legalAs I sat in the jury room listening to my fellow jurors deliberating the case before us, I was suddenly struck with the similarities to how some people with pain are talked about and treated.  Before us was a case of a convicted felon who had served his time. The charges against him included not registering when he moved to town.  The facts:

  • He moved into a motel that is used by transients who can pay by the day or the month.
  • He did in fact register with the police as was required BUT he made the fatal error of entering the wrong room number. The address was correct except for the room number.
  • When the probation officer came to check on him, the room from the window appeared to be vacant: bed made, no clothes seen, no garbage. The man who the probation officer was looking for was in the next room 211 rather than 210.

I voted not guilty, because I believed he had registered as required but being an imperfect human being he had entered the wrong room number. I know that I have done that before when I was traveling and staying in motels – mistakenly told someone the wrong room number. I was willing to give this man the benefit of the doubt.  But the other jurors were not so inclined. They pointed out that he was a convicted felon, he knew what was required and he did not comply to the letter of the law. He was being held to a higher standard. In essence, he could never make a mistake again or risk more jail time.

So how does this compare to people with pain?  As patients, we must:

  1. Take our meds exactly as directed, no more, no less without talking to our provider first.
  2. Follow all recommendations or risk losing our provider for the act of non-compliance.
  3. Try not to show emotion or raise our voice in frustration lest we risk being escorted out of the clinic or hospital by security.
  4. Sign opioid treatment agreements and submit to random drug testing.
  5. Be perfect;  we can never cross the line, not even once or we risk losing not only our pain medications but our provider as well.

We, as individuals, are looked at with suspicion and raised eyebrows. We, as a group, are blamed for the rise in substance abuse and addiction in the US. No other patient group is held to this standard.

Think about this. Those with diabetes can raise and lower their insulin dose at will so they can have that extra dessert.  People with hypertension can continue to receive medications and care even though they refuse to exercise, lose weight or make lifestyle changes. They can even choose not take their prescribed medications as directed and still not get discharged from the clinic. People with emphysema can continue to smoke and they will receive their medications and care. When someone is diagnosed with cardiac problems that cannot be easily managed by the primary provider; a referral is made to a specialist in cardiac medicine; chart notes and lab results are sent to the referral specialist. Phone calls are made and conversations are exchanged.  All care is coordinated.

Not so for the person diagnosed with a pain problem. What happens when our primary provider feels he/she cannot handle the case or will no longer prescribe pain medications because it makes them feel uncomfortable with a dose that is considered too high or given too long? (Even if they were the very physicians who started, increased and continued that medication.) Better yet, what about when arbitrary limits on total daily dosage or the duration of treatment is set by the practice as a blanket policy or even worse when the practice abruptly decides to no longer will see chronic pain patients or prescribe opioids?  Is a referral to a pain specialist considered?   No!! People with pain have told that they must find another provider to treat their pain. NO REFERRAL not even a list of who they might call, just a directive to go find another provider for pain treatment. Yes, the practice will continue to see you for your diabetes, hypertension, renal failure and emphysema but they will not see you for your pain. How fair is that? How ethical is that? How legal is that? Why are people with pain held to a higher standard and treated as “second class” patients?

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