Comments on: An Argument Against The Poppy Seed Medical Tragicomedy Sun, 13 Jul 2014 17:26:14 +0000 hourly 1 By: Kathleen Johnson Mon, 03 Feb 2014 03:43:31 +0000 I realize this post is several months old but I just wanted to give you a thumbs up for your willingness to do what is best for a patient rather than what they want. My best friend died after struggling for years with an addiction to prescribed pain meds and I know all to well some of the things people will say or do for a script.
With that said I also want to voice my frustration with my own condition. I suffer with severe migraines and there have been many times when my meds didn’t work. The only option I have in that situation is a shot. My frustration comes from one of the 2 hospitals in my smallish hometown. They have access to my records, my doctor is affiliated with them, yet I was still accused by a nurse of drug seeking because I had averaged 1 ER visit every 3 weeks for around 3 months or so. I had to ask for toradol, knowing it was not a narcotic and that it worked sometimes with a migraine but not always. They were more than willing to give me that shot. Fortunately it worked that time. It’s very frustrating to have a condition that may require stronger meds because of the abuse that is out there. It’s also embarrassing and humiliating to have such a condition and be accused of seeking drugs. Yeah, there are times I seek stronger meds, whatever one will relieve the intense pain, vomiting, slurred speech, confusion, imbalance, and dehydration. People have thought I was drunk while I was in the middle of a severe migraine attack and to have to deal with the pain while at the same time being accused of seeking drugs is not an easy task for someone who can barely think from the pain.
So I do understand both sides. I watched my best friend slowly kill herself with a prescription drug addiction and was powerless to do anything except support her those few times that she went into rehab. And yet I have a condition that has often seen me in the ER seeking a shot for relief…

By: bluenotesBb Tue, 15 Oct 2013 18:05:57 +0000 Interesting; here is a thought,
So, This patient with a clear verifiable reason for pain, doesn’t deserve in house pain relief? I’m not talking about a take home prescription, but nothing to control pain while in the ER?

Her past overdose should not have any bearing on the physical pain she felt at that moment…….

By: Sue Tue, 20 Aug 2013 20:24:23 +0000 Totally agree Laura. I sincerely hope that these judgmental jerks someday develop a condition in which they are in need of serious pain relief and they are sitting on the side of the fence they judge so harshly.

By: DoctorWhoWeaves Mon, 12 Aug 2013 00:52:55 +0000 Opiod addiction due to existential angst. I have spent hours trying to explain this to various patients over the years. God bless you.

By: ED nurse Fri, 31 May 2013 19:34:48 +0000 Such interesting perspectives from all! My two cents as a healthcare provider is this: we have failed our patients. It is our jobs as physicians and nurses to explain to the patients our goal for their pain control and the ramifications of not following the directions of prescribed narcotics and all medications for that matter. For example: I occasionally take care of patients who are constipated and are requesting pain medication for the subsequent abd pain. On further exploration we find that they require narcotics chronically for pain control, and that no one has ever explained to them the importance of stool softeners while on these medications. When we explain that they are not going to get narcotics for the pain they are experiencing in their abd they become extremely angry; so now we have a vicious cycle.

If we do not get control of the prescription drug abuse in this country soon we will soon find ourselves with narcotic clinics for simple things like percocet, because people cannot be trusted to take their pain medication as prescribed.

Always enjoy your thought provoking blog Dr. Zac. Keep it up!

By: Tj Thu, 30 May 2013 02:57:31 +0000 Laura, not to say that the pain you experienced wasn’t real or as intense as you describe, but there is still yet an even bigger picture. Doctors don’t just come out of medical school “jaded”. Doctors become jaded because of the various patients they encounter; making decisions about an array of medical issues on a case by case basis. They try to be as personal as possible using similar tactics and treatments for varying individuals. So, while yes…there are in fact two sides, is there a right way to treat both parties with an adequate amount of medical treatment without favoring one over the other? Where is the line between prescribing too much and prescribing too little?

By: Nathan Mon, 27 May 2013 20:59:17 +0000 Hey there,

First of all I love reading your blog. As an ms1 who is interested in EM it’s such an interesting window into the world and mind of the field. Just a quick question. How do you see the patient satisfaction thing settling in the future. Seems like docs universally hate it and admins universally love it. Where do you think the equilibrium will end up?

Thanks again for all the thought you share.


By: The Other Side of the Knife Sun, 26 May 2013 22:35:05 +0000 Hello Zac,

I’ve missed your postings during the last couple of months. It’s great to “hear” from you again. I enjoy reading your perspectives concerning medical and social issues. I thought I might add my two cents to your most recent post, both as a patient and as an aspiring physician.

You see, Zac. I was born with a complex genetic mutation that eventually developed into a full fledged medical connection. The name of the condition is irrelevant, but the nature of it is on topic. The condition, itself, manifests in the central nervous system as well as in the branching nerves throughout the body. Because the nature of the condition presents itself in my nervous system, I’m quite prone to excruciating neuropathy, phantom pain, ocular migraines, lower back pain and neck pain, among other types of pain. My feet and back can be an especially difficult burden on my overall health at times.

Because my condition is highlighted as being especially painful, obtaining prescription painkillers was not difficult for me. In fact, perhaps it was too easy, because after I got them I began using them to treat the wrong kind of pain. The kind of pain that manifests itself not in the nervous system, but in the core of your existence. I was in a new town, no friends, no family, handling the burdens of a college student on my own after barely graduating from high school. Naturally, I turned to the only comfort I could find, those little pills that take away the bad thoughts in your fatigued mind and replace them with a sense of peace and relaxation.

Like I said, I was on my own. There would be no one to catch me if I fell, nor anyone to take the bottle out of my hands should I grow to attached to it. Life didn’t improve until some years after I decided (for no apparent reason other than that I was tired of feeling nothing) to discard the empty bottle and choose not to refill it.

That experience has changed how I view pain and medication. I still feel pain. Even with the occasional Tylenol or Advil PM, I still feel pain. And you know what? That’s ok. It’s good to feel some pain. Your goal as a doctor should not be to make sure the patient is in absolutely no pain (unless dying, in hospice or a nursing home, of course,) but to help them get better and to teach them how to better take care of themselves.

So, what do I do to cope with my pain these days? I keep myself active and I keep myself busy. I’m now an honors student, a math tutor at my state’s school for the deaf and an active volunteer in my community. Being in pain has not stopped me or prevented me from living life to the fullest because I chose, and actively choose, not to let it.

Feeling pain is part of being human. You are a good doctor, Dr. Zac. I mean that with the most sincerity. Keep up with the great blogging and take care of yourself.


The Other Side of the Knife

By: Dorielle Sun, 26 May 2013 03:06:39 +0000 This issue seems to be quite complicated. True. It does seem unfair that people who have pain can’t so easily get the drugs they want or need. However, since some people continue to abuse the distribution of drugs, doctors don’t have a choice but to be careful. I don’t think it makes you a bad doctor for protecting people and the drugs they get from you. Im surprised even that this individual would still expect to get these drugs even after she knew why the fear of abuse was the reason why you wouldn’t give them to her.

By: Zac Sat, 25 May 2013 14:41:35 +0000 Pain contracts are incredibly helpful. i find that patients come to me occasionally “willing to break the contract” because they ran out of their pain medications early (again) and they’re hurting. The immediate need for an opiate fix is honestly a sad thing to witness. Sticking with their contract will give them hundreds of pills per month, but they can’t think that far ahead. They need their dilaudid NOW because the last few percocets they had are starting to wear off.

It’s a miserable life, honestly.

The flip side is a very nice woman who was looking for adjunct therapies for her typical back pain, but did NOT want to violate her pain contract. That was a wonderful experience for us both. I got to try some new therapies, she left comfortable, and never a word was spoken about opiates.