Helen Chalmers
Well I'm feeling kind of cynical so maybe that colors this question for me, but I think that this is one of those "feel good" initiatives that is not taken at all seriously by the people who would have to take it seriously. I saw this on a nice poster on the wall in the exam room at my doctor's. It was printed up by a drug company, given out as a nice "freebie" to the doc. On the opposite wall was another nice little poster, also a drug company freebie. It said, "Your doctor cares about you too much to prescribe an antibiotic you don't need." One time I was 80% sure I had a viral sore throat, but felt sick enough that I decided a throat culture was a good idea. So I went in to the doctor. She did NOT do a throat culture. She said, "Oooo, that looks nasty. Our policy is to treat all sore throats." And she sat there RIGHT UNDER THE POSTER (the no-unnecessary-antibiotic poster) and wrote out a prescription for amoxicillin... (And yes she's still my doctor -- she believes that adhesions cause pain!)
The problem is that the people writing up these manifestos about how pain patients have a right to treatment are ignoring the 2-ton elephant at the party. In law-enforcement circles (as in the DEA, FBI, etc.) it is simply assumed as an unquestioned fact that there is no such thing as chronic pain. John Jones or Suzy Smith have a gallbladder removed, or open heart surgery, or a hammer-toe repaired. They are sick, in pain, they have surgery, the surgery causes pain, they get pain killers, the surgery cures their problems, they don't need any more painkillers after a couple of days or weeks. The law-enforcement types start out with the assumption that treatments never fail, nothing is ever untreatable, and that treatments could never make pain worse except temporarily. So anyone who claims to be still in pain 3 weeks after the treatment MUST be a druggie looking for a fix.
I've heard this from an ER doctor: "Yeah, right, they come in saying they are in terrible pain, and they know the 14-syllable name of exactly the narcotics they want, and the exact dosage." (rolls eyes.) As if someone who was in chronic pain for years would NOT know the names and dosages of the drugs that help? Anyone with an IQ larger than a box of rice-a-roni would figure that out after a few years! But you see they don't believe that anyone could be in pain for years and years.
I've read stories where the DEA or FBI will take the fact that a doctor has lots of patients on narcotics and use this as prima fascia evidence that the doctor is a drug dealer. As if there were no other explanation! Obviously if in a community most doctors are afraid to prescribe long-term narcotics, then the few doctors who ARE willing are going to collect all of the chronic pain patients in the community. I mean nobody thinks it especially ominous that a huge fraction of an OB's patients are pregnant, or that a huge fraction of a cardiologist's patients take nitroglycerin, right?
The 2-ton elephant at this party is that it is completely reasonable for a doctor to want OTHER DOCTORS to give adequate pain relief to the OTHER DOCTORS' patients, and is ready and willing to right all sorts of florid manifestos to that effect. But of course when it comes to giving his OWN patients adequate pain meds, he knows that every chronic pain patient that he treats adds a little to the very real risk that he will end up in jail, financially ruined, etc.
When that doctor treats you like a druggie, realize first off that he is LYING. And the person that he lies to first and foremost is HIMSELF! He is pretending that you are not really in pain because if he admitted that you were in pain then he would have to do something about it. And if he did something about it, he would be taking big risks. So he lies to himself to cover the fact that he is a coward.
Those conventions and summit meetings can prattle on about "patient's rights" until the cows come home, but nothing is ever going to change unless we can get the DEA and FBI et al to stop throwing doctors in jail for treating people who are in pain for more than a few weeks.
At Fri, 19 Apr 2002, Tish wrote:
>
>Is this pain patients bill of rights..a rule or a law or something.
>Can we take these to our Dr?
>Im so sick of having Drs look at me like i am a DOPE ADDICT!
>Because i need pain medicine.
>Thanx Tish
JOINT COMMISSION ON ACCREDIDATION OF HEALTH
> "Unrelieved pain has profound physiological and psychological consequences
> that result in significant costs to patients and families, to the health
> care system, and to society as a whole," according to Yank D. Coble, Jr.,
> M.D., president-elect, AMA. "Unfortunately, a variety of barriers impede
> the use of appropriate treatments, causing many patients to suffer
> needlessly. We have an important opportunity here to provide relief for
> patients by promoting consistency and quality in the management of pain."
>
> "Pain is the most common reason that patients seek medical care, yet we
> don't always know whether the treatments provided are effectively meeting
> patient needs. This must change," says Dennis S. O'Leary, M.D., president,
> JCAHO. "Working together, I am confident that we can make significant
> strides in addressing this serious public health issue."
>
> "One of the major precepts of caring for patients is to always strive to
> relieve pain and suffering" said Greg Pawlson, M.D., executive vice
> president, NCQA. "These measures will help us quantify how we're doing in
> that area, while at the same time driving improvement in the care delivered
> to a large, diverse patient population."
>
> The AMA, JCAHO and NCQA have worked together to coordinate performance
> measurement development activities since 1998 and earlier this year
> unveiled Coordinated Performance Measurement for the Management of Adult
> Diabetes -- a new approach to measuring performance in the delivery of care
> to diabetes patients.
>
> Purdue Pharma, L.P., is providing unrestricted funds to support development
> of the pain management measure set. Control and responsibility for the
> design and content of the measure set rest solely with the AMA, JCAHO and
> NCQA. JCAHO will function as the administrative center for the project.
>
> For additional information, please contact:
>
> AMA - Robert J. Mills (312-464-5970)
> JCAHO - Charlene D. Hill (630-792-5175)
> NCQA - Brian Schilling (202-955-5104)
>