Says Who??

Verstehen, through shared perspectives


Leave a comment

RESPONSE TO DR. JEFFREY FUDIN’S REQUEST

In Dr. Fudin’s post today, comPASSION Fatigue https://t.co/rilJGgQxFG , he defines Compassion Fatigue as “essentially a form of burnout common to those of us who actually care.” He and his co-author explain the problems of advocating for good care for chronic pain patients while navigating the endless stream of misinformation, outright lies, overreaching legislation and its advocates, and the inability to understand the differences between the illnesses of substance addiction, and the suffering of chronic pain patients. “[W]e continue as a society unable to hold two thoughts in our heads, the suffering of the addict now that rules the day and the suffering of the pain patient has been relegated to a bottom dweller,” the article states.

Since most fail to listen to anyone they do not agree with, and no one seems to care about truth in advertising, chronic pain advocates and their physicians (and pharmacists) grow disillusioned and weary of the task. I urge the reader to use the link above to read this very relevant article, where the authors make a much more articulate argument for the case than I have made here, as well as reporting important new information.

However, it is not my intention to simply report on the article or its excellence. The authors realistically ask a very relevant question: Is anyone out there still playing the game? Are we still actively advocating for chronic pain patients? My answer is difficult to write.

Having been an undertreated chronic pain patient for well over 40 years, as well as a nurse in a county jail who worked with police, substance abuse addicts, and drug dealers, I believe my claim to a broad understanding of the situation to be credible. I am also well trained in both statistical and qualitative research as a result of my graduate degrees. Yet I am repeatedly called out as ignorant, as a probable drug seeker, or as simply being wrong about everything. I do have pretty thick skin, having been an academic dean for several years, and while friends compliment me on my ability to persevere, my parents called it “stubbornness.” But so far, it has served me well.

Again, I hate to quit, or to give up on a good cause. But at my age I have learned to pick my battles. I have only so much energy, thanks to my years of pain and the many disease processes that have resulted from that pain.

At the same time, that last sentence explains exactly why I have chosen THIS battle, and I will not give up or shut up. You may not see me in writing as often, because I am tired and ill much of the time. But I will write, and I will talk, and I am definitely still in the game—just benched to rest a little more often. I am far from being alone in this situation, and I no more want to see hundreds of thousands of others suffer than I wish to suffer myself.

Meanwhile, here is a thanks to Dr. Jeff, and to all the compassionate pain management physicians (especially mineJ) who stay in the game despite all the prejudice, dishonesty and even the honest ignorance and misunderstanding that muddies the waters and stains our souls. Then too, the devastation of the lives ruined and lost unnecessarily because of undertreated or ignored pain, and the new rhetoric that is based on the notion that we are all alike and our pain should be treated the same, accordingly. And let us not forget to acknowledge those compassionate physicians who have lost so much after being targeted and charged by federal agents with no accountability for their actions when they were wrong.

I am beginning to ramble, so I end with this statement: The pain of burnout and the pain of disability cannot end this battle. It is too easy already for many to forget or deny the reality of our existence. Our voices must continue to compel the truth into being.

Talmud quote


Leave a comment

Has the War on Doctors been Lost?

According To Margalit Gur-Alie (founder, BizMed), “There really is no war on doctors. There is a war on patients, and doctors are merely collateral damage [emphasis mine]. You [doctors] are an exploitable asset, to be bought and sold like cattle…” http://www.kevinmd.com/blog/2014/06/really-war-doctors-theres-war-patients.html. In this ingeniously constructed article, Gur-Alie turns the entire idea of “social capital” –- heretofore a positive concept within which we value human dignity, and also show how the poor and oppressed of the world can become the authors of their own freedom-—on its head.

Assigning the term “social capital” to patients, doctors (formerly wealthy and powerful, by inference) as social capital are nullified at worst, and become mere agents of the “owners” of production –- in this sense, the insurance companies, and probably beyond them the international economic cartels that control them –- doctors whose sole purpose is to maximize the productivity of the “covered lives” assigned to them.

The article is interesting on several levels. One of the benefits of growing old is that you get to watch old theories die and be reborn in new calls to action on behalf of a new chosen population. In this neoMarxist work, we see the Bourgeoisie (both new “owners” and the old “owners” – doctors) on one side, and the Proletariat (workers, or patients in this case) on the side populated by the oppressed. The final section of the paper is a manifesto, calling the (workers of the world) patients to arm themselves with knowledge, and unite to save themselves.

I’m all for it! To a sociologist, this is conflict theory doing its job. My problem with the article is that the conflict perspective is only one of the many that are useful for understanding any complex social issue. Like any perspective used alone, it can narrow our understanding of the issue to the point of defeating its own cause by essentially disregarding facts that don’t fit in its worldview, even while stating them. In this article, for example, Gur-Alie claims that there is no war on doctors, then spends the first four paragraphs of the article exposing what has happened, and is continuing to happen, specifically in order to disempower the medical profession as a whole.

By implication, the author is saying that the war on doctors began when the first HMO opened its doors, and is proceeding as scheduled to the inescapable “new world order” in which doctors will be mere employees, judged only by their financial productivity (like piece-workers in a factory?). Here is where I have trouble understanding whether the author sees this as a bad thing, or merely a fait accompli.

At any rate, whether near its end or only begun, there is a war on doctors. And, as so clearly outlined by Gur-Alie, on patients as well. It is manifest in the current drug wars, and in the attempted coup being conducted by insurance companies to claim ownership of medical practice.

This war may become as life-threatening as any fought with the more conventional weapons of destruction.