Tuesday, December 21, 2004

The sad fact is, ignorant dilettantes crafted the war on drugs — what a waste!

Thinking about the experiences several friends and acquaintances have relayed to me concerning their experience with physicians, specifically so-called "pain specialists," who've created more pain and added to their unendurable lives a load of emotional confusion and fear unlike any they'd known before trusting their bodies care to these cowardly specialists, I am angry and frustrated at the callous disregard for the patients' needs these charlatans consistently (almost) apply when ministering to their "needs."

I put needs in quotes because it seems that the physicians who've set themselves up as arbiters of pain amelioration are, from the start, phonies at best; at worst, egomaniacal freaks who want to control their patients' lives, or at least that's how it appears.

In more than a few cases here in lil' old Lubbock, I've talked with pain patients who've had doctors who refused to listen to their complaints about lack of efficacy, choosing rather to tell the patients how they "should" feel after taking the prescribed medication and submitting to the surgery du jour. As a result, the physicians create groups of morphine- oxycontin- methadone-addicted folks who MUST consent to any indignity to get their medication, up to and including dangerous surgical procedures that may or may not produce beneficial results. The issue here is, is the patients' needs paramount, is the pain these doctors are supposed to be addressing in their practices really what they're trying to ameliorate? Or is it the doctors own careers that are at the heart of every medical record installed in their voluminous filing systems?

Many, many times pain patients are ousted from clinics or private practices without explanation or reason. All the physician has to do is scribble one word on a piece of paper and he or she is immediately free — legally and medically speaking — to blithely dump a patient on the street, sick, in withdrawal from taking opiate-medications for, in most cases, months or even years, as prescribed by these same doctors. The one word, by the way, is "noncompliant." That word alone describes to the medical world a plethora of possible actions or inactions on the patients' part that COMPELS the doctor to dump the bewildered patient. But what does it mean, really? In the murky world of pain management, noncompliance can mean anything from refusal to accept the next surgical procedure the doctor(s) would like to try, to outright abusive use of the prescribed medications.

In any case, that single buzzword gets the physician off the hook with his/her peers for any questions related to medical necessity or medical ethics that might arise if a patient squawks about being summarily dismissed by said physician(s).

What is happening, in many, many cases, is that pain specialists — an already marginalized, suspect group among mainstream physicians because they deal in (gasp) opiates and other addictive medications, sometimes prescribed for, as mentioned, years, are running scared from the DEA and, more often, their state boards of medicine enforcers - in Texas, the minions of the attorney general's office.

Because many times these "specialists" attack the pain on the front end with large doses of strong medicine while coaxing the patient into accepting more and more radical surgical procedures - procedures, I believe, that are often utilized to both try and alleviate the patients' pain and cover the physicians' collective asses (pain is such a subjective condition and so little is truly known about its pathology - is it emotional or physical? is it damaged nerve endings or gross injury that precipitates the condition? - that these "pioneers" who try and treat the suffering patient must keep one eye on the DEA and one eye on the patient. This situation inevitably, it seems to me, except in the cases where surgical outcomes are successful, lead to the patients' dependency on one or more pain-relieving medication and puts the doctor squarely under the spotlight of suspicious anti-drug agents, be they federal or state or both - create a conflict between medicine and law enforcement. And law enforcement, without a doubt, will out in ALL cases.

Hence, if a physician is challenged, say, by some youthful, energetic Department of Public Safety agent tasked with nailing drug-seekers and plain old addicts (all in the best interest of society, of course), the physician will, more often than not, err on the side of covering one's ass and immediately dump that patient - for cause or not. Forget that the physician has been prescribing the medications, doing the surgical procedures, etcetera. The premise is that the poor physician has been duped all along; that all those sophisticated tests, MRI imagery and X-rays lied, as did the patient, and the real issue is simply one of a drug addict trying to get a legal fix. Am I wrong? I think not!

Too much evidence leans in the direction of condemning these so-called pain specialists for being cowardly, unfeeling, unethical boobs if they're ever questioned by a legal authority, never mind that the legal entity has no standing in medical circles. Never mind that the patient, in most cases, has no record of drug abuse or arrests for drug use. All it takes for the the physician to duck his/her head into the proverbial sand is a visit from one of the state or federal drug lords' minions, and voila! Another one bites the dust!

The patient is then faced with the prospect of having been branded a "noncompliant," which in medical-speak means "drug-seeker," make no mistake about it. And this moniker, of course, makes it almost impossible for the patient to find another "pain specialist" who'll take responsibility for treating the patient, despite the fact that he or she may still be suffering miserably - in fact, suffering more so since they are, of course, drug-dependent after being prescribed strong opiates (or other physically addictive medications) and will inevitably feel the pain of withdrawal.

More on this later (I've got to run an emergency errand).

But to digress slightly from the path of this tirade - though not too far - I give you a link to check out, if only for its interesting reading.

The War On Drugs: The beginning ...Really, it's just food for thought.

Back soon. Merry Christmas and Happy New Year (if that's your thing)!


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