David Herlihy, executive director of the Vermont Board of Medical Practice, reminded doctors that they can be conservative about dispensing medicines for chronic pain.
“We’ve never disciplined anybody for under treatment of pain,” he said
I guess this quote… puts… chronic pain pts in a different treatment category as anyone else with a chronic disease.
I wonder if this Board has ever disciplined any doctor for under treatment of a pt with diabetes, high blood pressure, warfarin therapy,COPD or other chronic diseases… which under treatment could cause the pt’s quality of life to be compromised or the pt could end up being hospitalized or even dies..
IMO.. this is a failure to meet best practices and standard of care.. attorneys refer to this as MALPRACTICE !
So if this quote is correct… the Vermont Board of Medical Practice does not consider the under treatment of chronic pain malpractice?
Filed under: General Problems
KLS said: “This is yet another attempt to put pain patients in its own category thereby allowing the ridiculous prescribing of narcotics.”
I know doctors hate it when patients have their own opinions. But you say you’re not a doctor — you just listen to doctors all day long, and have taken the time to relay what they’re talking about, and how they’re talking about it. Did I get that right? So, I think the words you (and they) use say a lot. Like, what’s the deal with referring to pain patients as “it”?
Since you weren’t specific about your job, I guess you can blame me for making assumptions. I guess you can blame me too that, when I read your comment, my response is what followed. Perhaps it was a rant — or maybe even rage — but if you had any sympathy for pain patients, maybe you would understand why we are ranting and raging. No, instead you call our medication needs “ridiculous.”
I guess after almost 30 years of suffering from constant pain, yes, I have learned how to treat myself. It’s not like I have much of a choice — the medical industry has every penny I’ve ever earned, and then some. Anyway, even if I wanted to return to opioid treatment, where would I find a doctor willing to prescribe medication?
I trusted and relied on the medical industry for decades, and the end result wasn’t pretty. I won’t bore you with the details except to say that my “rage” is certainly justified.
I’m sorry if you feel picked on when you were allegedly only trying to commiserate. Funny, I didn’t get that from your posts at all. In fact, it seems that my rant brought out a similar one in you, which I think is very interesting. It’s also interesting that you decided to paint me as a non-compliant patient (with a mind of my own, thanks) — as if that were the worst thing in the world. Ha! Dude, you have no idea.
Yes, that is my advice to every pain patient: Treat yourself. Doctors suck.
Phew!! Rant over. I feel better now, thanks.
All over the country, Americans will be enjoying a holiday weekend with family and friends. For pain patients, it’s just another day… in pain.
Just dang. Rage much?
I am not a doctor. I did not even offer a veiled attempt to claim as much. I am, however, a medical professional that works along side doctors daily. I see what they go through and I hear what they gripe about. I also work along side clinical pharmacists who provide medication counseling to patients in the office setting. In short, I am on their side.
So no, I am not in agreement with the DEA putting provider’s feet to the fire. I never said that.
No, I have never heard a doctor blame a patient for addiction or for being in pain. I have seen them try to fix that addiction many times. So, I never said that either.
No, I don’t think every pain patient is an addict. I am not a PCP, and babysitting is not my job. I never said any of that.
I am not a coward. If I was I would not post an attempt to commiserate with pain patients and the attitude those patients suffer when obtaining narcotics and fear for the future.
I am not for restricting pain patients to ‘methodone clinics’ nor would I be a part of why that would happen. I do not know where your perception of what I said went horribly wrong, but it did.
And if I were a doctor, don’t bother looking for me. I would not have you. You are argumentative, accusatory, and probably non-compliant as a patient. And you seem to know it all, so you don’t need a doctor. Treat yourself.
I am certainly unsure where you dredged up all this stuff I supposedly said. You are wrong on all points and it’s people like you who lay blame, point the accusatory finger, and twist every word instead of having a discussion that includes all sides of the story and not just yours.
KLS said: “I would not question the CDC’s assertion of the rampant abuse and addiction rate of pain killers. It’s an opioid. It’s addictive.”
I think you’ll agree that a lot of things are addictive. Caffeine is addictive and too much of it can give you a heart attack. Sugar is addictive and too much of it can give you diabetes (and a heart attack). Too much water is bad for you, along with too much sleep. It’s unfortunate.
The CDC is reporting on emergency room visits and deaths caused by drug overdose. But the majority of these ER visits and deaths involve more than one drug. All one has to do is look at the M&M reports that the CDC puts out, which clearly show that it is the combination of opioids and other drugs, both legal and illegal, that cause the fatal mixture. Both alcohol and anti-anxiety medications are the top two drugs, mixed with opioids, that are likely to cause death. (With the exception of methadone, which appears to cause fatality all on its own.)
KLS said: “The DEA is leaning hard on physicians and laying the blame of addiction squarely at the feet of providers.”
And this makes sense to you? Blaming people’s addictions on drug providers? And yet, you seem to agree with the DEA, just like some other doctors who blame certain other doctors in their ranks as “bad” actors. As a doctor, how does it feel to be told what to do, not only by the DEA, but by insurance companies too? Was it the DEA and insurance companies who went to school for years and years to become a doctor?
KLS said: “This is not the fault of the provider or pharmacist. Like most things, this is the fault of people who scam and game the system and ruin good care for the rest of you.”
Oh, doctors love to place the blame on patients — scammers and addicts, all of them, right Dr. KLS? Doctors have been so convincing in this argument that other chronic pain patients are blaming “scammers” too. It’s pathetic. And for a doctor to blame the victims, people who are suffering… why, it’s inexcusable.
KLS said: “What I fear is pain management is going to go the way of methodone clinics.”
You are part of the reason that will happen, if it does. Feel good about yourself?
Your replies, Dr. KLS, kinda speak for themselves. You think every pain patient is a potential addict, and you, as a PCP, don’t want to “babysit” them. You’d prefer to babysit the patients in your practice who don’t have complex problems. You, Dr. KLS, are a coward, and I have a hard time believing you’re a doctor. If you are, please reveal yourself, so I can be sure to never visit your office.
Sorry this doesn’t relate to this situation but I have a question. My pharmacist, told me that I should go ‘pharmacy shopping’ if I prefer a certain pain medication. Wouldn’t I be tagged in some way? Sorry, this man is a complete idiot and should never have this job. Previous medication gave me headaches. I was taking 1500mg of ibuprofen. Then when I received a different kind, (ones that I used to have years ago) I went down to only taking 400-500mg of ibuprofen. I called them and told them to report to MedWatch. Can I report him for this kind of an answer? Why do I have to go through life with the headaches on top of the pain 24/7?
The Delaware Board of Physicians treats under treatment of pain in the same way that Vermont deals with it; it doesn’t. I guess those cases are to difficult for those doctors to figure out. But the Delaware Board WILL pretend they will investigate it.
So, no one has been disciplined for the undertreatment of pain? Well, how can a doctor be disciplined for something he can’t control? I mean, insurance companies limit treatment options, the DEA and the CDC want to remove almost all options, and patients can’t afford to keep paying for short-term and ineffective treatments. Other than drugs to manage pain, what else can doctors offer that actually works? They can’t fix us, and now they can’t help us.
I go back and forth on whether addiction is as prevalent as reported, and whether it is a “real” disease. However, I have no doubt that chronic pain is a medical condition in and of itself — as to whether it’s a disease, I’ll leave that for the “experts” to label.
I recommend Charlie Rose’s “Brain Series” — episode two deals with pain, but all thirteen episodes are extremely interesting. I won’t say I understood all of it, but I understood enough to know that chronic pain is a condition that usually develops from untreated or undertreated acute pain — once the pain reaches chronic levels and remains untreated or undertreated, intractable levels are next. It is a progressive condition, and one that is many times exacerbated by invasive treatments, like surgery.
What does a pain patient have to do to get some relief? (And no, patients aren’t asking for zero pain levels, that’s just silly.) I mean, who do I have to sleep with? Do we all have to slit our wrists before we become believable? How can anyone justify causing all this additional pain and suffering?
I hear you, it’s frightening. I would not question the CDC’s assertion of the rampant abuse and addiction rate of pain killers. It’s an opioid. It’s addictive.
I can feel for you. I am sure it does seem like no one wants to help. The DEA is leaning hard on physicians and laying the blame of addiction squarely at the feet of providers. So much that most of the primary care doctors I work with will no longer treat conditions that require chronic pain management. They refer them out to pain clinics. It’s too risky and there is little time to babysit an budding opioid addiction when you are forced by the health system to see 25-30 patients a day or not get your RVUs (doctor goals).
What I fear is pain management is going to go the way of methodone clinics. Weekly appointments, pill counts, urine drug screens to prove compliance and any deviation from the pain contract and you are out on the street. If you are compliant you get a pat on the head and appointment for next week to refill your meds.
This is not the fault of the provider or pharmacist. Like most things, this is the fault of people who scam and game the system and ruin good care for the rest of you. It’s unfortunate.
PER STEVE: OPIATES ARE POTENTIALLY ADDICTING
@KLS Intractable pain can most certainly be measured and documented. Besides the pain itself, high blood pressure, heart rate, eye changes, diaphoresis, guarding, adrenal insufficiency, etc. are all symptoms of chronic pain that can determine a patient’s pain level. The assessment of the pain patient is determined by the patient’s physician. Pharmacists do not have the educational background to determine the course of treatment. Their job is simply to fill the prescription as written.
I certainly agree there are indications, and as Peon pointed out wonderfully, underlying conditions that could be used to indicate a patient in pain. I think you missed my point. I am not talking about judging if a patient is telling the truth about being in pain. I am talking about how incredibly difficult it is to quantify pain. And if providers cannot quantify something with any degree of accuracy how can they be accused of under treatment or malpractice for goodness sake?
There is no infallible test. For people with hypertension, there’s blood pressure, for people with atrial fibrillation, there’s an INR, for people with COPD there is pulmonary function tests. All of these things provide a quantifiable number as to the effectiveness of the medication’s dosage. And yes, someone who throws a clot because the Warfarin dosage was not addressed can certainly sue for malpractice.
But pain is different. Pain is very subjective and ‘in the eye of beholder’. So how can any board hold a provider accountable for under treatment when there is no way to prove under treatment unless it’s failure to provide treatment at all. A lab can certainly run a quantitative blood test to determine the level of opioids in a sample but that test still can’t relate whether the patient’s pain is under control by those levels. The result won’t say, “Yep, the pain is a 0/0.
Also, everyone is jumping on the pharmacists here, but the original post by Steve talked about the Medical board and physicians under treating pain not pharmacist’s refusal to fill. Pharmacists’ refusal to fill almost always has to do with patient insurance, not whether or not he or she feels the patient’s treatment regimen is necessary.
Ah you’re correct, but pharmacists are now playing Doctor (or God) and they are controlling everything. If they think you should hold off, if they say they are out of stock just to make you wait or keep changing dates. It’s proven that your vitamin D gets depleted when you’re in pain. So they can’t look to see my physician put me on 50,000 iu’s of vitamin D because I’m in so much pain? They need more schooling…on second thought that would be dangerous.
It could very well be. I can’t discuss pharmacists playing God because I’ve never been witness to that behavior. I would be sad to know that were true.
At this point I don’t believe pharmacists would purposefully keep medications from patients. This is because they have ridiculous (retail) goals on the filling of prescriptions per hour. To refuse to fill a script results in a visit from the RPH and the phamracist certainly does not want that I promise you. They could lose their job by not filling prescriptions, narcotics or not.
Also, Vitamin D is available over the counter. You don’t need a prescription.
I think that in most instances there are indicators of chronic pain. The patient may have had a car accident and a damaged spine. We can pretty well guess the patient will be in pain. The same goes for rheumatoid arthritis and Lymes disease. So, there are tests that give a good indication of whether a patient is having chronic pain. Chronic pain is only a symptom of some underlying cause. If the cause cannot be corrected, then only treatment left is to administer pain medication to allow the patient to live a somewhat normal life. Chronic pain is not a disease, but instead is the manifestation of an underlying disease or ailment. When a pharmacist refuses to fill a prescription for a pain medication without any basis, he is making a decision about whether the patient has an ailment or not, but he does not have the patients medical records. It is not the pharmacists job to diagnose. Refusing to fill a prescription for a pain medication is the equivalent of diagnosing. So, pharmacists are playing doctor without a medical license. The DEA is doing the same thing. The job of the DEA is to insure that physicians comply with DEA regulations. It is not their job to limit drugs through the wholesalers or to threaten chains about the number of meds they dispense.
Very clear analysis of the actual issue going on – thAnk you!
Wonder if he’d have the same outlook if he was in pain?
Uh, probably because diabetes, hypertension, COPD, and anti-coagulation effectiveness can all be measured with blood test or spirometry. Pain relief is only relative to the patient’s assertion that pain relief is happening. And since, on a scale of 10/10 if the patient’s pain is 1 and not a zero then the doctor is undermedicating and under scrutiny?
Come on, really? You can’t be serious here in comparing these conditions.
This is yet another attempt to put pain patients in its own category thereby allowing the ridiculous prescribing of narcotics.
Sorry, it’s not malpractice to protect one’s DEA license because someone claims they are in 10/10 pain only because the pain is not 0/10.
They havent had a lawsuit for undertreatment of pain yet. Maybe those ‘bad drug ads’ might actually come in handy…I’ve seen them advertise for poor care in nursing homes.