Saturday, September 20, 2008

Doctors and Pain

 
 
There's a good NYTimes article on this website's front page about doctors' reluctance to prescribe painkillers.  (Locally on page A9 of today's Bee.)   The Times does not have a comment section on that page of their website; best you can do there is to e-mail the author.  If you do, cut/paste a copy to bioethic@practicalbioethics.org
 
I've heard from a local pain management specialist that if you're in a specialty that deals with pain (e.g., rheumatology, neurology) it's highly unlikely that you'll get a visit from the DEA -- it's his impression that it's only PCPs who prescribe an unusual amount of pain pills (think Anna Nicole's doctor) who have anything to fear.  Unfortunately, this unreasonable fear of getting in trouble means more patients like me who will never work again entirely as a result of years of untreated pain and the resultant sleepless nights.
 
Whatever happened to "first, do no harm"?
 
I strongly believe that any doctor who refuses to prescribe necessary pain pills because he might have to answer a few questions from the DEA should have to answer a whole lot of questions from the Medical Ethics Committee.  Allowing patients to suffer needlessly should be punished as stringently as possible, and allowing a patient to become permanently disabled as a result of refusal to prescribe adequate pain medication should result in suspension of the doctor's medical license.
 
In my case, some of these were specialists who were diagnosing me with fibromyalgia, which is a non-inflammatory chronic pain condition, and anti-inflammatories like Advil (which is what I was told to take) are known to be useless.  There was no question in their minds about my diagnosis, and if they were holding themselves out to be specialists in fibromyalgia, they certainly should have known it's non-inflammatory pain and NSAIDs wouldn't help.  Therefore, there's no excuse for them continually telling me to take something that doesn't help in order to avoid their responsibility to prescribe something that does help. 
 
If they don't even know that much about fibromyalgia, then they have no business holding themselves out to be specialists qualified to treat it, and should be brought up on ethics charges for that, too. 
 
Clearly, if I had enough pain to qualify for the fibromyalgia diagnosis, I had enough pain to justify a prescription for pain medication to help me sleep, and they easily could have avoided any problems with the DEA with the simple explanation that they prescribed pain pills for a chronic pain condition which had been repeatedly diagnosed by multiple doctors.  They chose to protect themselves from any questions and sacrifice my health instead.  Anyone who's more concerned about themselves than their patients' well-being should not be practicing patient-oriented medicine: go hide in the lab where you won't have to deal with patients and their problems.

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