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Old 12-24-2011, 07:15 PM
Ocean Ocean is offline
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Values Added: Refuted By Facts (Mark Kleiman & Harold Pollack)

Originally Posted by Wonderment View Post
Probably nurse. They are the ones on the front lines, and many tend to really, really resent "seekers." What I see as a volunteer a few hours a week is that the concept of addiction as a disease hasn't really taken hold (except for lip service). Nurses often feel that addicts are pseudo-patients who are taking the place of "real" patients, and physicians are all over the map. Some are too easy to hit up for prescriptions, others get into a pissing contest with the addict and don't want to be "outsmarted" or "made a fool of," others provide compassionate care consistent with best practices.

It's so hard with addiction not to view it in some sense as a moral failing (despite all the science to the contrary).

Also, the ER personnel are right: addicts DO increase wait time and reduce quality of service for other patients. And they can be very expensive, costs which get passed on to other payers. For example, malingerer addict comes in with "the worst headache of my life." This symptom, apparently, can be indicative of a very serious condition and requires major workups, costing thousands of dollars and tying up scarce equipment and resources. Same for shortness of breath, seizures, etc.
Just like any other human being trying to do his/her job, doctors and nurses resent when someone comes to them, not seeking their advice, but rather lying and trying to find ways of manipulating them for their purposes. Sometimes, it's possible to get through to the person and find a way to communicate more honestly, but sometimes, really the person has no interest in medical advice or recommendations. Technically speaking, they are not patients under the care of a doctor, but rather someone who is trying to use the doctor's prescribing privileges for other purposes. The other purposes are most frequently to continue an addiction or to obtain medications that can be sold in the street.

I usually try to be as straight forward as I can, and I tell patients that I'm willing to work with them if they are open to accepting my recommendations. But if they are not, I can't really help them. To some I recommend counseling first, or going to a drug program.

By the way, I'm referring to those seeking sedatives. I don't treat pain.
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