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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
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    "Opinions are like sphincters, everyone has one." - Chris Rangel

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    Friday, March 07, 2003

    Supporting Bad Habits: Chris Rangel on guideline-driven hospital support of drug addiction:

    With all the constant demands to "talk to her doctor" and "see who ever is in charge" I probably spent several hours dealing with this one case while I had over 20 other patients (many who where much sicker than this patient) to see and treat. Would it have been easier to just give this patient her Demerol and go about my way? Patients such as her have a tendency to raise all hell. They contact the hospital administration and the patient care advocate. You get constant pages from nurses, nursing supervisors, patient care advocates, the hospital administration, and even members in the hospital legal staff office who all wonder what the hell is going on! At each step I have to pause and explain and then document it in the chart and on and on and on. To hell with it! Just give the patient her narcotics! Right!? Wrong. This is not the correct thing to do.

    I contacted an anesthesiologist from the pain control service (though he said that they were no longer accepting Medicaid). I contacted a member of the psychiatry staff to evaluate the patient for substance abuse. All of this took more time but this was the ethical thing to do. Finally after hours of this crap the patient (realizing that she was not going to get the narcotic she wanted) left "against medical advice" (without signing the AMA form). Before leaving she proclaimed to her nurse that she was, "going to come back to the ER this evening and find a doctor who will treat her pain!"

    Her drug abuse must be stopped at some point for her own good. Unfortunately the system makes it very easy for patients such as this to continue their cycle of abuse. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made it a priority to treat pain as the "sixth vital sign" but they don't have much to say about the treatment of drug seeking patients. To refuse to treat a patient's "pain" is more likely to be seen as poor clinical practice

    Even worse, there are advocacy groups out there that coach people on how to use legal threats to get their drugs.

    posted by Sydney on 3/07/2003 07:30:00 AM 0 comments


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