A nutritious start to a day on the couch!

A nutritious start to a day on the couch!

Enough with the pain pills!

It seems as if every shift in the emergency department, I’m being accosted for pain  medication.  ‘Doctor, I’m dying,’ for the aches of the flu.  ‘Doc, come one man, I have to have something,’ for the chronic back pain.  ‘Doc, nobody has done anything for me!’ (After receiving the $10,000 work up for abdominal or chest pain, but then being denied the coveted narcotic.)

Yesterday, I told the patient with pneumonia I would give her pain medication, gave her morphine, told her I would give her medications at discharge (for pain) and still she looked up, plaintive, ‘but doctor, are you gonna’ give me anything…for…pain?’  Yes, yes, YES!

I’m sorry if you think I’m heartless. But I have never, in all of my 16 years of practice and preceding 3 years of residency, seen as many people so desperate for narcotic analgesics or anxiolytics (like Xanax, Ativan or Valium)!

We are constantly reminded that we physicians do a terrible job of pain relief.  Joint Commission watches us, our specialty organizations remind us, the government monitors us (damning us for both giving too many and too few), lawyers threaten us; even administrators with patient satisfaction surveys prod us.  But I’m telling you, we’re giving it out by the truck-load, from some bizarre, professionally dysfunctional combination of compassion and exasperation, and  it isn’t changing a thing, except to keep the raccoons coming back to the trash cans.

Do we really live in a time in which pain is that much worse?  Are we living longer with more severe illnesses and injuries?  Are we more sensitized?  Are we evolving into softer, less hardy individuals in a kind of mockery of traditional Darwinism?  Or are there just more pills, and more enabling family members and professionals?

I mean, physicians in neurology, pain management, family medicine, emergency medicine, all across the pantheon (I know, we aren’t gods, but it sounded cool) of medicine are practically throwing narcotics and sedatives at the populace who incessantly demand them, starting in grade-school! The blame goes both ways.  The demand is staggering, and the willingness to give prescriptions is epic.

USA Today recently ran a piece about the enormous problem of prescription narcotic abuse among the Medicaid population.

https://www.usatoday.com/news/health/2009-09-29-Medicaid-drug-abuse-fraud-Michael-Jackson_N.htm

I’m impressed that they would do this piece; I doubt if any academic medical center would do research on the topic.  It just isn’t ‘nice’ to accuse patients of abusing and gaming the system…or, heaven forbid, of lying!

I think, perhaps, that’s the problem.  Physicians and other care providers just don’t want to believe people will lie.  Furthermore, even the word ‘lie’ seems regressive and judgmental to the modern mind.  ‘Who are we to say what’s the truth and what isn’t,’ seems to be the line of disjointed logic.

I suggested this once, that patients lie, and a physician wrote to my editor and said, ‘who does Dr. Leap think he is to suggest that patients might lie?’  I wondered ‘Where do you practice, sister?  Gates of Heaven Medical Center?’

Maybe this is why we give out so many pain pills and things for anxiety.  We can expect a lot from ourselves.  We can call up our fortitude and endurance; but we don’t expect the same from our patients, so we’re willing to let them develop or wallow in their addictions, all the while we continue to confabulate and obfuscate about imaginary pathologies and named diseases that have no confirmation by science.

If we are so very bad at pain, then fine; just legalize the whole ‘kit and caboodle.’  I think it’s a terrible idea on many levels, but honestly, if we did it then emergency department volumes (and expenditures) would drop like a rock.  We wouldn’t have to spend time and someone else’s money trying to figure out how a bird flying overhead caused sudden, incapacitating leg cramps.  We could just intubate overdoses and be done with it.

I find it instructive that a program like Medicaid has so much abuse.  It’s no surprise.  When a thing costs a person nothing, nothing in personal financial or moral outlay, then they will use and abuse that thing.  Not only so, but in this particular case, they will take that thing and sell it on the black market, causing addiction in other individuals as well.

Read the USA Today article and weep for the future. When a thing is free, it will be abused.  And that seems to be the case for narcotics as much as anything else in the world of endless, emotion-based, governmental compassion; always lacking consequences.

Except for those paying the bills and sorting through the lies.

Edwin

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