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...
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