Comments on: Damned if you do, damned if you don’t (or how to get caught between a rock and a hard place)

By: davelo

davelo — Tue, 06 Jan 2004 01:08:11 +0000

Well it seems for Mr Holt that all of our medical problems are the fault of the Bush Administration. If only it were so simple…..

By: Matthew Holt

Matthew Holt — Mon, 05 Jan 2004 23:06:12 +0000

Storkdoc has a somewhat over agressive interpretation of my opinion being that the Bush adminstration is the cause of all medicine’s troubles….

However, whether pain is a big deal or not, no rational person can give a good reason for the criminalization of what is a health problem — be it pain or addiction to narcotics. Unles of course they are on a religious crusade or making money out of it or both (as in Ashcroft’s case)

By: Insults Unpunished

Insults Unpunished — Fri, 02 Jan 2004 00:13:50 +0000

Another Abuse Of The War On Drugs™
Worried Pain Doctors Decry Prosecutions (washingtonpost.com) I spotted this article over at db’s place earlier this week and had been meaning to comment on it. Of course, his comments are more well-informed since he’s a doctor, but I’ll focus on…

By: Mark

Mark — Thu, 01 Jan 2004 23:52:41 +0000

Craig,

I could not agree with you more. I have patients sitting my office looking quite comfortable,having normal measurable vitals who states that they have pain that is 10/10.

I’ll then ask them “So, if I cut off your arm with a chain saw and no pain meds this pain that your having now is about the same?”

Most patients will usually revise their scale down at this point, but I have had several who agreed.

I HATE the so called 5th vital sign.

By: kill as few patients as possible

kill as few patients as possible — Wed, 31 Dec 2003 15:50:48 +0000

DB’s Medical Rants: Damned if you do, damned if you don’t (or how to get caught between a rock and a hard place)
DB recently posted some excerpts from an article about doctors going to jail for overprescribing narcotics. He maks some good points, and I agree the handling this problem criminally is dumb, but I wanted to take a moment to comment

By: Craig

Craig — Wed, 31 Dec 2003 15:44:31 +0000

5th vital sign my butt. This is absolutely one of my pet peeves. I’m not saying we shouldn’t assess pain and treat pain, but it isnot a vital sign. For one thing, vital signs are objective, pain scales are not. For another, vital signs measure vital information. Significant abnormalities in any of the four real vital signs is always clinically significant, usually urgent. A reported 10/10 on a pain scale is sometimes significant, but basically never life-threatening in isolation. Any patient with life threatening pain will have other history and physical information to guide a doctor.

Elevating pain to the level of a vital sign has hastened the ridiculous pressure on physicians to treat all pain. Absolute freedom from pain is not a necessity of life. Even as I type this, I have a moderate pain in the left side of my neck which I woke up with (you know, a crick in my neck). I’m not comparing this to the pain of many patients with other conditions such as terminal cancer or severe rheumatoid arthritis, but I do think it compares to many of the patients I see in the Fast Track complaining of 10/10 back pain who are allergic to Toradol and all muscle relaxers except Soma and know that only a narcotic pain shot will work. I see far more of these patients than I do patients with a legitimate need for narcotic pain medications.

Finally, anyone who says that there aren’t major problems with physician overprescribing is either part of the problem, has their head in the sand, or is a complete idiot. I know of several docs who prescribe a buttload of narcotics to a ton of patients. Every other doc who’s being honest with you does too.

Look, I don’t mind seeing an elderly patient with rheumatoid arthritis or a dying cancer patient who’s become addicted to narcotics. Who cares? Pain control is important. But what is much more common is the 38 year old unemployed and apparently healthy young person whose been taking 100 hydrocodone tablets and 100 Soma tablets (as prescribed) a month and says they have to have them to deal with chronic back pain, which has been evaluated and is not surgical. Look, it’s a hard answer, but the truth is there is nowhere good to go from there. Being a drug addict in your 30′s does not predict a long health contributory life. Pain sucks, but as my grandmama used to say, “Nobody ever said it was going to be easy.”

It is not medically necessary to treat all pain to complete resolution. Somebody has to say it, so I will.

By: John Schedler

John Schedler — Wed, 31 Dec 2003 01:18:02 +0000

I make the bulk of my living representing Drs before the DEA & disciplinary authorities (WA State). Mr. Holt should know that the Reno Justice dept was much worse on this issue.

I can win these cases — I usually do. But they cost a fortune & insurance is usually of little or no help,

By: storkdoc

storkdoc — Wed, 31 Dec 2003 00:57:38 +0000

Well it seems for Mr Holt that all of our medical problems are the fault of the Bush Administration. If only it were so simple…..

By: Matthew Holt

Matthew Holt — Tue, 30 Dec 2003 18:58:44 +0000

This may be new to some readers but don't forget that the DEA is run by the justice department run by Ashcroft. Despite the fact that his nephew was let off drug- dealing charges that get others jailed for 10+ years and he himself broke the law in Missouri by helping the police effectively steal confiscated drug money from the school system, he is a total offensive bigot on the drug issue. The attack on pain doctors is well known amongst the drug reform community and is similar to the massively over-proportional attack by the hypocritical and frankly fascistic Christian right and their appointed representatives on people who disagree with their notions of drug use and abuse. And if you think the DEA gives a rat's arse about patients or doctors you are very much mistaken. Obviously the pain medication issue needs to be taken out of the criminal arena into the health arena, but there is no prospect of that with the Republicans in power.