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Lessons from day in court
A day in court changes doctor's perspective on prescribing pain medications
Date published: 7/27/2003
MY RECENT VISIT to court taxed my "bleeding-heart" liberalism, my view of drug addiction as a disease model and made me side with the commonwealth's attorney and his "string 'em up" rhetoric. The occasion was a visit to the Stafford County courthouse to appear as a witness in the case where one of my patients had falsified his prescription. A reputed, "slip of the pen" and the prescription I wrote for 20 Percocet, suddenly become 120. The sharp-eyed pharmacy technicians caught it and called the sheriff. In the course of the proceedings it transpired that my patient had quite a history, including distributing Oxycontin--a pain medicine that has built itself quite a reputation for abuse and distribution. So there I sat with this uncomfortable thought gradually percolating through my brain, "How many other of my patients are taking me for a ride?" A pain in my neckA large part of family practice involves dealing with people's pains--back pains, arthritis pains, headaches, fibromyalgia pains, neuropathies. They have (or they are) a pain in the neck. Maybe I'm too liberal and accumulate more than my fair share of pain patients. One always worries about patients abusing their pain medicines, or becoming addicted to them. Some even come with a pre-existing diagnosis of drug dependency of some kind. But when someone is sitting before you telling you they are in excruciating pain, and there's no test you can do to tell if they are or they aren't, what do you do? Tell them, "Sorry, I don't believe you?" But as you write out their prescription for abusable, saleable narcotics, there's a little voice niggling in the background, saying, "Sucker." One woman I saw the other day complained about how everyone treated her as a criminal when she asked for Percocet for her back pain. She was obviously naïve about these things, or a very sophisticated "hitter," judging how she nearly fell off the exam table when I talked about the court case. But it's a diseaseThe medical literature claims that doctors overall undertreat pain, and it has recently been cited as "the fifth vital sign," so that nurses in the hospital are obliged to rate a patient's pain on a scale of 1 to 10, as well as check their conventional vital signs.
Date published: 7/27/2003
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