DECEPTION, ADDICTION, AND THE DOCTOR-PATIENT RELATIONSHIP

It was one winter some years ago that a lawyer friend came in with symptoms of a cold – sniffles, congestion, sore throat and cough.  After looking at his throat through his open mouth, looking in his ears, his nose, pressing the sinuses, and listening to his heart and lungs, the conversation went like this:

Patient:  You know, you couldn’t pay me enough to be a doctor.
Doctor:  Oh yeah? Why not?
Patient:  Well, every day you have to look in places on people that
               are nasty.  Doing them rectal exams, and dealing with
               body fluids and such.
Doctor:  Well, I guess it goes with the territory.  But you couldn’t
               pay me enough to be a lawyer.
Patient:  And why is that?
Doctor:  Because everyone wants to have their way regardless of
              which side they’re on and will lie to you about it. 
              Besides, lawyers are the brunt of the funniest jokes
              around. 
We both laughed.

Later, after reflecting on our exchange, I realized that a lawyer’s clients really aren’t the only clients, of any professional, who might twist the facts, and bend the truth in the interest of personal benefit, not realizing that the loss of objectivity more times than not is to their own disadvantage.  

Most people are without doubt very truthful and forthright when seeking professional advice and especially medical help.  Some patients though before making an appointment will have canvassed the internet and will have formed a solid opinion or diagnosis of what they might have, or what they fear they might
have.  Often they are correct.  The internet is a powerful educator.  But they may skew and omit symptoms and events, purposefully or unwittingly attempting to guide the doctor into a particular opinion in hopes of him or her declaring the more benign diagnosis.

I encourage patients to read and get relevant information about their particular problem on the internet, often giving key words for them to Google.  It can be very helpful.  Besides, since the dawn of the information age physicians have become something less of repositories of medical information and something more of shepherds of information.

But the deception rendered by patients who use the internet pales in comparison and is less sophisticated than that rendered by prescription drug seekers and addicts.  In an earlier blog I wrote about the abuse and deception on the Coast surrounding the drugs Lorcet, Lortab, Xanax and Oxycontin.  Unknown to many, Pharmacy Benefit Managers like MEDCO, have begun sending to physicians Drug Utilization Reports on patients whose drug purchase patterns fall outside the scope of standard use.  I recently received such a report on a gentleman I saw who had an acute back strain. I prescribed 12 Lorcets for pain relief, with one refill.  The Utilization Report indicated he had been prescribed 100 Lorcets by a Gulfport physician two days before he saw me, and another 60 tablets by an Ocean Springs doctor five days after her saw me.  That’s a total of 184 Lorcet tablets he had access to in a 7 day period.  To think he’s using these tablets exclusively for medical purposes is akin to pretending you can lose weight eating double cheeseburgers every day.

Because the trust factor in such situations has been breached, it’s difficult to give deceiving patients the benefit of the doubt or to further the doctor-patient relationship.  For years Medicaid was the only entity providing these Utilization Reports.  But now this managing tool has been extended into the realm of private health insurance companies and will help physicians more easily and readily identify those intent on deceiving. 

Communication is important in any relationship, professional or personal.  But someone who is prescription drug seeking, while truly needing help in a particular way, will fail to communicate his/her need for help until they eventually destroy their relationship with their doctor, and others.  Something that’s really not necessary.  If you or someone close to you, a friend or family member, has a problem with prescription drug abuse I would encourage you to urge them to seek help.  Otherwise, for them, it may be more than the relationship with their doctor that is at risk of being terminated.