Wednesday, November 13, 2013

Why Do Doctors Keep Prescribing?

The New Yorker published a great piece on the prescription drug epidemic this week.  The article is written by Celine Gounder, a physician with personal experience dealing with chronic pain patients. 

I found one section of the article particularly helpful in explaining why doctors prescribe these powerful medications even when many of them know it's wrong for the patient:

"The pain-pill epidemic has also forced doctors like me to consider our own role. Doctors have a duty to relieve suffering, and many of us became doctors to help people. But giving that help isn’t straightforward, especially when it comes to chronic pain. Try explaining the downsides of narcotics to a patient while declining to give him the medication he wants. He might accuse you of not understanding because you’re not the one in pain; he might question why you won’t give him what another doctor prescribed; he might give you a bad rating on a doctor-grading Web site. He might even accuse you of malpractice. None of this is rewarding for doctors: we’re frustrated that we can’t cure the pain, and that our patients end up upset with us.

Doctors have a hard time saying no, whether a patient is asking for a narcotic to relieve pain or an antibiotic for the common cold. We are predisposed to say yes, even if we know it isn’t right. Some of us just don’t want to take the extra time during a busy day to explain why that prescription for a narcotic isn’t a good idea. Some of us also use the promise of prescription narcotics to persuade patients to keep their medical appointments, or to take their other medications."

This is the reality in the average physician's office today.  These are the cold hard facts of dependence and addiction.  And this is why the inappropriate use of prescription pain killers isn't going away any time soon. 

This is also why we have to come at these prescribers with more than just medical treatment guidelines that suggest the current drug regimen is inappropriate.  Many of these doctors (whether they openly acknowledge it or not) are already aware that the treatment is outside the boundaries of contemporary medical evidence.

So what do we do?
1) Prevent the inappropriate use of these medications in the first place.
2) Where dependence or addiction has arisen, offer the doctor and injured worker alternatives.  Cognitive behavioral therapy, functional restoration, referrals to a specialist, comprehensive pain programs, etc. 

Is the quality of these various options highly variable?  Yes. 
Are they potentially expensive?  Some more than others, but yes, there's cost associated with these paths. 

But as PRIUM's own Nurse Linda likes to say, "If you're going to take away my Hershey Kisses, you have to give me something else."  

On Twitter @PRIUM1

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