nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, July 29, 2010

Your Doctor Doesn't Know How To Treat Pain, So Lawmakers Have To Step In

In another move to tell doctors how to practice medicine, Washington State is developing regulations for how doctors prescribe pain medication.

Remember all the Hooey about "not coming between you and your doctor?"

The regulations are being considered for how patients with legitimate pain get treated; it's not about patients who are abusing drugs, or doctors who are acting criminally.

The state wants to tell you and your doctor when you are receiving too much medicine.  At some point the regulations would kick in and your doctor would have to refer you to a specialist who would review your pain management plan and either concur with it or change it.  As you might imagine, pain specialists are all for these rules, being the ones who would benefit from more referrals.

Doctors who fail to follow the rules will be subject to penalties and possible loss of license.

Pain is one of the most subjective symptoms.  Researchers have designed a number of ways to measure it, but nothing works better than the 1 to 10 scales you've seen displayed in clinics; 1 is minimal pain, 10 is maximal pain.  Patients are asked to give a number for where their pain is.  That's it.  There's nothing better to say whether someone is in more pain than another.

Doctors receive training in pain management in medical school that emphasizes multiple approaches--that narcotics have a place but should not be overused.  Practicing physicians are required by many states to undergo periodic training in pain management, which they must certify to the state medical board.

So, imagine this scenario.  You have a tooth extracted and develop an abscess.  The abscess is resistant to antibiotics and it's taking longer to improve than most dental complications.  In the meantime, the unremitting 24/7 pain is driving you nuts.  The only thing keeping you from shooting yourself is the narcotic pain relief.  At some point the regulations kick in, whether through some total number of pills, or days under treatment, or level of narcotic, that you must see a pain specialist in order to continue treatment.

In my area, the wait to see a pain specialist is 3-4 months.  How helpful is that?

If doctors are not following best clinical standards for something as basic as pain management, then the answer is education, not regulation.  This is another example of legislating medical practice.  Recall my post on one state's new law about the long-term treatment of Lyme Disease.  Also, recall my description of the President's Town Hall where a patient expressed his frustration with not being able to get the only effective medicine for six months because it was too expensive, and the President's reply that "that's how the system should work." (it's a long post, see near the bottom).

I see this as a trend.  Interest groups and government agencies all want you to receive the care they deem appropriate...despite the fact that it's your health, not theirs.

Doc D

1 comment:

WarmSocks said...

As a resident of WA, I find this appalling. Thanks for the alert.

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