Patient satisfaction surveys and the blame game

The problem is that what matters to patients and doctors does not always align. Someone may push for unnecessary testing because they read it on Google or Dr. Oz recommended it on his show. Someone may push for medications that are not medically indicated, i.e. antibiotics for viral infections. Someone may push for narcotics but refuse other pain control options offered by their providers. People are not always receptive to “no,” and some will threaten doctors with a low score…

I agree with Dr. Lee that patient satisfaction surveys have their place. I agree they can deliver valuable information that can impact positive change. However, as they stand now, they also promote false expectations. They hand the definition of “quality care” to the patients and undervalue the medical judgment of clinicians. There have been negative consequences as a result. To imply that patient satisfaction surveys have not contributed in some way to the opioid epidemic is to shamelessly pass the buck…

No one wants to take responsibility for the opioid crisis. The truth? Multiple factors led to the current state of affairs. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) emphasized pain scales with the implication that patients ought to be pain-free, an unrealistic expectation. Patient satisfaction surveys inadvertently decreased the importance of clinical judgment in the eyes of the public. The federal government also played a part by financially incentivizing hospitals based on patient satisfaction scores. Some doctors began to overprescribe medications due to these external pressures…

I’m a doctor. I have a medical degree. Therefore, I know what’s best. Really? Is that why about 400,000 patients die every year from doctors’ mistakes? Doctors admit they don’t have time to get to know their patients, yet we’re supposed to trust that they know what’s best for us?

Everybody involved in the drug war, including doctors, play their own versions of the blame game for the opioid “epidemic.” Sure, blame pain scales, although I’ve never looked at a pain scale and thought, oh boy, this says I can be pain-free! Doctor, I want to be a zero on the pain scale! Make it happen!

Sure, blame patient satisfaction surveys, although during my 25 years of being treated by the medical industry, I don’t recall filling out too many surveys. The last time I was in the hospital, I vaguely recall a postcard-sized survey, which I filled out to say nice things about one of my nurses. But for all the doctors I’ve seen? No, I don’t recall filling out any patient satisfaction surveys. And I can’t recall Medicare sending me any surveys, either.

Under comments:

Maggie1212 • 5 days ago
Amen. My hospital for about 2 years actually linked our entire bonus to patient satisfaction scores, instead of any measurable factors such as time to cath lab, appropriate ACLS meds given during Code 99s, time to antibiotics for pneumonia, etc which we suggested. During that time we had incredible pressure from hospital administrators to prescribe narcotics. You would get calls, asking, “why didn’t you just give him enough to get him through the weekend?” Absolutely unreal stuff.

DZ-015, M.D. Maggie1212 • 5 days ago
It’s very simple. Once the patient is on benzos or opioids for more than three weeks (with the exception of chronic progressive disease) the patient satisfaction score doesn’t count because their judgment on the issue is now impaired.

What should a bonus be tied to? Because I find it hard to believe that a hospital would base an entire bonus on patient satisfaction scores, instead of including things like how long the employee has worked there. And I also find it hard to believe that hospital administrators pressured employees to prescribe narcotics, although prescribing enough for the weekend doesn’t sound unreasonable. This hospital employee’s attitude pretty much says it all — it’s unreal to be asked to prescribe a couple days worth of painkillers. And low patient satisfaction scores just mean patients didn’t get the drugs they wanted — they have nothing to do with the employee’s performance at all.

Obviously, Medicare is collecting this data, although how many patients are actually participating is questionable. And the information is only on hospitals, not specific doctors.

Patient Experience encompasses 8 important aspects of hospital quality:

Communication with nurses
Communication with doctors
Responsiveness of hospital staff
Pain management
Cleanliness and quietness of hospital environment
Communication about medicines
Discharge information
Overall rating of hospital

Performance period: January 1, 2014 – December 31, 2014

UNM Hospital
Pain management: 0 out of 10
Overall rating: 2 out of 10

Lovelace Medical Center
Pain management: 1 out of 10
Overall rating: 2 out of 10

Lovelace Westside Hospital
Pain management: 4 out of 10
Overall rating: 6 out of 10

UNM Sandoval Regional Medical Center
Rio Rancho
Pain management: 0 out of 10
Overall rating: 4 out of 10

Christus Vincent Regional Medical Center
Santa Fe
Pain management: 3 out of 10
Overall rating: 1 out of 10

The opioid war targets cancer patients

First they came for the drug addicts. Then the pot smokers. Then chronic pain patients. Now they’re after cancer patients. The “experts” are doing everything they can to separate chronic pain from acute pain, because doctors only have to treat acute pain (but not always). And now cancer patients will be seen as potential drug addicts, too.

FRIDAY, July 29, 2016 — More people are surviving cancer, but many are left with persistent pain after treatment. New guidelines from the American Society of Clinical Oncology (ASCO) recommend that doctors routinely screen for such pain.

The guidelines also advise doctors to consider the use of non-traditional treatments for pain. These include hypnosis, meditation and medical marijuana where it’s legal.

ASCO also cautioned doctors to assess patients’ risk for overuse of opioid painkillers…

Advances in cancer diagnosis and treatment have led to a record 14 million cancer survivors in the United States. But, about 40 percent of survivors have persistent pain as a result of treatment, ASCO says…

The guidelines note that there are non-drug treatments for pain. These may include physical rehabilitation, acupuncture, massage, hypnosis and meditation. Also non-opioid painkillers — such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin — can ease pain. Certain types of antidepressants and anticonvulsants may be prescribed to relieve chronic pain and/or improve physical function, ASCO said…

Do you think these medical associations/societies are on the side of patients? No, they exist only to protect doctors. And yet they’re “guidelines” are followed like law, just like the CDC’s rules.

If there were active advocacy groups for patients, they would be reporting that anyone who is diagnosed with cancer should be aware — before treatment — of the possibility of developing a chronic pain condition from the treatment, which your doctor will refuse to treat after a certain period of time. In other words, you will probably survive, but there’s a good chance you will be in pain for the rest of your life. Sound good? Here, sign on the dotted line.

Do you think being a cancer survivor (or being terminal) will automatically grant you access to painkillers? Think again.

If I were a cancer survivor in chronic pain, and my doctor prescribed hypnosis or aspirin to treat my pain, I’d tell him to fuck off. (Doctors suck.)


The title of this post was given to me by Sir Derrick, gracias.


I visited Walmart at dawn this morning.


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I watched the sun rise from the parking lot.

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Although it may be hard to believe, I’m getting a little tired of Dilly Bars. So, I also stopped at Krispy Kreme. The doughnuts were good, of course, but I think they’ve shrunken in size since the last time I indulged. And I would be surprised if the doughnuts were made in-house, as they weren’t that fresh. (Did I mention how small they were?)


Then I had to go to Albertson’s, because they’re the only store that carries the kind of straws I like. Yes, I’m very picky about my straws. They have to be the skinny ones, not the fat ones. Because TMJ.

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Finally on my way home. Even at 7am, I was still sweating.

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It’s too damn hot. The End. 🙂

Doctors suck

Then last month I was given a new Primary Care Physician (PCP) at the Palm Desert, VA who told me in a phone conversation that the VA, Loma Linda had sent all the PCP’s a “memo” giving them the right to refuse pain medication to any Veteran who uses Medical Marijuana, if they so choose. So she refused to give me the pain medication I need as long as I use Medical Marijuana and has refused to care for me, a 100%, SC Disabled Veteran…

Patient contracts and a lawyer’s advice to doctors on managing pain patients

As the nation begins responding to the epidemic of overdoses and deaths caused by opioids, some people with chronic pain who have relied on these powerful painkillers for years are finding them harder to get. A survey conducted by the Boston Globe and Inspire, a health care social network of 200 online support groups with 800,000 members, found that nearly two-thirds of respondents reported that getting prescribed opioid medication had become more difficult in the past year…

Under comments:

JULY 15, 2016 AT 9:45 PM
Have you read the recent pain contracts required by the DEA of all LTO patients? They are horribly written, riddled with contradictions and typos, and they strip the patient of all rights. It’s assumed you’re a criminal just for claiming to be in chronic pain.

1. I have been informed about the potential for addiction to controlled substances. If this happens, I will follow my doctor’s guidance and participate in an addiction treatment program if prescribed.


6. I will adhere to the following rules:
> I will use only one pharmacy to fill my controlled substance pain medications.
> I will accept generic substitutes when available.
> I will not accept prescriptions for controlled substances (pain killers or sedatives) from other doctors without prior approval from MSPMI.
> I will not use illegal drugs and must limit my alcohol use. My doctor will periodically ask for a urine sample to check for illegal drugs, alcohol,and other pain killers.
> If a specific medication does not work for me I will return the unused portion to MSPMI.

10. I agree to submit to a urine and/or blood screen to document appropriate blood levels of prescription analgesics and to detect the use of non prescribed medications at any time.

Legal Tips for Physicians to Manage Pain Patients
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I have represented a number of physicians who have been accused of “overprescribing.” Some of these were criminal investigations by local law enforcement authorities, such as a county sheriff’s office. Some were investigations by the Drug Enforcement Administration (DEA). Some were investigations by the state licensing agency (in this case, the Florida Department of Health).

In almost every one of these cases, either the DEA, the Department of Health or the local law enforcement authority used undercover agents posing as patients to make appointments with the physician, agents usually wore a wire device, and gave the physician false information.

In several cases the investigation began when the patient died of a drug overdose (in several of these cases it was unclear whether it was a suicide by the patient or an accidental overdose). In each of these cases, there was an angry, upset family member who blamed the physicians for the patient’s death…

Here are some ideas on how physicians might protect themselves from drug-seeking patients. These are tips I give to physicians I advise on this issue…

(Note: The following tips are not applicable to physicians who treat cancer or hospice patients.) …

6. Patients who are clearly addicted to opiates should be referred a physician specializing in addiction medicine for rehabilitation. Do not accept this patient back until the patient does this.

8. If you are not a certified specialist in pain medicine, refer pain management patients out to one who is.

9. If you get any information that the patient has been “doctor shopping” or obtaining similar medications from more than one physician, immediately terminate the relationship and notify local law enforcement personnel. In many states, “doctor shopping” by patients is now a crime, and the physician is required to report the patient to law enforcement.

11. Require that prior medical records, especially diagnostic reports such as MRI and x-ray reports be received by your office directly from the other physicians or the radiology facility. Forgery of radiology reports and the sale of false reports is notorious among drug seekers.

13. If prescribing opiates for more than a short, chronic episode, require a pain management contract be signed by the patient in which the patient acknowledges your guidelines and requirements.

14. Require a urinalysis test before every visit. Wait and review the report prior to prescribing. An absence of the medications the patient is supposed to be taking is just as informative as the presence of medications you have not prescribed.

17. If the patient demonstrates drug seeking behavior (asking for certain medications by brand name and dosage, becoming angry and upset if the physician doesn’t prescribe what the patient wants, etc.), terminate the patient immediately.

20. Require current x-rays, MRI’s and diagnostic tests. Do not treat based on old x-rays and diagnostic test reports.

21. If you are not board certified in the subspecialty of pain medicine, and you are not part of a large, institutional of pain management clinics, then you should only have a few pain management patients in your practice. The majority of your patients should not be pain management patients.

23. You should consider reducing the amounts of narcotics at each patient visit. Gradually weaning the patient off of addictive medication should be a primary goal of the physician.

24. Be very wary of any patient presenting with no signs or symptoms of pain or who has inconsistent signs and symptoms of pain. These are patients who may be selling the medications or who may be undercover agents seek to entrap you.

FedEx scam

From:  FedEx 2Day A.M.
Re:  Problems with item delivery, n.00280037

Dear Customer,

Your parcel has arrived at July 22. Courier was unable to deliver the parcel to you.
Shipment Label is attached to this email.

Allen Fry,
FedEx Delivery Manager.

The problem is that I didn’t order anything, you stupid, anonymous, scum-of-the-Earth scammer.


Are Opioids the Next Antidepressant?

Essentially, all the anti-depressants now in use affect a single group of neurotransmitters called monoamines and are likely to treat only specific subtypes of depression. Clinicians and scientists alike are in agreement that other pathways in the brain that control mood need to be explored. The opioids are one such pathway…

Opioids may also hold out hope for a devastating illness formally known as borderline personality disorder. Characterized by severe emotional dysregulation, patients with this disorder have feelings of loneliness, rejection, anger and sadness that can quickly overwhelm them. They struggle to maintain relationships and are terrified of abandonment. They are often substance abusers and — in fact — opioids are frequently their drugs of choice. In one study, 44 percent of patients seeking buprenorphine treatment for their opioid addiction were found to have borderline personality disorder. There are no Food and Drug Administration-approved medications for this illness…

Research looking at opioid receptors in patients with borderline personality disorder in comparison to control subjects has documented abnormalities in these patients’ opioids system. It is a finding that would help explain why many opioid abusers describe the sensation they get from using drugs not as “getting high” but as “getting right,” or as “feeling normal.”

It may seem counterintuitive and even dangerous to be considering the medicinal use of substances that are currently a scourge to our society. Yet opioids have a long history of being used to treat melancholia and other psychological disorders — right up until the 1950s, when the current group of antidepressants were discovered…

Everybody Loves Blue

If the internet says so, it must be true.

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Why does almost everyone like the color blue?

mary · 7 years ago
Colors have deep subliminal meanings that affect our thinking and rational. Blue is a cool calming color that shows creativity and intelligence. It is a color of loyalty, strength, wisdom and trust. Blue has a calming effect on the psyche. Blue is the color of the sky and the sea and is often used to represent those images. Blue is a color that generally looks good in almost any shade and is a popular color among males. Blue is not a good color when used for food as there are few blue foods found in nature and it suppresses the appetite. If I keep writing blue again in the beginning of a sentence, I’m going to go insane. Blue.

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Paul Endress, Master of NLP & Hypnosis
At first I was cautious about the assumption that many people like blue. Then I was cautious that it might be a gender preference, but it is not. According to Sherwin Williams (the paint manufacturer), blue is the favorite color of both genders…

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Enjoying the sunset on my way to get gas. Time for some cloud therapy.


It’s a bear doing the back stroke.


Now it’s an angel with wings (and big lips).

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The angel followed me home from the gas station.


Then it morphed into a bird in flight.


The bird landed inside the sunset at the Walmart parking lot.


Another day in which I enjoyed the sunset.


Thanks for viewing. I mean it. You could be doing a dozen other things right now, yet you choose to visit me. Seriously, thanks. 🙂