Says Who??

Verstehen, through shared perspectives


2 Comments

AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


1 Comment

REFLECTIONS ON THE EFFICACY OF OPIOID PAIN RELIEF OVER TIME

pain photoBefore addressing the issues of this article, I will need to explain the position from which I write. At the present time I am a 76-year old, semi-retired sociologist and former nurse. As a sociologist, it was natural for me to include the sociology of medicine as one of my major interests. As a nurse, I worked for three years in the county jail nurse’s office, several years in the emergency room, and for six years as a hospital corpsman in the navy reserve.

I was introduced to the whole drug scene while working in the jail, where it was my job to treat substance abusers who were addicted to paint, glue, alcohol, and various drugs. This was in the very early ‘80s, and the majority of the street drugs were amphetamines, Quaaludes, heroin, and marijuana. It was necessary to control withdrawal symptoms from the time the inmates were booked, to keep them alive long enough to go to court, serve whatever time they were given, and be released back into the same environment with virtually no change in their lives except those imposed on felons. The recidivism rate was extremely high—more so than for any other offense. During the time I worked there, the fastest turn-around rate for a released prisoner being picked up drunk and brought back in to Booking was 30 minutes.

Of course, in the ER and even in the Navy reserve I saw evidence of substance abuse. As a corpsman I was also involved with both diagnosis and treatment. The most heartbreaking experiences, however, occurred while I was working at a private college in Appalachia from 1997-2013. I saw firsthand the growth of the OxyContin and heroin epidemic that Sam Quinones documents in Dreamland, followed by Meth and various other prescription drugs, soon followed by the amoral pill mills that so delighted students who were already dependent or in early stages of addiction. At their age, they were the most vulnerable to the brain disorder of addiction, and the main targets of the dealers who would actually supply their first pills free, to encourage a new customer. I saw so many beautiful, bright students succumb to the promise of a pill that would make their life better, more fun, or at least easier. I was able to help some, but not all, by far. They needed experienced and trained medical attention, and I was no longer in that field. I came to despise the very thought of drugs, dealers, and pill mill “doctors”.

But there is another side to my story. In 1968 I suffered the first experience of a bulging spinal disc. Within 3 years I was diagnosed with degenerative disc disease, and with osteoarthritis of the spine, hands, feet, shoulders and hips. By 2013, there was no part of my spine that was not affected; I had major stenosis at various levels, bone spurs, episodes of bulging and decayed discs, a vertebra that had decayed discs on both sides and was standing on edge, resulting in a spinal S-curve from my waist to the upper thoracic region. Unrelenting pain caused muscle spasms in my entire back and neck, adding to the pain. A meningioma would soon be discovered attached to my spinal cord at T3-4; it is benign—the only worry being that it will grow.

During those 45 years living with pain, I never had any medication stronger than NSAIDS. Like many patients, I could not tolerate narcotics or opioids. I had to learn meditation and “mind control” (pushing the awareness of pain to another part of my consciousness). I had a great deal of physical therapy. I played the piano and organ for distraction, until I could not. I walked from 1-3 miles every day, and I worked full time as a nurse, then as a college professor, usually working between 40-60 hours a week. I spent seven years in South Africa in the middle of a revolution. The more I could distract myself with external demands, the longer I could function. Again, until I could not.

In 2014, so disabled by pain I could neither work nor sufficiently care for myself, I was sent to a pain management specialist in Louisville, KY. After I was finally convinced that he was a legitimate pain specialist who would not try to get me addicted, we were able to work together very well. I learned to trust his judgement, and to follow his lead in determining my treatment.   As a result, I have been able to teach at a local university part time for the last two years, and it has been a year since I have had pain greater than 5 on the 0-10 scale. One of the reasons that the pain has not been greater, and has not persisted, is that when it gets to that point I take hydrocodone, at its very lowest dose. My pain doctor realized that I am able to tolerate very low doses of medications for other problems (many of which were caused or exacerbated by long-term use of NSAIDS), so we tried the opiate. The complete pain relief has been astounding to me. I have never before had medication do more than take the edge off the pain. Equally important, my need for the opiate is becoming less and less frequent. My chronic anxiety levels have dropped considerably, and that also is a source of pain relief.

Which brings me, finally, to the point of this article. I hope I have sufficiently established the experience and credentials that give me the foundation for writing it. I must write it, because for too long I have been reading articles by people who have based their judgement about the dangers and/or efficacy of opiate treatment for pain on short-term, inadequate research. In A World of Hurt, by Barry Meier, he quotes Dr. Jayne Ballantyne as saying that her studies, and those of others, show that after a short term of therapy, there is little to no efficacy (5% of patients) of opiates for pain. I have seen and heard these figures often; yet pain management physicians also have records of people who have been carefully managed on opiates and other pain relieving measures for at least twenty years, who are functioning without severe pain. None of these studies satisfy me that they meet the natural science or sociological requirements of longitudinal studies. The former studies fall far short of twenty years, and the latter are a matter of record but no sufficiently rigorous scientific research has been done to establish credibility.

Additionally, our understanding of the prevalence and range of chronic pain issues, and the new brain studies that have completely revised our knowledge of addiction, have rendered those studies irrelevant. But the continued widespread references to them has created a situation that is clearly morally and ethically bankrupt: Patients with persistent, severe pain—including, in many states, terminal cancer patients—are being deliberately, systematically deprived of relief and therefore from the ability to lead potentially productive lives, or at least to spend their final days in peace, without pain. This, while other substances that are addictive are legal and can be consumed by any adult, regardless of their risk factors for addiction, whether or not there is a “need” for the substance.

What would make opiate efficacy studies reliable and verifiable? First, to acknowledge that all pain patients are unique in their tolerance to pain, their response to pain, and their response to treatment. Not everyone can metabolize medications the same way. Not everyone responds equally to physical therapy, or to psychological counselling. Not everyone has the personality to effectively meditate, or to suppress awareness of moderate pain. But all of these treatments, as well as known risk factors, are variables that must be accounted for if you are judging the efficacy of pain treatment.

Then there is the issue of the selection of participants. When I read the studies done in past years, I found they were limited to a single practice, or a hospital, or other small group of patients with no concern for variables like age, risk factors, history of abuse, previous treatment and other illnesses. The participants were not chosen scientifically in order to be representative, so results are inevitably skewed. I am reminded of early anthropological ethnographic studies where small, isolated villages were researched, then the results extrapolated to all such groups: “from the particular to the general”. We now realize that you can’t do this and arrive at accurate conclusions. Yet, on the basis of these flawed opiate efficacy studies, people’s lives are being damaged, their families are suffering needlessly, and many patients who are cut off from their medication either take to street drugs with the risk of overdose, or just commit suicide in the first place.

We do need more research about the safety and efficacy of drugs. But it must be longitudinal and scientifically designed and the results assessed to be reliable and verifiable. We also need politicians to stop enacting laws and policies based on moral definitions of issues, which we can never come to consensus about, and work on the actual economic and environmental issues that they can actually improve.

Addiction is a disease, not a moral issue. Pain is a disease, not a moral issue. And we are not speaking of just a few people affected by the neglect resulting from ill-informed laws and regulations designed more to punish the innocent along with the guilty rather than to end the War on Drugs. We speak of hundreds of thousands, even millions of sufferers. When properly identified as scientific (medical) problems instead of moral issues, we can see the potential to improve conditions. People could be adding to the economy, rather than being forced to either live off of it, or to live in poverty while their pain continues to worsen.

Big Pharma—for example, Purdue Pharma– are far from innocent in this War. Additionally, the FDA is no longer as concerned with protecting potential patients as they are in protecting corporate rights to profit; witness the countless lawsuits for drugs improperly researched, improperly advertised, and improperly presented to physicians who must rely on that information in order to prescribe successfully. And the DEA is still, regardless of evidence that they are often destroying the lives of the innocent while failing to halt the spread of illegal drugs, using pain patients and their physicians as cannon fodder in their failed war on drugs.

A significant paradigm shift is required here. Educationally, culturally, legally and morally we must illuminate the darkness of our willful ignorance about the suffering of the innocent who have become scapegoats in the failed War on Drugs due to tunnel vision about the relationships between drugs, physicians, and pain; a tunnel vision that cannot see the greed and political will that perpetuates the drug problem. Every institution of our society has failed our physicians and their patients who are in pain, or addicted. Those institutions have either failed to adjust a false worldview that blames patients for their illnesses, or have just failed to assume responsibility for their role in finding solutions to the need for a collaborative approach to these widespread diseases, and to the devastation that has resulted from long term beliefs that they are moral issues that must be punished.

For over a century, that approach has not worked. And as the saying goes, insanity is defined as continuing to do the same thing over and over again (or doing even more of it), expecting different results. From family, to education, to religion, culture, economics and government we need a major overhaul of outdated and inaccurate beliefs, and development of procedures that decriminalize the treatment of chronic pain and addiction, as well as the afflictions themselves. Medical decisions need to be made by medical experts and their appropriate medical agencies, and the Criminal Justice system could concentrate on ridding our nation of illegal drugs by putting the same time and effort into stopping the dealers who daily increase the supply of drugs available on our streets. We might even look to the successes of other countries, and determine if their methods are importable.

I cannot bear the thought of more bright and beautiful college students ruining or ending their lives before they have even begun. The data suggests that it is not stopping with college students, but that high school and even middle school students are being targeted as “customers” of the illegal drug trade. I also cannot live with the knowledge that caring and dedicated physicians, who have spent nearly half of an average 70 year lifetime studying and working for the privilege of becoming practicing physicians, have lost everything they have worked for because they have tried to help their patients. (I am quite ok with pill mill “doctors” being brought to justice for their crimes, however!)

It is Christmas Eve as I write this. A time of hope, a time of expectation that the promises of life can be fulfilled. I am a sociologist because I believe in the amazing capability of human beings to solve the problems of life, separately and together. I am also all too well aware of our capability to create and maintain cultural and social institutions and structures that protect certain groups of humans at the expense of huge numbers of their fellow humans. I believe that most of us are better than this; that we can do better, and that bit by bit we can learn to adapt to change, to each other, and to the requirements of living in our world safely, together.

Please—let’s make 2017 the year we begin to deal with chronic pain and addiction as the disease processes they are, and begin to structure our corporate life accordingly, so that together we can end the war on drugs, and on patients and their physicians, and restore the rationality of the Enlightenment without killing the compassion of empathy.

enlifghtened being

RESOURCES: Books & Peer Reviewed Articles

Alexander, Michelle. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. 2012. The New Press, NY

Bateman, Dustin. Neurological & Sociological Aspects of Addiction.

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial. 1996. University of California Press.

Levinthal, Charles F. Messengers of Paradise. Opiates and the Brain. The Struggle Over Pain, Rage, Uncertainty and Addiction.

Meier, Barry. A World of Hurt: Fixing Pain Medicine’s Biggest Mistake. 2013. New York Times Company.

Parsons, Talcott. “Illness and the Role of the Physician: A Sociological Perspective.” American Journal of Orthopsychiatry 24 March 2010. Copyright © 2010, John Wiley and Sons.

Quinones, Sam. Dreamland: The True Tale of America’s Opiate Epidemic. 2015. Bloomsbury Publishing Plc.

Sternheimer, Karen. Connecting Social Problems and Popular Culture:   Why Media is not the Answer.  2nd Ed. 2013. Westview Press, Perseus Books Group.

Webster, Lynn R. The Painful Truth: What Chronic Pain is Really Like and Why it Matters to Each of Us.  2015  Webster Media, LLC.

Hyperlinks to articles on Web:

Addiction is a Brain Disease http://www.attcnetwork.org/explore/priorityareas/science/disease/

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter 

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter 

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….   http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide http://t.co/4vhF63eD6N

References from this article:

  1. Gagné P, Moamai J, Bourget D. Psychopathology and suicide among Quebec physicians: a nested case control study. Depress Res Treat. 2011;2011:936327. [Medline]. [Full Text].
  2. Adams D. Physician suicide: searching for answers. American Medical News [serial online]. April 25, 2005;Available at http://www.ama-assn.org/amednews/2005/04/25/prsa0425.htm.
  3. Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. Jun 18 2003;289(23):3161-6. [Medline].
  4. Hawton K, Malmberg A, Simkin S. Suicide in doctors. A psychological autopsy study. J Psychosom Res. Jul 2004;57(1):1-4. [Medline].
  5. Holmes VF, Rich CL. Suicide Among Physicians. In: Blumenthal SJ, Kupfer DJ, eds. Suicide Over the Life Cycle. Washington, DC: American Psychiatric Press; 2004:599-618.
  6. Middleton JL. Today I’m grieving a physician suicide. Ann Fam Med. May-Jun 2008;6(3):267-9. [Medline].
  7. Noonan D. Doctors who kill themselves. Newsweek. Apr 28 2008;151(17):16. [Medline].
  8. Petersen MR, Burnett CA. The suicide mortality of working physicians and dentists. Occup Med (Lond). Jan 2008;58(1):25-9. [Medline]. [Full Text].
  9. Worley LL. Our fallen peers: a mandate for change. Acad Psychiatry. Jan-Feb 2008;32(1):8-12. [Medline].
  10. Frank E, Dingle AD. Self-reported depression and suicide attempts among U.S. women physicians. Am J Psychiatry. Dec 1999;156(12):1887-94. [Medline].
  11. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. Dec 2004;161(12):2295-302. [Medline].
  12. Gross CP, Mead LA, Ford DE, et al. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. Nov 27 2000;160(21):3209-14. [Medline].
  13. Myers M, Fine C. Suicide in physicians: toward prevention. MedGenMed. Oct 21 2003;5(4):11. [Medline].
  14. Myers M. Doctors’ Marriages: A Look at the Problems and Their Solutions. 2nd ed. New York: Springer; 1994.
  15. Charles SC, Frisch PR. Adverse Events, Stress, and Litigation: A Physician’s Guide. New York: Oxford University Press; 2005.
  16. Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. Nov 2011;213(5):657-67. [Medline].
  17. Sessions S. Dr. Ticktin and the Expert Witness Industry. 2005;[Full Text].
  18. Myers M, Gabbard G. The Physician as Patient: A Clinical Handbook for Mental Health Professionals. American Psychiatric Publishing; 2008.
  19. Lehmann C. Aggressive Intervention Urged for Depression in Physicians. Psychiatric News. November 17, 2000.
  20. Miles SH. A piece of my mind. A challenge to licensing boards: the stigma of mental illness. JAMA. Sep 9 1998;280(10):865. [Medline].
  21. Hendin H, Maltsberger JT, Haas AP. A physician’s suicide. Am J Psychiatry. Dec 2003;160(12):2094-7. [Medline].
  22. Hendin H, Reynolds C, Fox D, et al. Licensing and Physician Mental Health: Problems and Possibilities. Journal of Medical Licensure and Discipline. 2007;93:6-11.
  23. Schwenk TL, Gorenflo DW, Leja LM. A survey on the impact of being depressed on the professional status and mental health care of physicians. J Clin Psychiatry. Apr 2008;69(4):617-20. [Medline].
  24. Polfliet SR. A National Analysis of Medical Licensure Applications. J Am Acad Psychiatry Law. 2008;36:369-74. [Full Text].
  25. Altchuler SI. Commentary: Granting medical licensure, honoring the Americans with disabilities act, and protecting the public: can we do all three?. Acad Med. Jun 2009;84(6):689-91. [Medline]. [Full Text].
  26. Schroeder R, Brazeau CM, Zackin F, Rovi S, Dickey J, Johnson MS, et al. Do state medical board applications violate the Americans With Disabilities Act?. Acad Med. Jun 2009;84(6):776-81. [Medline]. [Full Text].
  27. Andrew LB. Survey Says: Many EPs Suffer in Silence. Emergency Physicians Monthly Online [serial online]. March 2006;13:3:1-7. Available at http://www.epmonthly.com/index.php?option=com_content&task=view&id=226&Itemid=15.
  28. Shaw DL, Wedding D, Zeldow PB. Suicide among medical students and physicians, special problems of medical students. In: Wedding D, ed. Behavior and Medicine. 3rd ed. Hogrefe and Huber: 2001:78-9 (chap 6).
  29. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. Mar 1 2008;336(7642):488-91. [Medline]. [Full Text].
  30. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. Sep 23 2009;302(12):1294-300. [Medline].
  31. Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. BMJ. Sep 30 2006;333(7570):682. [Medline]. [Full Text].
  32. Moutier C, Norcross W, Jong P, et al. The Suicide Prevention and Depression Awareness Program at the University of California, San Diego School of Medicine. Acad Med. Mar 2012;87(3):320-6. [Medline].
  33. American Foundation for Suicide Prevention Physician Depression and Suicide Prevention Project. American Foundation for Suicide Prevention. Available at http://www.afsp.org/index.cfm?page_id=05804002-E8F4-13AB-2D4B97A0815A2744. Accessed 10 March 2010.
  34. Goldsmith SK, Pellmar TC, Kleinman AM. Reducing Suicide: A National Imperative. Institute of Medicine Monograph. National Academies Press; 2002:[Full Text].
  35. Andrew LB. PHPs Are in Your Corner. Emergency Physician Monthly Online. 2006;13:6:[Full Text].

Physician Risks

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict: Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics? http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …

 

dr-murphyFrom James P. Murphy, MD, MMM;

Practicing Pain Management Physician

Board Certified in Pain Management & Addiction Management

https://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture/

https://jamespmurphymd.com/2016/07/24/comparing-apples-to-apples-the-morphine-equivalent-daily-dose/

https://jamespmurphymd.com/2016/06/21/prescribing-controlled-substances-in-kentucky-cme-presentation-for-flaget-memorial-hospital-in-bardstown-ky-june-21-2016/

https://jamespmurphymd.com/2015/02/13/pathway-to-partnership/

https://jamespmurphymd.com/2015/09/a-stellar-time-at-bellarmine

 


1 Comment

EXPECTATIONS: Helpful and Otherwise

OLYMPUS DIGITAL CAMERA

Overheard in a college hallway: “I am who I am! I cannot be responsible for his expectations of me.”

The tone of voice was stressed, angry. The speaker was obviously struggling in some relationship where she felt the pain of believing she was expected to measure up to some standard with which she did not agree, or believed she could not meet. Her anger at not being accepted for that of which she felt capable seemed fed by her guilt that she had not measured up to the standards of someone important to her.

Or, was I projecting? Was I reading too much into a simple declaration, simply because it resonated so deeply? Who among us has not at some time felt the pangs of inadequacy, having somehow failed to be the person that a parent, teacher, friend or spouse thought us to be? More important, who of us is not guilty of verbally projecting our expectations on another in a judgmental fashion, capable of stripping the other of self-confidence and a sense of belonging.

Strange Family

Strange Family

As the Academic Dean of a small college in an rural area where students received a suboptimal education, as both student and faculty advocate I was often called upon to mediate the issues arising when faculty from more cosmopolitan backgrounds failed to recognize the intelligence and potential of their students, judging them only on their failure to have been adequately prepared for college level work. Faculty would often disparage the students publically, claiming they would not work, could not learn, and should not be in college. Their expectations of the students were as low as their claims, and the relationships between those faculty and their students were broken and painful. Neither group expected anything good to come from the other.unhappy 1

Yet my own experience with these students was that on the whole (of course there were exceptions – there always are) the more I expected from my students and the more I recognized their exceptional qualities, the harder they worked and the more they succeeded. Further, they returned my love and respect for them, and for each other. The same was true for my students in Africa, as well as for my students in a large city-based university.

The principle, I believe, crosses cultures and generations. I first heard it stated from a young OB-GYN physician who had been charged with overseeing residents, interns and patients in a central city hospital clinic. I had the privilege of working for him as he changed the appearance, the attitudes, and the quality of care at that clinic. Where it had been said patients were “herded like cattle” into the clinic area itself, and then into exam rooms where they were prodded, talked about over their heads between the teaching and learning physicians as though the patient was a dumb animal, where the environment itself was dirty and depressing—there was change. In an attractive, welcoming environment where every patient was treated as well as paying patients in a private doctor’s office, we were able to observe the change from surly, quarrelsome and often unwashed patients to patients who were no different from those in any doctor’s office, where they trusted their caregivers and returned the respect they were given.

What that young physician believed and lived by, and helped everyone around him to emulate, was the statement he always made: “People will respect themselves and act accordingly if they are treated with respect and dignity.” Most did just that.

What I told my faculty members was “These students will live up to—or DOWN to—your expectations. Either outcome will be elicited by your treatment of them.”

Expectations make us or break us. Expressed in love as realistic possibilities that honor and dignify the humanity of the other, they can inspire. Expressed as a judgment of the failures of the other, or as a goal absolutely not in accord with the dreams and goals of the other, they are destructive. And that includes the expectations we have of ourselves.

self-confidence


Leave a comment

THE SKY IS FALLING

The expressions of a pervasive sense of impending doom are on the increase, whether you read/listen to the armchair experts on social media, or the professional experts in science, economics, philosophy, or religion. Yet as I look around me in the “real-life” portion of my world, people seem to be pretty much absorbed by the joys and/or challenges of daily living rather than wondering whether the world is going to end in a financial meltdown, climate change disasters, the extremes of social anarchy, or World War III. Then, of course, there are others who only argue about who is to blame for any of these terminal disasters, as opposed to those who fatalistically refuse to think about it: “Whatever will be, will be.” Finally we have those who are totally unaware, perhaps desensitized by a lifetime of failed threats of the immanent End of Time.

-Remember the back yard bomb shelters of the Cold War era, complete with supplies to support a family until it was safe to return to the earth’s surface (however long that would be)?

-Remember the End Times and the Space Ship arrival cults? (True, these are not entirely gone).

-Remember Y2K, and the Mayan Calendar date of December 2012?

Or, just pick up the New Testament and read the words of the prophets who followed Jesus, claiming the Rapture would occur just any day, despite the words of Jesus himself, who stressed that the date could not be known. Yet the Second Coming of Christ has been predicted many times in the past 2000 years. It seems that when we are not fearing the end of the world, we are happily anticipating it.

Widespread dissatisfaction with and/or fear of the world as it is, however, have always been accompanied by cries that “the sky is falling.” And sometimes, it does – though not even close to earth-wide since the destruction of the dinosaurs. It happens to us as individuals, too. When everything goes wrong in our lives – economically, health-wise, or in relationships – the suicide rates go up, while others still consider ending it all or pray to die, because their situation is intolerable. The reasons for coming disaster mount up, while our ability to think rationally enough to take action for positive change in our own lives rapidly disappears. If that is our individual coping mode, how can we expect to fare any better in large groups, or as a nation?

Where is the leadership that can put aside their personal fears and aspirations, and show us the way to work together to solve the problems that have solutions, and learn how to prepare for the “new normal” when change is inevitable?

Where are the families and the communities that can help each other to get through the bad times, and show their children how to deal with disaster and failure as well as with success and wealth? I know for a fact that these exist, but perhaps there simply are not enough of them. Or maybe they have forgotten.

Where are the teachers who used to show us how to apply theory and practice to real life situations, and how to think critically in order to separate truth from fiction when possible? I do know of some.

Finally, we can’t blame all these people for our individual and collective feelings of impending doom. I believe that our lives will improve when we stop rushing head-long and helter-skelter into the end of time and stop to get our common sense back.

Yes, indeed, there are threats to our safety and well-being. There are major changes coming to life as we know it. (In fact, there always have been – they just come faster now). We can’t afford either denial or complaisance, and we never could. We have, however, succeeded grandly as a human race when we have cooperatively put our mental and physical resources together to figure out how to meet the challenges of the day, how to be good stewards of our resources, and how to live together in relative peace. This works for nations, for communities, for families, and for individuals.

The sky is not falling yet. It may never fall. But there are definitely some threats. While those who can, work together to see that the potential for damage is lessened as much as possible, the rest of us need to be cooperating – with those who are knowledgeable, as well as with each other — and not giving in to fears of the future or to total denial.

The way to get through a challenge is to work it out, and work it through. Life has always been like that.


2 Comments

OPEN LETTER TO MAYORS, GOVERNORS, AND MEMBERS OF STATE AND FEDERAL GOVERNMENT

I don’t understand it. In fact, I find it deeply painful and disturbing. For months now, I have experienced the reluctance of most officials to hear the requests of chronic pain patients—and even of their care providers—to officially proclaim a Pain Care Providers Day on March 20th. They seem unable to open their hearts and minds to the reality of the huge difference between people who actually constantly suffer in pain, and people who use drugs recreationally whether or not they become addicted to them. They do not see the hundreds of dedicated men and women of great integrity who practice medicine with honesty and skill, because they are focused on the tiny percentage of people who obtained MD degrees for the sole purpose of opening up yet another pathway of delivering drugs illegally.

Historically and cross-culturally, recreational drug use has existed since earliest human history. Drugs and wine have been consumed ritually in religious and cultural traditional performance. Drugs and their use exist, and as we learned repeatedly throughout history, prohibiting them only results in increasing their illegal presence and use.

In contemporary experience, other countries have decided to legalize and regulate drugs, just as they have done with prostitution and other vices that disrupt societal stability. And it has worked great improvements, where carefully planned and executed!

Even in America, we are at least learning that addiction is an illness of the brain, and that it is less likely to occur in elderly people, or with people who suffer severe chronic pain. This is a huge step in our understanding, and if nothing else the campaign to acknowledge and show our gratitude for our pain care providers has helped to advance research in this area, and publicize the results. That is REAL progress!

Before I write another word, however, I must also state my profound gratitude to those officials who HAVE supported and proclaimed Pain Care Providers Day. The day will be observed by those of us (and we number in the millions!) who have benefitted from the patience, skill and dedication of physicians, pharmacists, physical therapists, physician’s assistants, nurse clinicians, nurses, EMTs, medical techs in all areas of medicine, nurse’s aides, and especially those who sacrifice many of their own needs to care for chronic pain patients in their own families or neighborhoods. What they do is life-giving, needed, and produces results that range from easing intolerable pain and/or doing for us what we are no longer able to do for ourselves, all the way to helping us regain the ability to be a productive member of society. Though it is insufficient to truly acknowledge the huge debt we owe you, we do say THANK YOU, AND MAY GOD BLESS YOU ACCORDINGLY!

IT IS NOT TOO LATE. FRIDAY, MARCH 20TH IS PAIN CARE PROVIDERS DAY. If you are an official with the power to proclaim the day, please…please have the compassion to do so. If you have not asked your mayor, governor or representative to proclaim the day, please take the time to think about your friend or relative who cares for someone in pain. Remember the medical professionals who care for these patients under great pressure from drastic regulations that threaten their very lives. And remember to thank those officials who have already had the courage and conviction to proclaim this day.

And don’t forget – on Friday, March 20th, the first day of Spring, do something special for your pain care provider. Send them flowers, or a thank you note, or just give them a hug! Let them know how very special and necessary they are to you and to all of us.

The US Pain Foundation has provided a sample proclamation for Pain Care Providers Day.  It can be found at http://goo.gl/qPsfCL.


1 Comment

A VERY BLESSED CHRISTMAS

The first Sunday of Advent, four Sundays before Christmas, signals the start of the New Year for the Church. Throughout Advent we consciously await the Nativity, which is then joyously proclaimed through triumphant music, beautiful decorations and pageantry, and renewal of the reverence and faith that accompanies the wonder of the manger scene. Sharing this time together as a church community gives strength to our love for each other and for our shared walk in faith. It is both a fitting and necessary beginning to each new year.

Not everyone is always able to be present at the festivities, however. Many are shut-ins, too ill or disabled to attend. Others may be away from home, serving country and faith in other lands while being homesick, and being equally missed at home. Still others have either abandoned the church, or felt abandoned by it, and will not be a part of this renewal. Christmas is not always a time of joy for many reasons.

Today, Christmas Day 2014, although I had planned to participate in all events at my church home, as well as get-togethers in the homes of friends, I am confined to home on this day. Despite having had two flu vaccinations in the past ten months, I was afflicted with the particular strain of flu that this year’s vaccinations won’t protect against. For once, I was grateful for email and the telephone! Friends and family kept up with me, kept me entertained, and projected the warmth of their personalities into my days, even when they were mad a me for refusing to let them anywhere near me. If nothing else, I was going to make sure that the particular bug that infected me would not infect anyone else!

That still meant a lot of time alone, and time to reflect on present days and past blessiings. As I relived this past year, I recalled so clearly the long days and nights of a year ago when in my pain and illness I begged God to deliver me from this life. He did, but not as I expected. For most of this year my pain has subsided to very manageable levels, and my activity has returned to near normal. My various physical conditions have been identified and treated, and in the New Year I will begin teaching again as an adjunct at a local University. The year 2015, unlike its predecessor, is a year filled with hope and purpose for me.

I am reminded of a similar year, half a lifetime ago, when at the end of my resources and without hope I made a decision that took me on a 33-year journey of challenge, adventure, and great satisfaction in life. https://maryleejames.com/2014/06/19/this-is-why-it-matters-to-me/   The satisfaction came from knowing that my purpose was to share with others the gift of education that had been given to me, and I have been allowed to do that on two continents.

Now it appears that I have been blessed with a third chance to rise from the shambles of my life, escape the worst effects of chronic pain and illness, and live again. This time, in order to give back, my time and efforts will be made on behalf of that huge segment of our society that lives in chronic pain and is way too often discriminated against by a range of people within their own families and friends, all the way to departments in our state and local governments. Equally distressing, the very physicians who actually do listen and try to help them are also targeted for discrimination, if not actual harassment.

Some progess has been made, but not nearly enough. At some point, we must stop blaming inanimate objects for our social ills and accept the facts that guns, pills, alcohol, cars, computers, cell phones , money and other material things are not at fault for our misuse of them.

Today, I realized anew that the pageantry, decorations, music and companionship are not the real Christmas. The real Christmas is within me, and has filled me with peace and joy on this blessed day.

I humbly pray for the same for all of you. A very blessed Christmas, and renewed peace and joy for the New Year!

 xmas scene


1 Comment

THE HEALERS

Wood-carving-pointing-at-the-Great-Zim-Ruins-590x393He was a handsome Shona man, in traditional dress, and he spoke English fluently with a refined British accent. His dark eyes could not hide his amusement at finding a middle-aged white female American in his place of business: A traditional healer’s hut, just outside of Harare, Zimbabwe. He was the traditional healer, and I had cajoled a Shona colleague into taking me to visit him because I was–as usual–almost terminally curious–this time, about exactly how the widely-known and respected traditionalist had so much success in his practice of the art of healing. I had just explained this to him, and asked if I might have a consultation.

“Certainly, you may” he began, “but you must understand that I cannot work with you the same way that I work with my own people, because you would neither understand nor believe everything that I tell you. I am willing to help you and talk to you as the white American person that you are, if you desire, and come as close as possible in that way to giving you the experience of the traditional healer that you seek.”

Now I was really interested. The Healer (I was beginning to think of him in capital letters, now) was obviously well educated, extremely intelligent, and willing to provide me with at least a glimpse into the world of his Shona ancestry. Yes, I wanted to see and hear what he had in mind.

trad healer workHe invited me to sit on some rugs on the floor in front of him. We were surrounded by the anticipated tools of his trade that he would routinely use to divine the causes and cures of the diseases of his own people. He did not use them with me.   Instead, he began by detailing a number of physical problems that I had:   I had suffered back pain for a long time, he told me. OK, I thought, that is good observation–I moved and walked like a person with back problems. Then he discussed the problems that I have with my right foot. He was continuing to be very observant– the scar from the surgery to correct a trimalleolar fracture three years previously was now very, very faint.

He progressed in this vein for a short period of time, then, smiling mischievously, he informed me that my (long deceased) maternal grandfather was providing him with information about my spirit that needed to be addressed. I was suitably impressed with facts from my personal history that he then presented, but I was also aware that fortune tellers in my own country are often able to elicit and/or supply the same kinds of information with equally uncanny accuracy.

At the end, though, he began to advise me about how to correct some actual imbalances in my life. Here, I was able to completely appreciate traditional medicine’s understanding of the reciprocal relationships between the health of the individual and the health of the family, and/or the community. Additionally, his advice included definitive steps to renew a relationship with the earth itself, and a new understanding of the value of doing that. When I finally took my leave from him, I felt renewed and refreshed, yet he had done nothing but talk to me, reflecting back to me how he saw my life and how I could optimize my physical and spiritual health. (Note for Epilogue: It worked.)

Later that week, while on the plane returning to my home in South Africa, I reflected on questions of how this healer had both exemplified the traditional qualities of the Healer ever since ancient times, and used very modern understandings of the potential needs of someone from a culture not his own. I compared my visit with him to my experiences both working with and professionally consulting physicians in my own home country of the USA. When did the most effective Western healers I knew utilize similar tools to those of this Healer who had the wisdom and knowledge from ancient times, combined with very modern knowledge and skills?

  1.  Acknowledging my cultural roots, the African healer immediately and consistently maintained eye contact with me. This was all the more useful to me, because for months I had struggled to properly show the respect of downcast eyes demanded of many southern African peoples in the presence of a superior; in this instance, his being both male and having the status of Healer, I should have maintained this respectful position. If you who are of my culture believe that this is easy, you should try it sometime! I had learned that I must ignore my compulsion to earnestly seek eye contact with male African leadership (in order to allow my honesty and concern to be evident). In those situations, it would have proven the exact opposite and offended the one whose support and trust I sought. This Healer, however, set aside his own pride and dignity to allow me to be myself and to gain the most from our visit. Western physicians who maintain eye contact—who actually SEE their patients, and allow themselves to be seen in this personal intimacy—are already ahead in the process of healing. Western healers who are also well informed about the cultures and habits of the populations they serve, are best equipped to provide real healing to those peoples.
  2. The African healer, prior to any real conversation, conducted a visual examination that was both careful, yet discreet, but thorough enough to pick up on major issues of my medical history. He then confirmed his observations verbally with me. While Western physicians rely on carefully questioned medical histories, regarding both past and present issues, the most effective of these also incorporate information gained from careful and complete visual examination of the entire patient, including how they walk, move and sit. Even though the information acquired may not be immediately relevant, they might take the time to confirm their observations with the patient.
  3. Having dispensed with any possible physical symptoms that might need to be addressed, the African healer moved on to more spiritual, and/or psychological problems. Again, he provided an overview of his observations (as revealed to him by my grandfather, in his interpretation), and began discussing how to address any that I agreed needed to be addressed. The most effective Western physicians of my experience incorporated a concern for their patient’s total well-being, and sought to first verify, then connect any need to integrate this knowledge with their treatment of the current condition.
  4.  Both physical and psychological/spiritual issues were connected to my family and my physical environment by the African healer, who utilized both my family history and my present environment—including the earth itself—in his treatment plan. Western medicine acknowledges these elements of many illnesses, but traditional cultures never separate the patient from family, community, and earth in the diagnosis of illness, as well as in the treatment thereof. In Western medicine, if we have to address these “side” issues, they are usually referred to other specialists. From my experience, however, effective physicians still retain a healthy respect for the role of the social and physical environment of their patients, and how these may powerfully effect healing.

 

For a long time, I missed the experience of a number of these comforting and important characteristics of the Healer when it was necessary for me to seek treatment for the ailments of increasing age. It has been both a blessing and a deeply healing experience for me to find myself in a place where so many physicians, as well as other health care providers at all levels, consciously hold to the highest and most humane standards of the sacred calling of Healer, even while embracing all that modern medicine adds to that calling. I can’t praise them enough for their courage, and for being willing to add all these things to the time-consuming and demanding professional lives that they must keep in balance.

8783005-surgeons-and-medical-assistant-wearing-mask-and-uniform-operating-patient Nor can I stress with enough force and determination my belief that this calling, and the fulfillment of the vocation in its highest standards, is allowed only to human beings who have been gifted with the empathy, compassion and commitment to carry it through successfully.

 

IT CANNOT BE FULFILLED BY INSURANCE COMPANIES, LEGISLATIVE BODIES, BUREAUCRATIC STRUCTURES OF MEDICAL CORPORATIONS, OR COMPUTER PROGRAMS!

8950296-smiling-doctors-with-stethoscopes-over-blue-background