CPAC is Canada's largest independent, not-for-profit charitable organization serving people affected by pain, through education, information, support & advocacy.

Monday, 13 July 2020

Is Anybody Listening? The Failing Doctor/Patient Relationship: Part Two

Written by guest author Barry Ulmer

Physicians have been subjected to this campaign of official intimidation for years, but it has intensified over the past several years with the intentional efforts of a few anti-opiate crusaders who have effectively hijacked the whole area of pain medicine with debunked claims. Even more scurrilous there has developed an ethos of suspicion toward people in pain which now affects the patient/doctor relationship. Without so much as a peep from academic circles of medical ethics, the profession has adopted wholesale the imperatives that have been foisted upon it. This has led to a good number of physicians that will treat people with pain with an opiate to become more or less a compliance officer in a drug rehabilitation clinic, routinely forcing patients to perform random urine drug screens in order to prove they are worthy of receiving pain care. A significant number of patients don’t metabolize opiates as expected, a fact that isn’t widely known.

It is not unheard of for a physician to abruptly discontinue the use of opiates simply because he/she suspects “abuse”. If a patient’s family in any way objects to his or her use of the medication and just suspects the patient is addicted, many physicians will terminate care immediately, before incurring the wrath of their regulatory body. If a patient loses a prescription or has their pills stolen they are also likely out of luck of receiving any replacements. Many chronic pain patients are forced to sign what is euphemistically called a “pain contract” with their physician which gives the physician permission to terminate opiate treatment should any one of a litany of events occur. These “contracts” often have patients agreeing not to call him/her on weekends and skip visiting the local ER should they need more relief. If a patient is not happy with their care, they can attempt to find a new physician. However, then they become branded as a difficult patient, non-compliant or a malcontent and shut out of other practices that may prescribe opiates. With the standard of suspicion set firmly in place, the power relationship between doctor and the person in pain is tilted entirely on the side of the doctor. As a result the important patient/doctor relationship suffers even more.

To subject oneself to the ravages of modern pain practice is to put oneself at the mercy of people who are well versed in denying meaningful relief. Since the fall of 2016, when a group of anti-opiate crusaders obtained the ear of Health Canada, the field of pain medicine has been turned upside down. Much of this developed in secrecy to the exclusion of well qualified physicians who had years of experience in the field. It appears that every aspect of what is available now functions to profit off the suffering of the patient. Whereas medical management of pain is often the least expensive and most humane approach to serious intractable pain, the widespread denial of care functions to push out most vulnerable citizens into numerous surgeries, expensive poly-pharmaceutical regimens, tapering of medication, rounds of physical rehabilitation, repeated efforts at diagnosis, and interventional pain treatments that are exceedingly expensive and of little help to those suffering the disease of severe chronic pain. It would appear people with pain are slaves of the system, with many of those purporting to serve them profiting from their predictable decline.

Monday, 6 July 2020

Is Anybody Listening? The Failing Doctor/Patient Relationship: Part One

Written by guest author Barry Ulmer

One of the most disturbing consequences of the unwarranted attack on the use of opiates and the least talked about in polite company, is the steady failure in patient/doctor relationships within the pain community that has taken place over the past few years. In third world countries where opiates are generally unavailable, physicians speak truthfully to their patients when they tell them they have nothing to relieve their pain. In countries like Canada, where opiate pain medications are ostensibly legal, but where physicians have been intimidated and coerced into withholding pain treatment, doctors feign ignorance or as a colleague says, “sheer impotence”.

There is certainly ample evidence that a great deal of pain relief is found in opiate medications and they are readily available in pharmacies. But, physicians in Canada are disciplined, sanctioned for periods of time, losing their right to prescribe, blackballed by colleagues and even in one case that I am aware of have the police show up on their doorstep to intimidate them. Many lose their licenses to practice and are destroyed financially simply for treating pain that is inconsistent with the opinions of regulatory bodies and other government agencies. If you ask the physician who refuses to treat pain with opiates if his/her fear of official attention is the reason of their failure to serve their patient, you are often met with something quite different than such a humble confession. Instead, you will hear about the addictive nature of opiates, or that their use should be confined for the care of the terminally ill when addiction is not a concern, or they simply will not work on your condition. Your physician will extol the virtues of the anti-inflammatory or psychiatric drugs. He or she will talk about the miracle of physiotherapy, biofeedback, acupuncture and the importance of a positive outlook on life in treating your pain.

These responses do have a place in the treatment of pain after the pain has been medically controlled. However, to recommend or proceed with them as if they replace the pain relief many receive from as opiate is like telling someone their house is burning and recommend throwing a glass of water on it to put the fire out, or making a diabetic exercise to earn their insulin. To a person in suicidal levels of pain, this kind of dissembling amounts to psychological and physical abuse. Yet this conversation between many physicians and patients is par for the course under the directions we are now in. It is a refrain patients hear over and over, until they stop searching for relief and give up living all together.

The fundamental truth that confronts anyone concerned with the quality of the doctor/patient relationship at present—namely, that most physicians have basically been turned against the interests of their patients—remains almost entirely unacknowledged by the profession as a whole. Resulting in a hodgepodge of an underworld of pain treatment—where there are still a few idealistic, caring physicians, and others who are taking advantage of what is perceived to be easy money—patients are essentially held captive in this system with their ability to function and provide for their families held hostage to the demands their physicians make on them in order to comply with what the physician believes is required by their regulatory body, provincial health departments and Health Canada (see the discredited 2017 pain guideline). It makes no difference that the demands might be utterly unreasonable, entirely degrading to the patient, or to the detriment of their health. The patient has no choice but to submit to the physician (see the results of forced tapering) or go to the street for medications—a prospect that brings with it even more onerous sanctions.

To be continued...