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"Did doctors who cared too much lead to the opioid epidemic? REALLY!?!





















The about to be discussed article asked, if doctors caring too much lead to the opioid epidemic? Really? Cared TOO MUCH? Please! I could NOT tell if this author was being cynical or serious.
 
I have had patients get upset about me NOT giving them “something stronger” but with my litany of patients of complaints NOT once, that I can recall, did a patient complain that I did NOT treat their pain, NOT once. By complaint, I mean to administrators and NOT just jumping up and down upset. I could be wrong because I DO NOT entertain patient’s complaints as I see them as an issue for administrators as the customer experience is their doing. But because of that, I am sure if a patient had ever complained that I had failed to manage their pain an administrator would have pointed that out. NOT because of the complaint itself but because administrators like to rotate the knife they stick in the backs of healthcare workers.
 
Believe me, I am NOT a fan of administrators, but NEVER have I heard an administrator tell me ONCE “to give more pain medication to make patients more satisfied”. NOT ONCE! NOR have I EVER been reported to the state board for “alleged inadequate treatment of pain.” That said, because of my lack of the mentioned experiences I DO NOT see how the author of this article would make those claims. Again, if anyone I would be the one to be complain about as I have had a litany of patient complaints but NOT once because of opioids or have I even been told ONCE to prescribe more opioids, or any treatment other than my own, to satisfy patients. NOT ONCE!
 
What I been told instead is to “lower my standards”, “be more likable”, “smile”, “sit on the bed with patients”, “hold their hand”, “be more accommodating”, “interact with families”, “customer recovery”, “be more personable”, “shake hands”, “[kiss more ass]”…yada, yada, yada. But never to write for more opioids or even just opioids to make anyone “more satisfied”.
 
There was ONCE, ONCE, a physician, NOT administration, who was upset with me because I declined to give a patient “something else for pain” after I offered ibuprofen and the patient checked in again. Which was fine with me. But the physician picked up the chart and was NOT happy asking me, “Why didn’t you just give [the patient] what [the patient] wanted? Now I have to deal with [the patient]. It was so easy. If you had given [the patient] what [the patient] wanted [the patient] would have been gone and I didn’t have to deal with [the patient]. Not to mention, it causes a back log of patients to be seen.” My answer, “Here is your opportunity to give [the patient] what [the patient] wants. But not me.” Again, NOT an administrator but a physician who I guess saw “giving [the patient] what [the patient] wanted” as the path of least resistance—or as we have ALWAYS done it. But again, to be clear, NOT an administrator but a physician seeing patients.
 
That said, there was the emergency director who told me that inappropriate ultrasounds were okay but NOT an MRI. Actually, the director suggested almost anything was fair game to avoid a patient complain and the ultrasounds was okay but an MRI was NOT okay was simply an example of that IDIOT-ology [sic].
 
Having said that, I DOUBT those encouraging or writing narcotics for NO reason are either genuinely concern about treating pain or compassionate. If so then why ALL the drama? As mentioned in the article, all medical interventions, medicines and otherwise have risks, whether thrombolytics or antidepressants, why even Ibuprofen. Thus, if pain were being managed compassionately then the risks would not be the case. Instead, the case here is because those encouraging and writing opioids without reason now find themselves with opioid epidemic blood on their hands and they are looking to point fingers without, actually, pointing fingers.
 
Thus they resort to choosing their words wisely, like, Did we, [REALLY {MY WORD}], as a profession, care too much?

PLEASE!
 
I DO NOT prescribe antibiotics for a head cold. It does NOT matter if the patient complains or the patient is the President of the Hair Club for Men or even the President of the United States. I DO NOT. I DO NOT order CT scans of any kind either just because a patient might complain. I DO NOT. I just DO NOT. I try NOT to order anything unless needed but NOT because the patient wants it.
 
If for any matter, I believe my job is on the line because a patient might complain after I declined the patient’s request I document such in the chart, “antibiotics, CT-scans, work note, x-ray, blood test or whatever per patient’s request despite NOT clinically indicated.” And when I DO, I DO so kicking and fighting and ONLY do so just to get them out of there so that I can move on to the next patient. But I WILL NOT do the same for opioids for any reason, or lack thereof, I WILL NOT. And that was before the opioid epidemic and the unnecessary, what I call NEW industry, MANDATORY training to tell me not to do so.
 
A NEW industry is what I have labeled healthcare’s inability, or junior-high school approach, to creating NEW industries without fixing the problem. But that is another topic.
 
On that note, I DO NOT prescribe opioids for back pain, headaches, arthritis, dental pain, abdominal pain, lacerations, muscle/skeletal pain (except fractures), nerve pain (except herpes zoster/post-hepatic neuralgia) …and the list goes on and on. It would be easier for me to list the reasons I DO prescribe opioids for rather than NOT. And those reasons are: 2 degree burns, fractures, corneal abrasion, incision and drainage, herpes zoster/post-hepatic neuralgia, kidney stones, cancer pain, maybe ovarian cysts but for the most part diagnoses I can see rather than told about subjectively. When I do prescribe opioids, and by that, I mean at discharge, it is for 6-10 tabs and NO MORE! And that is in the emergency department where the acuity is the most acute.
 
So please, spare me the claim that we are where we are with opioids because of the attempt to ease suffering with compassion and science. That is BS!
 
In no manner am I suggesting drug seekers get a pass but this article is simply about scapegoating. First, drug seekers are not patients they are addicts and although they might raise hell in your clinic, emergency department or floors contrary to popular belief, they rarely, if ever, submit complains. Again, drug seekers are not patients they are addicts and the last thing they want is to be banned from their next fix or income.
 
On that note, bad things happen to bad people too so be careful with dismissing drug seekers. I would also add, don’t blame drug seekers for low satisfaction scores, as the problem isn’t the drug seekers or the even the low scores but the consequences of low scores. And for that you must look at those interpreting the numbers, healthcare administrators.
 
By NO means do I tout myself as a customer experience guru as I am far from such expertise. What I am a subject matter expert on is patient complaints. As I have more patient complaints than any healthcare worker on the planet. That’s not bragging, as anyone who is job hunting will tell you how painful job hunting is. Nonetheless, because of my expertise with patient complaints I will tell you that complaints come from those with hidden agendas, grandiose beliefs and expectations all extending from EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS and those with entitlement issues and why healthcare falls for the manipulative behavior EVERY TIME.
 
Being the patient complaint guru, if I can add anything of value to this conversation it would be that rather use drug seekers, the opioid epidemic or even complaining patients as scapegoats we would MAKE HEALTHCARE GREAT AGAIN if we instead addressed the real problem with regard to satisfaction scores and that is the administration’s knee-jerk reactions and sequel JUST because a patient complained.
 
The reason, customer satisfaction is NOT about customers, in ANY industry, but instead about customer retention and profits. And that is the SAME in healthcare where studies have shown there is NO correlation between satisfied patients and good healthcare. On the contrary, studies have shown the most satisfied patients are more likely to be admitted and more likely to die.
 
So PLEASE, spare me this claim that we are where we are because we cared too much! If we cared any, at ALL, we would say, “NO!” instead. But we DON’T! We DON’T say “NO!” only because patients will complain if we DO NOT cater to their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. Whether those expectations are opioids, antibiotics, MRIs or whatever else they desired, because they tired of waiting, thought it was too noisy at the nurses’ station, they missed their hunny-bunny or whatever the flavor of the week it is. Placating is NOT advocacy or compassion or TOO MUCH caring. Placating is NOTHING MORE than placating.
 
With that said, we are where we are in healthcare, whether opioids, any other collateral damage our profession has suffered and our great nation’s silent national crisis, because we catered to EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS without saying, “No.” NO! It really is that simple. Now no one wants to take blame or point fingers. Thus we coddle! Like the mentioned article.
 
“[Customer service] is not the solution to [healthcare’s] problems. [Customer service] is [healthcare’s] problem.” –The Knitted Brow [Ronald Reagan]
 
All that said because we have become so complacent with the status quo in healthcare and those who are not complacent fear pushing back so no one dares to ask for change. But I AM! As the time of small thinking and nibbling at the edges must end. We must take healthcare back to MAKE HEALTHCARE GREAT AGAIN!
 
Just my two sense [sic].

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