Insurance companies and defense attorneys frequently question injury claimants on their specific degree of pain and suffering. Knowing this is a subjective element of damages the big corporations and their hired guns move next to the medical providers to seek better clarity. Inevitably there is the case where the doctor did not believe the patient was truly in pain but subsequently prescribed pain medicine. Why on Earth would a medical provider be at such odds with themselves? It must be because he fears legal repercussions and higher insurance premiums, right? Or is it because he is paid more, or even paid by the pharmaceutical company?
Two articles caught my attention over the past few days:
- "Diagnosing a Patient as a Faker" by Melinda Beck of the WSJ- reporting on several issues in medicine and not totally in line with her eye catching headline. However, she cites the Archives of Internal Medicine, 2011 indicating: a) Prescriptions rose nearly 50% from 2000-2009, b) Abuse of opioid pain relievers is the second leading cause of accidental death in the U.S., after car crashes, and c) 15%-20% of doctor visits in the U.S. involve an opioid prescription; and
- "Doctors Already Know Secret to Better Health Care" by Walter Ezell in The Greenville News-illustrating the need for more in depth time between patients and doctors, not just quick visits, drugs, and positive reinforcement for negative health habits. To quote Ezell's article:
Only medical doctors can prescribe prescription medicine or perform surgery. This isn’t necessarily because surgery and drugs are the most important contributors to human health, but because in the wrong hands, they are dangerous.
Here is the paradox. Because doctors have a monopoly on drugging and invasive procedures, and spent a lot of money to join the guild, they get paid more for those practices and need to get paid well. There is an economic incentive to do more drugging and surgery, with little incentive to give patients the time, empathy and wisdom that are critical to achieving optimum health.
Doctors who want to address the whole person (and there are many) are swimming against the tide of their own economic interest. Unless they are working in an academic medical center, or already involved in an alternative practice, they may not have time to lavish the needed attention that each patient deserves.
We could all use more in depth time with our doctors in explaining all that ails us. The doctors may prefer more one on one time but being mandated by corporate interests within the hospital administration and/or through pure bottom line views of paying overhead, can't manage this need.
Patients are certainly to blame in going into the doctor's office and not being as detailed as possible in explaining mechanisms of injury or symptoms. Of course, some patients probably take advantage of this being their only human interaction outside their normal day and talk about unrelated issues.
The bottom line is that only doctors can prescribe pain medications and only patients can control their adherence to healthy habits. Unfortunately there is too much subjective gray area in between and too many entities vying for a piece of that control.
