The following commentary was featured on KevinMD.
“The doctors who did this should be hanged.”
It was statement that came at me with a bang. It stood out in its thread, in the accusatory way of old courtroom scenes of black and white movies, where the heroine dramatically screams out at the jury, seated wide-eyed in their box nearby.
But it was merely a response to a Facebook post on the very same topic discusses over and over in news outlets today- the opioid epidemic. It was typed in nonchalantly, by a peaceful-looking individual, who had clearly had their buttons pushed and was subsequently irate. I don’t think she meant harm by it, but it hit me like a ton of bricks. I thought about her accusation long and hard; about all the accusations on the thread.
The doctors who did this? Have we honestly ‘done this’? Why am I lumped into a collective, and deemed responsible for something grand like an epidemic, when I slave through patient after patient, and do my due diligence of the searches and actions described above? Have I failed at something and not recognized it?
More quotes from the general public on this matter, screaming at me from the computer screen, as if typed in all-caps, below. Under each one, my visceral reaction:
“Doctors like this all over the country are running mills.”
I’m not. But I prescribe pain medications and am now fearful of being labeled and blamed, thanks to accusations like this.
“Yes, the doctors and big pharmaceutical companies fueled the opiate epidemic, and guess who is making billions off of rehab drugs like suboxone? You guessed it those same doctors and big pharmaceuticals.”
Doctors make billions? How exactly does my prescribing a medication result in money directly in my pocket? I don’t benefit from a prescription monetarily. I do, however, admit to an emotional benefit when my prescriptions result in lowering blood pressure. Or normalizing glucose levels of a diabetic. Or making pain disappear. We’ll leave out cholesterol levels at this time because of the growing trend to suddenly blame doctors for ‘greed’ in prescribing statins to lower patients’ cholesterol levels and heart disease risk. It all seems to be a conspiracy.Except that no one’s filled me in on the plot, and I’m actually one of them.
Plus, is it just me or do faceless accusations seem to be the biggest ‘in’ thing on social media these days?
“The opioid problem in this state starts with the doctors overprescribing them.”
What defines ‘overprescribing?’ Under which scenario would an over-prescription be an accurate description? If Percocet is to be taken every 4-6 hours, as is FDA-approved, is it not legitimate that one quite possibly prescribes a larger supply? Should I negotiate the number of tablets, much like the sale price at an auction? If not, does the patient need a return visit for more? Because I know what takes place when this happens. The patient says, “The doctor is only making me come in for a co-pay.” He then subsequently rates me poorly on the mail-home patient survey, which comes back full circle to kick me in the ass, since government ironically plans to change reimbursement based on scores in patient satisfaction, recorded on this very same survey. A catch-22, to say the least.
“Our society has changed. People are now told they don’t have to deal with any discomfort or problem. We supposedly have a solution for everything. So someone who has pain rather than deal with it goes to the doctor and gets something to make the pain go away. 50 years ago it was deal with it until it’s gone.”
This actually makes some sense, and I agree with some of it. But the bottom line is that I practice medicine, and, to some degree, am here to serve. If someone stands before me, in pain, asking for an appropriate ‘next’ medication, and that medication is controlled, who am I to tell them to ‘just deal with it’?
“Doctors are drug dealers in white coats”
Drug dealers? Is this also true for antibiotics that make you better? Or for anti-depressants that make you better? Or diabetes medications that make you better? What is it about our line of work that makes us so vulnerable to criticism? What has turned us into dealers in the eyes of the public, especially now, when we’re equipped with a magnifying glass to weed out those who have grown dependent or actually abuse?
“Doctors all over this country are getting people addicted” and “About time the doctors get the blame for this epidemic”
Ouch. A collective accusation, once again, and it hits right where it counts.
What strikes me to the core is the fact that the general public has stopped seeing us as the healers, and started viewing us as the drug dealers. We are now the enemy. It leads me to ask the following:
When did we who practice medicine, and mean no harm, actually start doing exactly what we swore not to do? When did we turn into the bad guys and how do we revert back to the good ?
This all happened because we tried to help. I imagine patient X, the first narcotics patient, who stood in front of his doctor, cringing in pain, who was subsequently made to feel better by that little blue paper, signed illegibly (an attempt to infuse some comic relief into this serious post) and traded in at the pharmacy for gold. When the patient thanked him for his miracle treatment, the doctor must have thought, Eureka! Boy, was he wrong.
The blame also came about because we have 15 minute slots in which to resolve patient problems, which, when they happen to be pain, can be tough to tackle. Because there aren’t many effective alternatives. Because we haven’t been properly trained in identifying and, more importantly, confronting head on, the issue of dependence and addiction. Because we don’t enjoy confrontations. Because we want our patients to leave happy.
These somehow all got mixed up and turned us into the bad guys.
I believe I speak for all doctors when I say that we didn’t mean to contribute, even if we did. It was unintentional. I can confidently say that most of us are in this to heal and make things better. It’s what I’d like to think, and for the most part, it stands quite true. We all swore an oath, and are upheld to an unspoken ethical code of conduct, which we practice every single day.
I’m sorry that you think I’m responsible for the epidemic, and that all doctors are in it for greed. If you take a moment to think of all we’ve sacrificed to be where we are today, maybe you’d think twice about the placement of such blame. I don’t ever want to turn anyone away, but I also want to practice safe medicine. More importantly, I want to fix this terrible epidemic, along with everyone else around me, so I’ll keep on chugging and plugging into those searches, asking for urine samples, and sometimes simply saying no. Even if I’ll make a few mistakes along the way, I know I’ll at least have put in the effort, using the best of my judgement. If I have the best intentions at heart, hopefully I’ll make a difference in someone’s life.
To read more commentary on the opioid epidemic, see Doctor, time to Swap Stethoscope for a Magnifying Glass.