ADVICE TO DOCTORS RE:
(or "What the government has taught doctors.")
Until wrongs are righted and procedural changes are made, physicians have little choice other than to be unusually suspicious of new patients, to require unnecessary and expensive tests, to waste time on excessive documentation, or to turn away suffering patients, even if they think the patients may not find anyone else to treat them.
If you're thinking about getting into pain management using opioids as appropriate:
- DON'T. Forget what you learned in medical school -- drug agents now set medical standards.
- If you do, first discuss the risks with your family.
- They could lose a mother or father or breadwinner, their home, their car, their college fund;
- There could be years of harassment and legal fees;
- Your colleagues will probably ostracize you and family members at the first sign of trouble.
If you are already prescribing opioids:
- Beware of new patients. If you accept a new patient, do background checks, demand old records before writing the first Rx, obtain urine screens and get them to sign opioid contracts. It is safer to turn them down, explain why, and give them an action item (call their congressman, for example).
- Do thorough physicals, even if unnecessary and not helpful.
- Make voluminous notes.
- Exercise zero tolerance for patient slip-ups (such as losing a prescription).
- Beware of any patients with a history of drug abuse. Even if now clean and in genuine pain, they might be induced by government zealots to testify against you to save themselves from imprisonment on drug charges.
- Refer patients early and often to addictionologists, orthopedists, pain specialists, psychologists, regardless of expense or your opinion of helpfulness.
- Keep a low profile and beware of saying anything that might offend an official of law enforcement, the licensure board, or the state medical society.
- Never forget that you could be held to a standard of strict liability for any patient misbehavior or for any bad outcomes such as death, no matter the cause and without regard to the culpability of the patient or his associates. Remember, your medical decisions will be reviewed by drug agents who will decide if your actions were medically reasonable.
- Consider phasing out this part of your practice, giving patients plenty of time to find another doctor.