Re: POTUS 45.22 - The Genius of Donald Trump
You're allergic or have a reverse reaction, and are the exception. This is well-documented, by you and the medical community.
Most people get their (too large) script, take a few pills, and are OK. It sits in their bathroom cabinet for a couple years, until their kids or grandkids find it, and roll the dice...
About 5-10% can't stop once they pop. But, this doesn't necessarily mean they're addicted to EVERYTHING. Some can say no to one drug, but can't stop with another.
Based on genetics. SOme people can take certain meds (codeine is one) experience no pain relief. THey really are telling the truth when they say it doesn't work. Unfortunately they can also get toxic on it because that part still happens.
I got vic for a bad sore throat once, I got codeine as a kid for strep from the ER...to pretend there is any sort of regulation on this crap is the height of ignorance.
Agreed, and my point. Basically, right now if you ask for something like that, you'll get it. It's sick.
That’s just insane when something like an OTC analgesic will work.
Well, sure, because Big Advil isn't cutting checks to doctors.
They flipping track if we buy Sudafed because it MIGHT be used to make Meth but they can prescribe friggin heroin as often as they want for whatever they want. As someone who lost a cousin to opiodes and whose gf lost her brother to them that is friggin disgusting.
But hey walrus you are right...doctors should be able to prescribe whatever they want. Maybe we can go back to the days of prescribing cocaine for headaches and psychological trauma too right? Wouldnt want any bureaucrats getting in the way. Great take.
So the other resident medical person hasn't chimed in so I will. (long winded but hoping to educate thatthis is not all just lazy/poor medicine)
-a number of yrs ago they made pain as the 5th vital sign (Blood pressure, pulse, respirations, temp being the other 4). When they did that they also had a HUGE push to tell us we were way under-treating pain including seminars at conferences, etc. Take home was we were way too cautious and causing people distress they shouldn't have to deal with. We had been taught poorly and needed to shift our thinking. If they person didn't get asked about pain or if the pain wasn't well controlled there were financial penalties for reimbursement.
You shouldn't prescribe narcotics over the phone unless the pt is yours. If a pt called the Doc on call they were told to go to the ER for pain management (esp if the pt wasn't theirs). Correct medical practice but when the 5th VS thing came we got penalized for not meeting insurance measures. At the same time, pt's ER copayments went up. They complained to the insurance companies if you refused to write more med without seeing them. Bad marks for you and loss of sig $$$ (10-30K in withhold for a small practice for not meeting insurance co measures). Many surgeries are 'bundled' and pay is the same no matter how many visits the patient has. Another motivator for some to prevent need for re-visit (wrong thinking but in the context of being told they should be prescribing more...)
Created a perfect storm in the wrong way. Providers were penalized for setting limits, encouraged to write more med to prevent need for revisit/re-eval, patient need for visits decreased, satisfaction was up (and was not measured by good medical practice- we were told if we explained well enough pts wouldn't complain).
I was told way more than once I better write enough so the person on call didn't have to deal with anything over the weekend or until I was back in the office.
-HIPPA made it against the law to call the surrounding ERs or other Providers to warn them when a drug seeker popped up. We used to call the ER and say watch out for so and so, their story is squirrelly. Now that is illegal.
-Narcotic prescribing has always been monitored but has not in a cohesive way. There are few Federal regulations and different State ones. You can get in big trouble for fraudulently prescribing but unless you do so on a monumental level, in one place, they don't catch on. In order to have regs you also have to have consensus regarding what is correct practice. Pain management is something that is a developing field. In the last few yrs my State and surrounding ones have all passed rules for what needs to be done before prescription including creating a clearinghouse that lists all prescriptions a patient has had for controlled substances. Some states have reciprocity but not all. My State also now requires continuing ed credits in opiod prescribing.
-It is possible some Docs get payoffs for prescription writing but I have never seen it in my career (counting school >30 yrs). Many States are now legislating what Pharma can give to Providers but again it is a patchwork. Some states are less regulated than others. Some have conflicting rules.
I want my doctor to be able to prescribe for me what he or she feels will work for me not what Handy or one of his prized bureaucrats thinks will work for me.
THIS!!!!! It is upon the Provider to make a decision using evidence based medicine. Every patient is different. The Provider needs to be held accountable for what they do but to tell me I can't prescribe something arbitrarily without having the slightest knowledge of medicine or the patient is flat out wrong. The various Boards need to be setting up their own paramenters but legislators need to keep their hands outta my pie unless they want to take the responsibility for the outcome.
When I had my knee scoped last summer, the recovery room nurse game me an oxycodone. I wasn’t experiencing any pain at the time, but I took it anyway, because I was kinda groggy and I figured I might need it later. On the way home, I experienced the worst nausea ever – because oxycodone does that, especially on an empty stomach, and I hadn’t had anything to eat for about 18 hours. Fortunately, I also had a prescription for an anti-nausea drug, and ten minutes after I took it I was fine.
To this day, I’m convinced that (1) any pain I might have experienced could have been handled by ibuprofen or acetaminophen; (2) that even if I had needed an opioid, it didn’t need to be given prophylactically – I could have handled the pain while it started to take effect; and (3) the medical profession – not just the rogues who hand out opioid prescriptions on request – are part, a big part, of the problem.
And I consider it ironic that the only medication I really needed was to counteract the side effect of the medication I probably didn't need in the first place.
There were some studies done that showed people who were given pain med in recovery/coming out of anesthesia, before they were fully 'awake' had sig less pain and need for pain meds than those who woke out of anesthesia in pain. There is also some interesting stuff showing that people given long acting pain meds had much better outcomes than those with short acting meds. The short acting ones clear out quickly and therefore more med is needed. Long acting ones cleared slower and the pain was controlled to manageable levels with less meds.
