I just wrote this post on KevinMD.com’s post feed about pain medication and doctors role in responding to pain.

I’m so tired of doctors being thrown under the bus…it’s hard enough to help people has it has—

Patients need to take more responsibility for the drugs they take and the medical actions on their bodies. We live in the Internet age for fuck’s sake, there’s no excuse not to do your homework.

Your physician is your best advisor, your best collaborator, but ultimately it’s your body so stand by your decisions.

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In medicine, everything is a cost – benefit analysis. I agree pain should be treated, but the question is to what extent and how much.

What’s finally coming into discussion, is that doctors *treating* pain is actually hurting some patients more then helping them. In a case of pain from a disease like MS, you take pain pills, but then the next day the pain is still going to be there. Treating pain from events, like a surgery or a broken bone, is an event with a limited amount of time. But treating pain for chronic pain management creates other problems in patients — because the pain itself will never go away.

I agree pain is miserable, and definitely if the patient is so miserable their quality of life is dramatically effected, but then the patient should also sign off and accept that the treatment for pain has serious consequences and the treatment itself could kill them — either directly, or by destroying their liver, etc.

Right now, doctors are being thrown under the bus for these types of patients. The family members are then going after the doctors ‘you got my sister addicted’ or ‘you destroyed my father’s liver’, which is completely unfair to the physician.

Patients need to accept and be able to accept responsibility for the decisions we make, in collaboration with our physicians. I agree, we patients live with our bodies, and therefore we are the ultimate judge of how ‘tolerable’ our condition truly is — but then we also need to accept the dire consequences of these decisions, and stop punishing the physicians who are just trying to help them.

A patient with a lifeline pain condition and a patient with a severe addiction are going to present to the physician *exactly* the same way — both will talk of their severe pain, both types of patients will rattle on about different diagnoses, some of which can be approved conclusively (like MS—brain lesions), and some diagnoses which can’t be proven conclusively, like “chronic fatigue”.

(Chronic fatigue — a very real condition in some people, but there isn’t a conclusive laboratory test, so it’s a clinical evaluation.)

Clinical evaluation : the word of the patient.

What if the patient is lying? Is that the job of a doctor, to be a lie detector tester?

Or isn’t it the job of a doctor to *listen* to their patients, trust them, then respond accordingly?

So then — hence the delimma — the truly chronically ill patient and the just addicted are going to look and sound the same.

How can the doctor help one group and stop the other?

He couldn’t can’t. There is no absolutely conclusively lab test to proven anyone’s level of pain.

Therefore, patients (and their families) need to accept responsibility for the choices we make, for the drugs that we choose to take, and stop throwing physicians under the bus for simply doing their job.

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[this was my original post, that someone slammed, then I wrote the post above:]

Agree!! Part of living with a chronic illness is learning how to live with a certain degree of pain. Warm baths, heating pads, using the sauna. Pain isn’t pleasant of course, but pain is a part of life when you’re chronically ill. Doctors should be encouraged to work with patients on using meditation, yoga, and various heat therapies to reduce pain.