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.

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