Is there any point asking about the pain scale anymore?  Everyone is a ten.  And even when our patients are moving through life with prescriptions for Fentanyl and Methadone for ‘chronic pain,’ they still come to the emergency department  pleading that they can’t help that they’re out of their narcotic a few days earlier.  Stating that they called their physician who wouldn’t refill them, but said, ‘if you need pain medicine, you’ll have to go to the ER.’

Pain being, allegedly, the 5th vital sign, we are encouraged to treat it, not disbelieve it.  And thus, emergency department patients with a ‘high tolerance’ for pain medication end up with enough narcotic to put down a bull elephant, all the while whispering and slurring the words, ‘can I have something else…my pain is so bad.’

To accomplish this, they have abdominal pain that (despite multiple surgeries and enough CT radiation to revisit bomb experiences at Bikini Atol) never turns out to have any real etiology.  And their multiple back MR studies show (wonder of wonders) ‘degenerative disc disease.’  Which everyone who works in medicine for long enough probably has as well.

I know I beat this drum all the time, but people, let me break it down.  We are a nation of addicts.  We are a nation where too many individuals use any excuse to obtain narcotics,  obtain disability and sleep their lives away.   We are a nation of ‘benefits,’ wherein a small number demands their ‘benefits’ and ‘rights’ to endless slumber, ceaseless medical evaluations and lifelong disability…which is supplemented by income they obtain by working (a thing they are allegedly too broken to do).  Benefits that others pay for by ignoring their back pain, ignoring their own desire to plop down before the big-screen and stay home on someone else’s dime.

We will collapse.  We will be buried under a cataclysmic flood of prescriptions and disability forms.  We will stop producing anything and spend all our best productivity, all our children’s futures to provide solace for those who do not shout loudest, but moan loudest.

Unless someday, for moral and financial reasons, we finally say no.


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