My patient needed her Backup Gun

[AJMD429]

.
Some background:

Primary care physicians have been deemed inadequate to treat chronic pain (even those of us with pharmacy degrees - which is ironic, since pharmacists without medical degrees now don't just 'advise' us about dosing or medication selection, they demand dosage changes and even demand medication changes, often demanding we switch back to medications which caused serious side-effects, but don't look as bad on the pharmacy 'profile' - evidently THEIR pharmacy degree grants them Magic Powers to diagnose, treat, and prescribe, whereas MY pharmacy degree doesn't do that - or if it does, my Medical degree somehow un-does that Magic Power).

Anyway, we now have to send our known and trusted patients to 'pain specialists', even when their pain may be caused due to recent cancer diagnosis, sexual assault, or other things very emotionally stressful, which may benefit from the continuity and compassion they get from the physician who has been with them for three decades, instead of some new physician who ignores all their other medical and family and social circumstances, and just treats them as another 'drug addict' because they require pain medication to get through their day.

Backup Gun Used:

So...... one of my patients who happens to have been a rape-victim, goes to her new Pain Specialist (as demanded by the pharmacist), and during the visit, when she handed the doctor her bottle of pills to show him what I'd been prescribing, the new doctor snatched her purse from her lap and started looking through it for other pills (whicn she didn't have), at which point she asked him to give her her purse back. He did not, then he encountered her firearm (which was why she didn't want her purse in unauthorized hands), then took it out of her purse and was 'waving it around' and asking her why she had a gun. She replied that it was none of his business, and repeated her request that he hand her back her purse, and put her firearm back in its place. He refused. So...... she got her backup gun out from her ankle holster, and 'displayed it' and repeated her request: "put my gun down and give me back my purse". He said "I'm going to call the police...!" She then said "Go ahead - then you can explain to them why you took my purse without my permission, and why you then took possession of a firearm that wasn't yours, and started waving it around unsafely."

Evidently smart enough to realize the 'issue', he complied, then demanded she leave his office and not return.

I'm sure he will decide MY patients are all a bunch of violent drug-dealers or something, if he's the typical histrionic hoplophobe academia tends to produce. His automobile probably functions perfectly, and he probably lives in a gated subdivision, yet he likely would be 'woke' and claim he understands the 'plight of the poor and minorities' - yet I'll bet HIS wife never has to ride the last bus home at midnight to a ghetto apartment after working all day. Or perhaps he's one of the hypocrite anti-gunners who believes THEY are ok to own firearms because they are 'special', because of wealth, or medical degree, or whatever. I guess he doesn't think my patient is 'special', and HER right to protect herself is nullified because she's not a physician, not wealthy, and < gasp > takes pain medication (which she's NEVER abuses, misused, or diverted, and which has worked well for her with less side effects and risk than the alternatives we've tried).

Sadly there are many arrogant physicians like this, and they prey upon the patients who have chronic pain, because they have so little choice.

I've had pain specialists tell patients the only way to 'earn' their pain medication prescriptions is to submit to expensive injections that don't help their symptoms, which to me isn't much different than demanding sex in exchange for prescriptions (in either case the patient is forced to do something that doesn't help their pain, against their will, for the sole benefit of the physician). In fact, we have had patients whose pain specialist demanded sexual favors in exchange for legitimately needed prescriptions for cancer pain or spinal stenosis or whatever.

Yet those of us who treat patients suffering from chronic pain who are 'merely' primary care physicians, are told we are practicing beyond our skills to treat chronic pain.

I'd love to have seen the look on his face when his LITERAL 'gun-grabbing' stunt failed.

[Walt]

AJ, I would be proud to have you as my physician.

[mickbr]

Too many things these days seem geared towards dissolving good sense and and breaking the relationships that make free citizens strong . My tin foil hat was always tight so I try not to ramble on too much. Doc we are lucky to have fellas like you on our side and on the forum as well.

[vancelw]

Our local "pain specialist" got convicted for overprescibing (aka providing excess for street deals)

Edit:

https://www.cbsnews.com/texas/news/texa ... se-deaths/

[Bill in Oregon]

Doc, this is the most infuriating thing I have seen online in recent memory -- and we all know how fouled up things are these days.
That pain specialist was so far out of line he begs to be prosecuted. I feel SO SORRY for your patient who was basically raped all over again by this shameful man.
How dare he presume to know what that poor woman has been through. He has simply no concept of what being a victim of sexual violence does to one's sense of personal security -- nor what it may take to protect it.
I really hate to talk about this, but I was raped and sodomized at the age of five in Corvallis, Oregon, by a stranger with a knife who threatened to cut my throat and something else with it if I yelled or told anyone. (He was probably an older teenage runaway from a nearby boys' home for wards of the state and God alone knows what he had been through to produce this behavior.) To say this has shaped every day of my life in the intervening 65 years would put it mildly. It might not be difficult to imagine that one result of the experience was knowing just how vulnerable a person -- especially younger and weaker -- can be, and that it prompts one to ponder deeply the issue of personal, physical security and what tools are available to protect it.
I can't help but wonder if your patient might successfully file a complaint with the Indiana Medical Licensing Board, but again, she might end up the one on trial.
This just makes me angrier by the minute as I think about it. I will pray for that woman just in case it helps.
With all my back surgeries and six more spinal injections just last month by a pain specialist in Abilene, I have dealt with several of these doctors over the past 30 years. Only one of the five was sketchy, trying desperately to sell me on a spinal cord stimulator that my neurosurgeon assured me was a blind alley. The other four were clearly trying to help -- and of course balance their precarious practices against the welter of state and federal regulations surrounding the prescription of pain medications. My primary concern about pain specialists is their sometimes narrow focus on just pain relief and not treating the problem holistically.
God bless all of you in the medical profession who truly try. It is a heavy burden and a huge responsibility and I thank you for it.

[gamekeeper]

I am impressed that the lady had and used her backup gun I am not impressed with the so-called doctor and his outrageous behaviour.

[jeepnik]

First the patient needs to file criminal charges for the purse and gun antics. Then she needs to contact a lawyer for possible civil suit. Third contact the state licensing board and file a complaint.

How far the various agencies and attorneys can take this remains to be seen. But it will be documented on three different levels.

No I don’t know about your state, but here folks can look up a doctor and see if complaints have been filed.

[mickbr]

Good heavens Bill, sorry that happened to you.

[Bill in Oregon]

Mick, there were three of us playing in the back yard next to a wooded lot. He abused each in turn. I kept in touch with my fellow victims over the years. We all dealt with multiple divorces, clinical depression, alcohol abuse or worse. These kinds of crimes were largely ignored in horror in the 1950s -- the less said about it among the adults the better and no clue about counseling for the children. This species of crime casts a lifelong shadow that makes it particularly heinous.

[AJMD429]

.
Male sexual assault fortunately doesn't result in the victim becoming pregnant which is one less thing to deal with them female victims have to deal with, but the way society treats males is often worse. Not wanting to feed into the who-is-the-biggest-victim mindset of the left, I do think it has to be noted that that kind of assault is horrible for either sex.

The tales of abuse by pharmacists, at least here in Indiana this past year, are horrific. I am trying to assemble them and anonymize them for formal presentation to the State board of pharmacy and attorney general's office.

As a former pharmacist myself, I recognize their ability to contribute positively to developing the most efficacious and safe medication regimens for complex patients, but they very seldom do that anymore, instead abandoning the complex and difficult patients as 'outliers', and trying to avoid filling any controversial medications for them, even to the extent of lying to the patient about whether the medication is available.

They have also gone from consulting and advising the physician about medication selection or dose, with the physician ultimately having the final say as to what he prescribes, to dictating and demanding what dosages are given, what medications are used or not used, and essentially doing the prescribing because they flat out refuse to fill what the physician prescribes if it is outside their corporate protocols.

What's really weird is these young pharmacists seem to feel THEIR pharmacy degree entitles them to not only advise about medications and doses, but go beyond that to dictating what is prescribed. In many cases, they also dictate whether or not the patient is getting non-medication treatments, such as physical therapy. They will refuse to fill in prescription unless the patient is sent to physical therapy, or sometimes insist that the patient go back to physical therapy instead of doing therapy at home. We've even had pharmacists say that “the patient needs to try dry needling”, or some other specific type of physical therapy, before they will fill a person's pain medication. In the old days, that would all be considered "practicing outside their scope of training". Now, the tables have turned, and physicians trained in primary care, which certainly includes treatment of chronic conditions, including pain, are accused of practicing outside our scope of training.

My question is why my pharmacy degree is less potent than theirs, because obviously their pharmacy degree endows them with the magical abilities to diagnose and treat, including prescribing (versus consulting and dispensing), and somehow even extends into the realm of which physical therapy modalities are to be prescribed. I would think my pharmacy degree might endow me with similar abilities, and that having the additional four years of a medical degree as well as 3 years of family practice residency, might solidify such powers, but in fact it seems to have done the opposite. The fact that I have the additional medical training to prescribe, in today's world means that I have LESS prescriptive authority than the pharmacist, who didn't used to have prescriptive authority at all...!

Really confusing....

[Grizz]

First the patient needs to file criminal charges for the purse and gun antics. Then she needs to contact a lawyer for possible civil suit. Third contact the state licensing board and file a complaint.

How far the various agencies and attorneys can take this remains to be seen. But it will be documented on three different levels.

No I don’t know about your state, but here folks can look up a doctor and see if complaints have been filed.

THIS ^^^^ -> this is why I don't trust doctors or the medical "establishment" or "experts" or any government but His Government,

† grizz

[Paladin]

We are back to the problems caused by HUMANs.
What do you call the Doctor who graduates at the top of his class and becomes one of the most respected in the medical Profession DOCTOR? What do you call a Doctor who graduates at the bottom of his class and is more interested in money from any source? Doctor. How do you tell the difference?
Without work and help from others?

[jeepnik]

One thing my wife always insists upon is that I be in the room when she sees either a doctor or dentist. Even if they are female.

The only time we had a problem was when she suffered a minor concussion. The doctor wanted her alone to ask if she had been struck. I would dearly have loved to have seen his face when she explained how her head came in contact with the headboard.

She has never let me live that one down.

[mickbr]

.
Male sexual assault fortunately doesn't result in the victim becoming pregnant which is one less thing to deal with them female victims have to deal with, but the way society treats males is often worse. Not wanting to feed into the who-is-the-biggest-victim mindset of the left, I do think it has to be noted that that kind of assault is horrible for either sex.

Especially kids too Doc. If i was in charge I wouldnt even allow child torture to exist in the universe. Put me in charge at 6am Id have it sorted by 605. Anyone argues about free will of humans in relation to child-rapists, they dissappeatr at 606

[2ndovc]

Bill, my gosh. I can't imagine the pain that has caused over the years.

It does seem that the more recent crop of medical professionals don't have the concern for their patients they used to or the ability to even speak to them without being condescending,
Fortunately there are still people that care a lot about what they do and their patients.

During my recent stay at the Cleveland Clinic( don't let the name fool you, it's one of the top hospitals in the country) in November, a new addition to the team of people trying to figure out what had happened, spotted an extreme spike in some of my test results that were not being investigated, He has taken a special interest in this issue as an oncologist, and I had a bone marrow biopsy yesterday. I can tell you that it was not the least bit pleasant. Won't know the full results for a couple of weeks.

On the flip side of that coin, I was visited by a different Dr. during that stay, who looked like she had just graduated and all of about thirty. She had no idea how to talk to people or even start a conversation.
Due to the high volume of patients when I was admitted, I was placed on the floor with liver and other patients waiting for transplant surgeries. So apparently some of these people have done things to themselves that weren't the best choices. I get that, but after talking to me for a few minutes w/out asking anything about my background she asks "So, you live in a group home?". I pretty much laughed in her face and after getting myself together, stated to her maybe a little loudly, no I live in a nice big house that I built myself with a beautiful wife, one stepson and a herd of dogs. Anything else you would like to know? Maybe that I'm an educated professional that makes a good living? I went on a bit longer, but you get it..
One of the nurses heard the whole conversation and was just shaking his head and smiled when she left rather abruptly. When he was sure she was gone, he said some of these people spend years in school, but never learn how to talk to people.
I was hoping she would come back, but I never saw that one again.

jb

[Grizz]

" Tomorrow the sun will rise. Who knows what the tide could bring?"

the term socially patterned sadist pops into my mind . . .

sorry for your trials, hope for your healing,

regards, grizz

[Bill in Oregon]

Doc, I was unaware of this whole business of runaway pharmacists either assuming or being delegated authority that they have not earned. How can they possibly know if a patient has had or needs physical therapy? That requires medical examination, diagnosis and a prescription. Since when do pharmacists write prescriptions? As to dry needling, I had it once and it was both uncomfortable and complete waste of my time.
I hope your efforts documenting these issues bear fruit; they sound to me like a public service.
Jason, thanks for the thoughts. I hope your bone marrow biopsy results are encouraging.
As to the whole business of medical staff being able to communicate, we used to call it bedside manner. I have seen a gray-haired and much beloved D.O. here in my small Texas town a couple of times, and I have never been so charmed or put at ease. He walked in with the results of my endoscopy, sat down in the little patient chair right next to me, -- you know, the two against the back wall -- put his hand on my shoulder and said, Bill, let's take a look at your report. I felt like I was in the presence of an old friend, or my pastor, or a beloved uncle. I can't help but compare this behavior with that of my neurosurgeon in El Paso who would enter the room, sit on his swivel chair as far away as possible and look at his laptop the whole time making very few comments and very little eye contact. The "ice man."

[AJMD429]

”…I felt like I was in the presence of an old friend, or my pastor, or a beloved uncle. I can't help but compare this behavior with that of my neurosurgeon in El Paso who would enter the room, sit on his swivel chair as far away as possible and look at his laptop the whole time making very few comments and very little eye contact. The "ice man…”

That is definitely what has changed.

Part of it is the way doctors use computers.

Thirty years ago, the computer provided information to the doctor, who used that information to make a decision.

Now the doctor functions as a data entry clerk, putting information into the computer, then the computer makes the decision.

It has corrupted all areas of life, but especially phydicians, and I think now pharmacists. I’ve seen physical therapists who mostly do ‘data entry’ with the patient as an afterthought. Probably will hit nursing next.

This should frighten us all…

[AJMD429]

I had to laugh; another patient brought in a news clipping about that same pain doc; seems he did jail time for assaulting a spouse. Probably illegal for him to even touch a firearm...

[Bill in Oregon]

Doc, maybe there is justice in the world ...

[hornetguy]

trying desperately to sell me on a spinal cord stimulator that my neurosurgeon assured me was a blind alley.

Hey Bill.... neurostim devices are usually the last resort for patients with chronic pain. They DO work, at least to some extent, for at least 80% of people that have them inplanted, and properly tuned.
Like many other medical procedures, they are not 100% effective.... only your neuro/pain guy can tell you whether you are a "good" candidate for that.
I have worked for a neurostim manufacturer for the past 20 years... and have heard quite a few truly amazing stories from patients that have been suicidal from their chronic pain, only to be brought back to 90% of where they were before their condition began... literally life-saving stuff.

Like I said, since they are quite expensive, and involve surgery, most physicians see them as a last effort to curb pain.... after rehab, pain meds, etc. have been tried and found inadequate... but, they do work.

I hope you find relief from your pain.... constant pain is very debilitating, mentally.... even minor constant pain.

[AJMD429]

.
Yeah the neurostim units can work wonders. We usually at least fiddle with a dual channel external interferential unit for awhile too (Zynex NexWave in our case).

[piller]

Working at an independent Pharmacy now. Love it. We are contracted with a couple of pain management Doctors. Doctor G is pretty good about keeping his patients where they can function. Extreme pain makes it hard to think, focus, or even do much else.

[Bill in Oregon]

I looked closely at the Abbott stimulator the pain doc in Alamogordo was pushing. I did a fair amount of online research. But combined with my neurosurgeon's advice based on what he had seen, and statistics such as these from what I consider reliable sources, I decided against one. I did not appreciate the car-dealer-style pressure to buy, either. A friend's wife had one implanted and had mixed results. Another friend with crippling pain was waiting for the VA to approve having his no-longer-working device removed when he died.
I acknowledge for some patients, these things can be life changers.

From the Cleveland Clinic: "The success rate for spinal cord stimulators depends partly on the condition they're treating and the device type. On average, about half of people see more than a 50% improvement in their pain. The effectiveness of spinal cord stimulators can also decrease over time for unknown reasons."