . . .

  • DoubtfulGuest

    Confirmation bias?

  • DoubtfulGuest

    LOL, you guys know I’m not anti-vax, right?

    • ninguem

      didn’t know one way or the other……nothing directed personally at you at all, apologies if you felt otherwise.

      • DoubtfulGuest

        It’s all good, hence my LOL. A peace offering:

        http://www.youtube.com/watch?v=u1xw0Ob5bqs

        and (song starts about 4:30):

        http://www.youtube.com/watch?v=mZnrsi74Izc

        • ninguem

          The only quibble I’d have, the first video made it seem like a 19th century family just shrugged their shoulders when a child died of infectious disease. In times past, they most definitely did care about that dead child.

          The practice of postmortem photography……..

          http://en.wikipedia.org/wiki/Post-mortem_photography

          …….taking pictures of that dead child.

          That daguerrotype was expensive. People today sometimes comment on why no one smiled in old 19th century photographs. I don’t know, but one thing that came to mind, it was an important thing to get your picture taken, it wasn’t cheap, though the price was slowly coming in reach of the middle class.

          They may have accepted that death as how it is…..or was……but they definitely mourned and missed that child. If nothing else, they spent a lot of money to memorialize that child.

          I’m sure they would have loved to spend ten times that much for a vaccine, were it magically available back then.

          • DoubtfulGuest

            Agree…the beginning was a little crass & unnecessary…I interpreted it as sarcasm, to hook your attention and then he went back on those statements after about the first half minute. But it would have been better without it. PM photography is fascinating, sad, and scary at the same time I think. Mostly sad. Sometimes you can’t tell if the person is alive or dead, which can activate that ‘uncanny valley’ response. But I can completely understand why they took those photographs. I feel badly for people back then. Well, I didn’t feel attacked at all by you or CSPrF, I just wanted to make sure there was no confusion about where I stand, since CSPrF had replied to me and then you added on to his/her comment.

          • ninguem

            wow, hard to find smiling Victorians, very good.

            Another nice place for old photographs

            http://www.shorpy.com/

  • querywoman

    Wow! I get this one quite well!

  • PamelaWibleMD

    Unfortunately, despite our efforts to share EBM, patients may leave the office feeling “hassled, shamed, talk down to, and more.” Maybe there is a better delivery? Don’t know in this case as I was not there. I do try to avoid power struggles with patients even if I have divergent views. Unlikely to end well.

  • PamelaWibleMD

    Correct. The prejudice against the elderly is so widespread. Just thought it was an odd image: An airport employee rolling a mobile woman with moderate hearing loss away in a wheelchair.

  • SarahJ89

    I nearly died thanks to profiling. I was sent home twice in 24 hours from the ER, my husband was lied to about the tests they took, tests that had been ordered were never done, staff joked about me in the hallway outside the door within easy earshot of my distraught husband. The ER doctor and my PCP both told me later they don’t know why I’m still alive.

    I asked for the procedure to make a formal complaint and was told “We don’t have anyone in that position right now” (a lie–they didn’t fill that position ever). I was directed instead to Risk Management–not knowing it was the hospital’s PR risk, not my life that was being managed. I insisted upon a meeting with the heads of the departments involved. The hospital did everything they could to prevent me from bringing the two people who had been there in the ER with me to the meeting. When I arrived the Risk Management woman wasn’t there, but had sent someone else who immediately tried to seize control of the meeting. But it was my meeting so I told her that and passed out written agendas.

    The department heads were appalled and apologized profusely. One of them pointed out the testing that had been ordered but never done, which I hadn’t noticed. One person did end up being fired, but the doctor in charge remains untouched to this day. The only thing I asked for–that the falsehoods and discrepancies in the record be corrected (I left a corrected copy) was never done, despite assurances it would be. I am lucky this happened before EHR because it’s as if it never happened. If it’s not digitized it simply doesn’t exist. I shudder to think what danger I would be in at this, the only ER available in my area, if this stuff remained on my records.

    It took me several years to figure out one of the rescue squad guys decided I was lying and told the ER staff that when I arrived. That’s all it took to nearly kill me. My word, my mild-mannered CPA husband’s word, my friend’s word all meant nothing. They may as well have gagged us.

    I will never trust a doctor again. I tell my doctor nothing. I wouldn’t dream of confiding in a doctor, no matter how well meaning, for fear a distortion will end up on my records. It’s frightening to think one rescue squad person set this in motion because I stopped answering his (silly to me at the time) questions. I now know how vulnerable we all are.

    I used to work in a career which required me to read medical reports a good portion of the day. I have seen people whose lives were dogged by a misdiagnosis or nasty comment for decades. These people were discredited before they ever walked in the door.

  • PamelaWibleMD

    I have been to cholesterol-laden Pharma dinners to learn about the latest treatments for high cholesterol from a man who looked like Homer Simpson as the speaker. He basically said not to try diet because nobody can really do it. I’ve been vegan for > 20 years with a total cholesterol of 108. I’ve seen patients lower their cholesterol by 100 by diet alone.

  • JR

    Look at the photo. She’s not a young woman. Think about the time she had her children. I imagine it’s been at least 10 years since she had a baby.

    The study about autism was published in 1998 and retracted only in February of 2010. The author only had his license removed in May of 2010 (according to a CNN news report from 2011). Frankly, if a patient was refusing vaccines in 1998 – 2004, I don’t think it’s fair to call that bad mothering. It seemed to me everyone was worried if vaccines were safe or not around that time, because the answer wasn’t really clear.

  • Rob Burnside

    I’m not sure any of us can completely avoid profiling–and being profiled– in our secondary relationships, particularly when meeting someone else for the first time. It seems as natural as our autonomic nervous system’s “fight/flight” response. How aware we our of our own feelings and how we compensate for them makes all the difference.

    • PamelaWibleMD

      We all do it to a degree. The key is to keep an open heart and notice our subtle behaviors. People do not want to be “boxed in” to a group and then mistreated as a result.

      A dark-skinned friend of mine was to complete his daughter’s birth certificate with her race. He wrote in HUMAN.

      • Rob Burnside

        Ha! Good for him. He’s thinking ahead, and making a statement in the present.

  • Margaret Fleming

    No mention of profiling older patients as dumb, crippled, uninformed, ignorant, etc. This happens less in the offices of doctors I’ve met and more, much more in the articles and study reports on line every day! By the way, I have asked one doctor to stop using the word elderly. Many serious diseases can happen at any age. Don’t put me in a box when you see grey hair or a birthdate on a paper!

    • PamelaWibleMD

      While there are illnesses more prevalent in certain populations,
      I think clear, compassionate communication can help people feel that they are getting the personalized care they deserve.

      • Margaret Fleming

        A doctor may feel true compassion for grey haired people as a group, and still be unaware that my combination of problems is not the same as any other person I’ve ever met who happens to be my age.

  • PamelaWibleMD

    I’m so sorry for your suffering. Do you have a primary care doctor? Always best to have one doctor who can look at your entire case.

    • PamelaWibleMD

      You might also try getting in at a teaching hospital. A really great med student or resident assigned to your case may be just what you need. Have you seen the map of ideal clinics on my webpage?

  • PamelaWibleMD

    I am sad that you feel this way. This is exactly what we need to change –> The culture of distrust between doctor and patient. It requires both doctor and patients to change their attitudes and embrace each other with respect and appreciation. A group effort. I hope you will view your doctors as hardworking humanitarians. That’s who we are at the core.

  • PamelaWibleMD

    ebgb – I do hope you can find a primary care physician who you can bond with. A good primary care doc who has time to care can actually prevent a lot of the profiling cases above. Patients need time with a doctor who knows their big picture story. Docs in the ED, surgeons, specialists etc . . do not generally have time – or sometimes interest or training – to dive into a patients life (emotional, spiritual, social, physical) the way a primary care doc does. When we do not understand your big picture, we can jump to the wrong conclusions and obviously misdiagnoses are the result.

  • Buddy Ray Williams

    I agree that the woman who refused to have her child vaccinated is a bad mother… For God’s sake people, it’s the 21st century, no child should be condemned to possibly die from contracting a simple disease because of a parent’s ignorance…..

    • PamelaWibleMD

      I find many of my patients who are anti-vaccine are open to discussing and accepting certain vaccines if they feel that they are not “hassled, shamed, talked down to, and more.”

  • PamelaWibleMD

    “I kept telling him no vaccines whatsoever, zero, nada” may have been her response after the adversarial relationship had been established. I am suggesting that we develop a non-adversarial relationship. I find that many patients who are “against” something will listen to the opinion of a trusted doctor. And they change their minds based on more than facts. Sometimes an emotional connection is needed.