The doctors who are most qualified in making the determination are often the ones with the most legitimate patients taking those drugs but all the legal teams and regulators are completely incapable of differentiating them from the prescription mills (excuse me, "pain management centers").
Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudo...
Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.
We live in two different computer simulations I guess.
It's much stupider than that.
Addicts want the drug.
So all of the indicators of addiction are actually indicators of wanting the drug.
So anyone who wants the drug is, ipso facto, an addict.
There's no element of addicts trying to look more genuine. Look at that list of red flags:
- Complaining of a need for a drug.
- Asking for more of a drug.
- Asking for a particular drug by name.
- Sometimes taking a drug on your own initiative.
https://intervention911.com/common-signs-of-drug-seeking-beh...
- laiming they need more drugs to replace a lost or stolen prescription
- Misrepresenting their symptoms
- Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”
- Unwillingness or inability to provide a complete health history or contact information for previous physicians
It's possible for a non-addicted person to do this, but actual statistics matter.
> Claiming they need more drugs to replace a lost or stolen prescription
Have you really never lost a prescription? I've lost portions of mine once or twice (i.e. I had a week left and lost the bottle). Luckily not having mine is more of an annoyance than anything, but I can empathize for someone in pain who lost theirs. Stealing medications is common in addicts as well, and for every addict that steals a prescription, there's someone that legitimately did have their prescription stolen.
> Misrepresenting their symptoms
If this can be shown objectively, I can't see any way a non-addict would do this. I fear that it sows distrust between the patient and the doctor, though. The doctor is always looking for signs of the patient misrepresenting symptoms, and the patient is always worried that the doctor is going to think that they're misrepresenting their symptoms.
> Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping”
Uncommon, but it wouldn't be entirely shocking for someone to travel for access to a better doctor. This wouldn't be that out there for someone who has cancer, for example.
> Unwillingness or inability to provide a complete health history or contact information for previous physicians
I've moved a few times in my life. My complete health history probably involves 30 or so doctors if we go back to childhood. I don't think I could even name all of them, much less have contact info for them.
The statistics do matter, but we're talking about subjecting people to pain here. The evidentiary bar should probably be higher than "you did a thing that addicts are statistically more likely to do". I think especially so when the worst case scenario is that we give an addict a fix. I'm not advocating drug use, but the harm caused seems pretty minimal, beyond the cost of administering that dose in a hospital.
Could they not check the chart? Is there even a chart anymore?
You'd be surprised at how questionable hospital care is run in NY, even with $450 / month insurance with a high deductible.
To protect the privacy of the person I know, here's a story from 2-5 months ago:
- Person A goes into doctor's office for something pretty common
- Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms
- Person A gets the scan
- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous
- Person A books surgery
- Hospital gives prep instructions to be performed by Person A 48 hours before surgery
- Person A does everything and goes in for surgery
- Person A is prepped for surgery and is put under anesthesia
- Surgeon comes in and looks at the scan in the operating room
- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer
- Person A is wondering how the surgery went after coming to from being put out
- Nurse says no surgery was done and even she was able to look at the scan and see nothing was wrong
- Person A is told to go home and wait 4-6 weeks to self heal
So let's ignore thousands of dollars in bills (deductibles). All of this could have been avoided if someone actually looked at the results of the scan before going through the motions of putting someone under anesthesia and a massive amount of stress.
That's only 1 of many stories. In another case someone I knew had their blood drawn twice in the hospital because the 2nd nurse didn't believe them when they said they just got their blood drawn by another nurse 10 minutes ago. The vials were literally next to them, about 3 arm's lengths away.
That said man do they fuck up, most recently was a fun one, I had a scheduled appointment, turned up for it, doctor was in his treatment room seeing patients, forgot to see me and went for lunch.
I mean it's minor but I'd checked in, the computer had me as waiting but he'd looked at the list, not seen me and went for lunch - I spoke to the nurse told her I didn't mind waiting while he ate and she tracked him down, he was incredibly apologetic (unnecessarily so, shit happens).
It's inevitable in a system as complex as healthcare that mistakes are going to be made but we probably should assess the proximal causes much like the airlines/plane manufacturers did to reduce the incidence.
Rather than going to lunch, after I sat waiting for 3hrs they closed the department. When I went up to let them know I hadn't been seen yet, they apologised profusely, called back the specialist - who had already left - and saw me after closing time.
That's really scary.
Beyond that, I'm not sure what benefit there would be to a surgeon independently reviewing the case early. Thinking about what they'll need you do in tomorrow's surgery would distract them during today's surgery.
The whole story smells of very bad medical practices (and I'm speaking with the perspective of someone living in a formerly communist country, not some medical Mecca).
>- Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms
>- Person A gets the scan
>- Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous
>- Person A books surgery
>- Surgeon comes in and looks at the scan in the operating room
>- Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer
This seems really unusual. I'd also say that (as someone who lives in NYC), I can't imagine things going this way.
I have never heard of a surgeon not reviewing the radiology reports, preparing a surgical plan and consulting with the patient pre-surgery.
If this is true, it's flat-out malpractice.
Given the sheer number of people, resources and precious operating room time involved in ordering, prepping and performing surgery, your story stretches credulity well past the breaking point. To put a fine point on it, I call bullshit.
I had surgery a couple years ago. I had specific symptoms and went to my doctor.
He referred me to an actual surgeon who ordered an MRI. The MRI showed what we expected it to show and then the surgeon ordered an additional scan to cover more area to make sure he understood exactly what was necessary. He then recommended surgery.
Not taking the surgeon's word for it, I sought a second opinion. Fortunately, my ex's brother was a surgeon in the same specialty and he offered to look at the MRI (I would have gone to another surgeon myself had he not been available to me).
He completely concurred with the surgeon and I had a successful surgery.
However, the normal process for surgical procedures, especially since there are significant pre-surgery protocols including medical history workups, blood work, discussions about what the surgery entails and risk factors, as well as a pre-surgery consult with the surgeon and/or his scrub nurse.
What's more, the surgical team (not with the patient) will meet at least once pre-surgery to review the surgical plan (which includes reviewing any imaging), and this may result in additional testing if there's any ambiguity.
And none of that is optional. What's more, on the day of the surgery during prep they will mark the location to be operated upon and confirm, multiple times, via existing imaging, discussions with the patient to confirm, specifically, what the surgery is for and what procedure is to be performed.
All of that is done before any sedation or anaesthesia is administered.
So no. That's not a credible story.
This is off topic, but when a drug is 100x more powerful, they just give 100x less of it. So whether you get morphine or fentanyl the effect is approximately the same - and that's intentional.
i somehow think that a medical doctor should be able to tell whether a person has an opioid [at least in a pain relieving dose] in their system.