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

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    Saturday, April 28, 2007

    Pain and Suffering: One doctor's trial for over-prescribing pain medications ends up highlighting a doctor who the defense argues underprescribed pain medications:

    Dr. Hamill-Ruth, who noted that she never prescribed the highest-strength OxyContin tablet, said some of Dr. Hurwitz’s actions were “illegal and immoral” because he prescribed high doses despite warning signs in patient behavior that the opioids were being resold or misused.

    Then, during cross-examination by the defense, Dr. Hamill-Ruth was shown records of a patient who had switched to Dr. Hurwitz after being under her care at the University of Virginia Pain Management Center. This patient, Kathleen Lohrey, an occupational therapist living in Charlottesville, Va., complained of migraine headaches so severe that she stayed in bed most days.

    Treating chronic pain so often puts doctors - and patients - between a rock and a hard place. It is possible to kill people with these narcotics. I've seen patients ask for more and more narcotic analgesics for their chronic headaches or chronic back pain while they're in the hospital for something else, until they become unresponsive. It's not good medicine, but it happens because nurses and physicians in recent years have been trained to treat pain as another vital sign. We can't measure pain, though, so we have to take a patient's word for it. It's not that every patient who uses too much pain medication is an abuser, but that pain so often has a large emotional component to it. Narcotics don't treat that emotional aspect. They just sedate.

    Treating chronic pain also has its emotional aspects for doctors:

    When Dr. Hurwitz testified last week, he spent hours going through the histories of those he called his “misbehaving patients,” telling why he believed they all had genuine problems. “Ultimately, pain is what the patient says it is,” he told the jury, contrasting his approach with what he called the traditional “Father Knows Best” approach of old-school doctors.

    In retrospect, he acknowledged, he should have been more suspicious of patients who asked for early refills, reported losing prescriptions and tested positive for illegal drugs. He did get rid of the worst patients, he said, but he believed others were reforming, and he feared they would not get help anywhere else if he dismissed them.

    “I felt that I had a duty to the patients,” he said. “I hated the idea of inflicting the pain of withdrawal on them.” After the closure of his practice in 2002, he said, two of his patients committed suicide because they gave up hope of finding pain relief.

    The most moving testimony came from Mrs. Lohrey and other patients who described their despondency before finding Dr. Hurwitz. They said they were amazed not just at the pain relief he provided but at the way he listened to them, and gave them his cellphone number with instructions to call whenever they wanted.

    Is that a case of uber-compassion or someone who doesn't know how to establish boundaries?

    The jury thought the former, but convicted him anyway:

    One of the jurors left the courthouse in tears, and others whom I talked to said it had been a wrenching decision for all of them because they believed Dr. Hurwitz was a compassionate doctor.

    posted by Sydney on 4/28/2007 09:13:00 AM 0 comments


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