The Gray Area of Pain Medicine (or, “Regarding The Suspension of One Pain Doctor’s License”)
My wife and I have been following, with some interest, the story of a local psychiatrist who specializes in treating patients with chronic pain conditions who appears likely to have his medical license pulled by the State of Connecticut.
It’s a subject of some interest to us because my wife suffers from chronic pain courtesy of a brain injury sustained in a car accident.
Imagine what it would be like to have a migraine 24/7/365. Add the sensation of random stabs by a knife into your body. That’s what my wife lives through. Of course, you and I can’t possibly imagine what it feels like unless we’ve felt it ourselves. We can try to imagine it, but most peoples’ imagination is mercifully not as cruel as reality can be.
(True story: one of my wife’s doctors was semi-dismissive of her pain until he himself had his first migraine. He became extremely empathetic after his unfortunate educational experience.)
Thankfully, my wife is not doing as badly as the hell she survived for the first few years after the accident. Part of that is thanks to an experimental implant which is semi-effective. Quite a bit of it is the result of her having learned to cope. And yes, she’s a walking pharmacy when it comes to meds. Her portable medicine cabinet isn’t as full as it once was; she was on some eye-bulgingly potent pain meds simply to help her survive until she could develop the necessary coping skills.
My cube-neighbor at one of my offices recently had a nasty encounter with a kidney stone. He talked about some of the meds he was given to assist with the unpleasantness. I’m familiar with them from my wife’s ordeal – they aren’t potent enough to make a difference to her.
The amount and type of medication my wife was on was of concern to some doctors, family, friends, and random busybodies. After all, most of us know of someone who has drugged themselves into oblivion rather than face reality. We’ve heard stories about doctors who just find it easier to give certain difficult patients pills, rather than really attempting to treat their ailments. It’s not unreasonable to expect that regulators have an interest in stepping in to address or prevent such situations when they arise.
But what happens when the patient really is in an unimaginable state of pain? Isn’t it conceivable that there are situations where oblivion is an appropriate place to occasionally retreat while re-learning how to live? Or, what if the pain is associated with a terminal condition, where making the patient comfortable really is the best that can be done?
It’s with that background that we were upset to see the Journal Inquirer‘s article on Saturday (not available online to nonsubscribers, unfortunately) about this pain specialist’s hearing before the Connecticut Medical Examination Board.
The doctor “wrote more prescriptions than Yale-New Haven Hospital despite having 7% as many patients” trumpets the article. However, is that really surprising given that he specializes in the treatment of chronic pain, that he likely has many such patients given the lack of such specialists in the state.and the hospital sees all sorts of patients, most of whom have fewer chronic issues?
The state apparently has taken issue with some of this doctor’s patients also having turned to illicit drugs. Again, is such behavior really surprising if a patient’s life is hellacious enough that board-approved medicine won’t provide relief? I realize that it’s tempting for a regulatory agency to say that run-of-the-mill junkies shouldn’t be able to get their fix from doctors. But what about those patients who really do have chronic health issues? Should they be blocked from help because they don’t have other access to relief, or because they can’t afford legal alternatives? Is a state-appointed outside APRN really qualified to look at files and separate the junkies from suffering patients?
(It’s tempting to invoke medical marijuana here.but I’m told that even in states where medical cannabis is legal, it’s not cheap, and I have my suspicions that it wouldn’t take the edge off my wife’s pain spikes.)
The state also apparently takes issue with some of this doctors’ patients who have to go to multiple pharmacies to fill prescriptions. Here also, my wife and I know the “joy” of encountering pharmacists unfamiliar with chronic pain patients and balk at filling some scripts. Or, when uncommon medications are involved, one learns which pharmacies are likely to keep them in stock and shop accordingly. And, of course, meds aren’t cheap, and one learns to comparison shop if/when the out-of-pocket expense isn’t just a small co-pay.
And speaking of costs – the article reported that the state also had issues with some of this doctors patients engaging in diversion – filling scripts, and then selling some of their meds on the street. I can see where a government agency would take issue with that, but such behavior isn’t necessarily nefarious. While neither my wife nor I have engaged in such activities, we’re both painfully aware of just how expensive meds are, especially when paying for them while adapting to a reduced income after being rendered unable to work. Should patients lose access to a doctor in an uncommon specialty, just because some others who see that doctor do what they must to make ends meet?
The JI article did mention that “at least one patient died.as a result of prescribing practices” of this doctor. There were no details in the article, and I don’t know any either. It’s reasonable for regulatory authorities to look into odd deaths, to confirm that there is no malpractice occurring. It’s understandable that permission to practice medicine would be pulled if a doctor’s patients were at risk of injury or death due to that doctor’s practices. However, I also unfortunately know that a decent number of chronic pain patients suffer from terminal health conditions, and I’m not sure that an outside party is necessarily qualified to draw the lines between “needs a lot of meds” and “given too many meds”, or – if you want to go there – between “made comfortable” and “assisted suicide”.
(Lest anyone read too much into that – no, my wife doesn’t count as “terminal” or “potential patient of Dr. Kevorkian”. She’s as healthy as can be expected – healthy enough that “survive and learn to cope until medical science advances enough for a better answer to be found” is the correct treatment plan.)
Neither my wife nor I know the specifics in this doctor’s case – we learned of it through the grapevine, and because the few other pain docs in the area are getting more swamped than usual with new patients seeking appointments. Perhaps there is something happening here that really needs state intervention.
We also heard through the grapevine that the state brought in a medical professional to tell this doctor’s patients that they were all just addicts and would be once they got through withdrawal. To me at least, that calls into question the state’s motivations. At a minimum, it’s a sign of a person who is clueless about the nightmare some unfortunate patients have to live through.
So if I don’t know the details, why am I writing this? Well, not that many people are aware of the challenges faced by people with chronic pain conditions. Fewer people can appreciate it. It’s a weird area of medical reality where strict rules don’t work, and where there is very little pure black or pure white.just a lot of gray. There aren’t many doctors with the appreciation, knowledge, and skills to help people like my wife – appointments are hard enough to come by, so learning of one practice being shut down is not good news.
On top of that, chronic pain patients and their loved ones already undergo the stress of having friends, family, and acquaintances thinking they know best, disparaging what these patients are going through and thinking they know more than trained professionals regarding appropriate care. Even at the worst, my wife was not a “druggie”, “addict”, or “zombie”. She’s a survivor, one who’s finding her way through hell as best she can.
It sucks when the clueless can’t see that. It’s horrible when “the clueless” happens to include regulators.
Bad things happen, and it’s natural that our government would have an interest in preventing or mitigating them. But sometimes, it’s necessary for our officials and regulators to recognize that reality can be very gray, and sometimes it is appropriate to tolerate a little bad if that’s the only way for some good to occur.
Let’s Hear it for the Tax Code
It’s nice to see the IRS code being so charitable, per the Washington Post:
BP said Tuesday that it plans to cut its U.S. tax bill by $9.9 billion, or about half the amount pledged to aid victims of the disaster, by deducting costs related to the oil spill.[…]
Under U.S. corporate tax law, companies can take credits on up to 35 percent of their losses.
The credit for BP could mean, however, that taxpayers will indirectly foot part of the bill for the $20 billion fund that BP established to compensate people and businesses harmed by the disaster.
You know, under state insurance regulation in a few states, insurers are not allowed to take credit for certain income statement items – e.g., lobbying, punitive damages – when seeking permission to revise rates, on the grounds that state consumers should not be asked to subsidize such expenses.
While I can appreciate that the federal tax code provides the tax credit for losses item to help better recognize unstable earnings patterns, and to temper the tax burden into a more stable flow…perhaps a little tweak is in order, to avoid giving the appearance that taxpayers are being asked to, for example, clean up environmental catastrophes arising from a corporation’s disregard for appropriate safety protocols?
iPad Quote du Jour
Seen at Wired News:
As a mainstream, closed-platform device whose major claim is ease of use and sex appeal, the iPad is everything that [geeks] are not.
Ouch!
(Although, I must admit that since I’ve started playing with an iPad, I have felt my inner geek growing more lax..)
iPhone Bumper Buyers Take Note
If you bought a bumper before Uncle Steve made his apology, check your email.
I just got a note saying my refund was automatically processed — no virtual paperwork required.
iPhone Thought Du Jour
So, AT&T’s servers can’t handle the crush of fanboys seeking to preorder iPhone 4’s on its first day of pre-availability.
Doesn’t that bode ill for those considering selling their souls to AT&T for two years?
(And I’m making this observation from Connecticut, where AT&T’s connectivity is actually decent.)
World Cup Quote du Jour
Seen in the Wall Street Journal:
Besides, who are we in the U.S. to complain about vuvuzelas? We gave the world Twitter and Ke$ha.
Pay As You Go Auto Insurance Coming to California
This Insurance Journal article crossed my desk today:
State Farm Mutual Automobile Insurance Co.is the first insurer to submit an application to offer an program that rewards California drivers who voluntarily drive fewer miles with lower auto insurance rates. […]
Assuming that State Farm obtains approval from the state insurance department, State Farm customers will have an option to move into the new verified mileage plan, which State Farm has labeled its "Drive Safe and Save" program. Those who enroll will be given an initial discount for joining the program.
Considering that “miles driven” is the most often lied-about rating/underwriting variable when it comes to personal auto insurance, I’ll be interested in hearing about how State Farm goes about verifying mileage.
Mileage is a wonderful rating variable or exposure base in theory. Getting accurate, verifiable data is the challenge.
Massachusetts Water Snark
The word that most of the Boston metropolitan area is on a boil water order due to a major water main break has me wondering…
It would be just like some Massachusetts activists I know to protest the Arizona anti-immigrant legislation and show solidarity with undocumented Mexicans by making their water supply resemble Mexico’s.
VBScript for Time Announcement
Filing this for future reference: found because I had need of a quick script that would cause my PC to speak the current time….
Dim message,sapi if hour(Now())<=12 then message="The time is " & formatDateTime(Now(), vbShortTime) else message="The time is " & formatDateTime(TimeSerial(hour(dateadd("h",-12,Now())),minute(Now()),second(Now())), vbShortTime) end if set sapi = CreateObject("sapi.spvoice") sapi.Speak message
