5/5/2014, Prescription for Disaster

Now, this is what I call journalism:

http://www.newyorker.com/magazine/2014/05/05/prescription-for-disaster

Selected excerpts:

A 1989 article in the New England Journal of Medicine stated, “To allow a patient to experience unbearable pain or suffering is unethical medical practice.”

In a letter of thanks to [Dr.] Schneider, one patient wrote, “I call you the pick-up doctor, why? Because after these other doctors screw your life up from negligence in surgery (like the disc on my back), they do not want to bother with you anymore. So you get referred to Dr. Schneider.”

Pain is inadequately treated, particularly among the poor and the mentally ill, in part because there are lingering doubts about whether such a subjective experience is proportional or “real.”

Although about a hundred million Americans suffer from chronic pain, according to a recent report by the Institute of Medicine, medical schools devote, on average, only nine hours to pain, and only about four thousand physicians are board-certified as pain specialists.

When some patients were discharged, they became belligerent, yelling at the providers, throwing soda cans, or spitting in their faces. The physician assistant Kim Hébert later testified that she called the local police more than twenty times. “Patients threatened to stalk me, patients threatened to cut me up in multiple pieces, patients threatened harm on my family,” she said.

Opioids are unique among medications, because there is no maximum dose. Unlike painkillers such as aspirin or Tylenol, consuming large quantities is unlikely to permanently damage the organs.

The D.E.A. began investigating about six hundred and fifty doctors a year, particularly those at “pill mills”—clinics where doctors sell drugs in exchange for cash, with little regard for the practice of medicine—but the agency’s tactics did little to slow drug abuse. Deaths from opioids have quadrupled in the past ten years.

After Schneider’s arrest, the Sedgwick County Medical Society was overwhelmed by calls from former patients requesting referrals. The society held a meeting to discuss what to do about Schneider’s patients, who complained in letters to him that no one wanted them. Jon Parks, the Wichita pain specialist, said he told the doctors at the meeting, “There has always been a Dr. Schneider in our community.” He said that doctors in the area dealt with chronic pain inappropriately, by administering nerve blocks, one of the few forms of pain treatment that were reimbursed well. “These doctors stick needles in, take their cash, and run,” he said. When the procedures failed, patients were on their own, and ended up in Haysville. He said to the doctors, “No offense, but this is self-wrought.”

George Watson, formerly the chief of staff at Riverside Medical Center, in Wichita, wrote a letter to the Kansas Board of Healing Arts, explaining that Schneider “sees the rejects of medicine that WE won’t see. He sees the people who have had all the surgeries and epidural steroid injections that insurance would buy, before it ran out, AND they still have pain.”

He [Mark Sullivan, a professor of psychiatry at the University of Washington] believes that doctors are inappropriately adopting a “palliative-care mentality” to “relieve the suffering of people who have had very tough lives.”

Yeah, I don’t think these doctors are listening… I’d like this professor to switch places with a pain patient who’s assembling aircraft machinery for a week, then we can sit down and talk about “very tough lives.” Heck, he doesn’t have to work as an aircraft mechanic, he can pick items off of shelves all day at the nearest Amazon warehouse.  I wonder how long he would last in over 90 degree heat in a 10-hour shift?

Professor Sullivan thinks pain is mainly about “mentality,” and appears to be very dismissive of the physical part of it. But then, he’s a professor of psychiatry, so I guess he’s a little biased.

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