Rx or Dx shopping?

Sitting here having my Sunday AM coffee (yes, and cigarette) perusing what the internet has to offer me today.

    • Facebook friends mostly asleep still, or at church, or out enjoying the few hours of sun that peeked through this morning after the blanket of fog lifted.
    • No new rentals in the local papers and Craig’s list is the usual wasteland of ads poached by questionable realtors competing to place tenants in overpriced apartments which justify their ungodly expense by offering “luxuries” like community activities, rec rooms, weight rooms, and massive (utility sucking) windows despite having shitty construction, poor management, and paper-thin walls.
    •  News stories.

There’s one on a national prescription database to help curb prescription drug abuse that catches my eye. It’s in my local paper, which is a bit too local for me to post a direct link to, but it’s a “big” story so it can be found repeated in any number of other online sources.

Forbes:  Fighting prescription drug abuse with a national online database, where ER physician Robert Glatter writes “It would be quite valuable for a physician to have knowledge of previous visits to clinics and hospitals as well as prescriptions that a patient may have received in a real-time fashion–not only as a safety-net, but also as a way to deter the ever growing problem of prescription drug abuse by “doctor shopping”.”

The Boston Globe: Bill would require screening on prescription pain relievers, “Implementation of the bill is expected to cost between $2 million and $4 million, mostly related to the expansion of the database. But lawmakers emphasized yesterday that the practice of doctor shopping and hospitalizations from overdoses carry costs as well.”

Ok, so here’s the thing.  I know that there are people out there who love the pills.  I don’t personally know any one, or know that I know anyone, with this affliction.  But I realize that my own direct experiences do not inform the entirety of the picture.  However, my own experiences are valid and are shared by others, and the rhetoric of these reports makes me nervous that people like me – non-drug seekers who end up “doctor shopping” because we have something that no one can or will diagnose and who, along the way, may accumulate some scripts for the more commonly abused drugs – are going to find the legitimacy of our experience completely trashed by casting us as people who are looking for something illicit and/or inappropriate.  Again.

I believe I’ve said it elsewhere on this blog, but let me say it again here for the sake of anyone who drops in to this blog by virtue of this one post.  I am not a fan of the narcotics.  I’m not a fan of the pills, in fact.  In the order of medical intervention, they are right up there just under invasive procedures for things I’d like to avoid.  Narcotics in particular seem to seriously screw my body up.  I spend most of my days fighting fatigue, hypotension and all the physical symptoms that it brings, nausea, bowel problems – adding narcotics into the mix is a recipe for complications that may be minor for some, if the goal is to pursue a high over all else.  They are not minor for me, someone whose goal is to feel BETTER or at least avoid accumulating a set of sensations and bodily phenomena which combine to make my life an impossible, dysfucntional hell.

Black and white picture of shelves of pills in glass bottles. Attribution: Candy Pills: At a Tiburon candy store. Snapped on: April 13, 2005.  Hasselblad 500C/M, Planar 80 C T* ISO125, Ilford FP4+ film, developed with TMax 6 minutes @ 21°C.

* …and one pill makes you small…

But I end up doctor shopping.  And because whatever is going on with me is difficult to diagnose, or because I sometimes see doctors who don’t have the time to deal with a complex patient, I end up with scripts – some of them for narcotics.  Most of them, I don’t fill.  Last Fall, when my primary care’s office sent me running to the ER from chest pain, I got a script for something…Vicodin maybe?  I didn’t fill it.  My criteria for taking extra-strength pain medication is unbearable, horrible pain that is at 7 or above on my own personal version of the pain scale (which, btw, is skewed high I think – a history of endometriosis, migraines, and bowel spasms can do that to a person).  However, my criteria for seeking medical attention has a lower threshold.  If it is interfering with my daily, necessary activities (washing, eating, dressing, voiding, working) and it lasts more than a few days, I will call the doctor.  What I’m seeking in this case is not drugs, or not only drugs, and certainly not just drugs to mask the symptoms without an explanation of what caused them and how to avoid that in the future.

What I’m seeking primarily or exclusively is ruling out something immediately bad (e.g., pulmonary embolism) and an understanding of how to feel better in the future.  What I tend to get is ruling out something that will kill me on the spot (usually) and an offer for meds – pain meds, antiseizure meds, appetite stimulant meds, psych meds, intestinal motility killing meds, antibiotic meds, anti-vertigo meds, anti-nausea meds, vasoactive meds, salt-retaining/volume expanding meds, PPI meds, histamine blocking meds.  If the thing that brought me into the doctor’s office, clinic, or ER continues after I am discharged without an explanation (and with meds that will only make my life shitty in other ways while reducing the initial symptom – e.g. narcotic pain meds), I am going to end up “presenting” elsewhere to try to get that last crucial bit…i.e. the answer about what the hell this is and a solution.  Not a pain pill, a solution.

So what bugs the bejeesus out of me is that I and people like me will end up looking like the pain med seeking “doctor shoppers” because the doctors we see  don’t have the tools or the skills to more effectively treat us.  yeah, I said it.  That sounds blamey, it shouldn’t.  I fully believe my body is a confounding bastard, so I don’t blame the doctors entirely for having a hard time.  I also believe that my contextualizing of my symptoms can effectively minimize to people who aren’t me and don’t understand the context; that my doctors are not incentivized or are actively punished for including research and THINKING time as part of their diagnostic process.  But I do run into doctors who are too arrogant, too biased, or possibly too stupid to do anything more than run one (possibly inappropriate, or inappropriately done) test then push you out the door – perhaps with a script, perhaps for pain meds, stuffed into  your hands and vague if any instruction about follow up or follow through on what brought you to them in the first place.

You put that all together and you are going to end up with people who are doctor shopping because they are symptomatic.  They may get pain meds, they may take pain meds, but they are not looking for pain meds.  They are looking for answers  and I worry that a one size fits all use of this database is going to put another attitudinal obstacle in our paths – we’re busy navigating the hurdles of being labeled as a socially inappropriate attention seeker only to be thrown into the pit of criminally inappropriate drug seeker.  And that troubles me.

* Photo © 2006-2007 Dennis Mojadocreative commons license

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  1. I think you should send that in as a letter to the editor and even to the Congressional rep for your district. It’s a valid perspective and something that needs to be heard.


  2. mo

     /  May 6, 2012

    Very good post! I have a friend who ER hops and seeks out doctors and clinics that will give her drugs. She has a handful of doctors that just give her diet pills and Vicoden under the table, avoiding insurance, it costs costs her a pretty penny for her habit, but she gets them easily. These junkies that make it nearly impossible to get treatment when you are really seeking help.

  3. I sometimes find it amazing that doctors are supposedly near-geniuses (because you can’t study to be one unless you get a near-perfect score when you leave school). And yet..and yet..some of them seem downright thick.

  4. MedMo (I need to change your blog title in my links!) I might. It’s a little revealing. Mo – that is awful – do you think the docs who give your friend the “under the table” meds are aware that they are being played? Beautiful, I was married to one like that. He was, well, he was a GOOD student in most of his subjects, which allowed him to get good grades. He was bright & good at science, but he had only moderate wit, his verbal intelligence was low, he was not smart at practicalities (for lack of a better word), and his “emotional intelligence” was somewhere around that of a 9 or 10 year old. And saying all that, with the exception of one other (a woman), he was among the best of his cohort (not just me saying so, he was chosen to be chief resident).


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