The attitude when it comes to treating chronic pain


Here is the attitude of ER physicians: “Here are a few pills to hold you out for one or two days. Follow up with your PCP — he or she should be managing your chronic pain — not me. Now get out of my ER!”

Here is the attitude of PCPs: “I simply don’t have the time or expertise to manage chronic pain patients. Let’s refer you to pain management. Need pain medicine before pain management can see you in three or four weeks? Go to urgent care or the ER.”

Here is the attitude of urgent care physicians: “I may give you a very limited supply of Vicodin or Percocet, but you really need to follow up with your PCP and/or a pain management specialist. Urgent care is not equipped to provide chronic pain management service.”

Here is the attitude of pain management specialists: “I will address your pain, but not necessarily with narcotics. We can give you steroid injections in your back and refer you to PT. If you violate your narcotics contract with us, we’ll dismiss you from our practice. Here’s a cup — now leave us a urine specimen so we can do a comprehensive urine drug screen.”

Here is the attitude of the medical boards: “As a clinician entrusted with the care of your patients, you are morally obligated to mollify their pain and provide compassionate relief from suffering. On the other hand, if you don’t perform a full examination of the patient, and keep detailed records of each encounter documenting the patient’s pain level, justifying your prescribing of all narcotics, and showing that all other treatment modalities have been tried and failed, we will issue a public admonition or yank your license.”

Here is the attitude of the patient: “Damn! It’s getting harder for me to get my Vicodin or Percocet these days. I may go into withdrawal! Heroin is cheaper and less of a hassle.”

Here is the attitude of physicians who are exposed to these conflicting attitudes 50 times a day, day after day after day: “It’s 5 o’clock somewhere. Better to have a bottle in front of me than a frontal lobotomy.”

Joel R. Cooper is a family physician who blogs at his self-titled site, Dr. Joel Cooper.

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