Cites below. I will slightly modify my original statement to clarify that it really should have said “analogies” or “examples.”
This plot was just on the latest episode of The Mentalist.
Thanks for making my point for me. This is what I have been saying all along.
The nurse should be punished, regardless of any fully developed intent or lack thereof.
I’m glad we finally agree.
You go ahead and declare victory to an empty room, dear, if it makes you feel better about yourself.
Intensivists in the US are almost always boarded in Pulmonary/Critical Care, a fellowship out of internal medicine. Our anesthesiologists rarely work outside the OR. The only time I’ve ever seen one in the ICU was when a difficult intubation had to be done, and in those cases the anesthesiologist was gone within five minutes of the tube going in, leaving the P/CC doc (or his resident) to manage the vent.
It says a lot that after six years at the same hospital I honestly don’t know who our anesthesiologists are. I assume they’re the people in OR scrubs at the medical staff meetings that I never see at any other time.
Pain clinics in the US are occasionally run by anesthesiologists, but far more often they’re run by primary care physicians who wanted to make more money. That’s not necessarily a rip–one of my best friends took that path, and he runs a great clinic. But pain clinics in the US are of variable quality and legitimacy, to say the least.
As to the OP, I’m surprised this sort of thing doesn’t happen more often. I live and practice in a place where prescription opiate abuse is a major driver of the economy, so our hospital and clinics probably have stricter safeguards than most places.
But I never go a day without hearing a new story about addiction turning people into sociopaths. For instance, I’ve had several cancer patients decline hospice referrals because if their neighbors see the hospice nurse’s car in their driveway (they’re not marked, but they’re known) they’ll break into the house later and steal their drugs. For that matter, I can’t tell you how many times I’ve diagnosed someone with cancer who later that day had a son/daughter/grandson/brother/neighbor call up and ask what kind of drugs they got.
I can’t imagine the impulse that would lead me to steal a patient’s (or my grandmother’s) pain medicine, because I’m lucky enough to have never been an addict. But I’m not surprised by it anymore.
I think you have some incorrect information. Pain management clinics are run mostly by physiatrist with the recently added board certification in pain management or anesthesiologists. I suppose a PCP can get a board certification in pain management as well but I am very active in many group management organizations for orthopedic surgeons, physiatry anesthesiology, and pain specialists and have no heard of one yet.
I think you have some incorrect information. 
One needn’t be board-certified in pain medicine to run a pain management clinic. One only needs a license to practice medicine and a DEA number, in most state jurisdictions.
I certainly do enough pain management work in my primary care practice, and have taken enough continuing medical education in the subject to call myself ‘trained in pain management’ and even hang out a shingle proclaiming such. I’m not inclined to do so, but I know others who have done just that. Nor am I inclined to claim ‘board certification in pain medicine’ as that would be untrue.
Neurologists and Psychiatrists can also get a ‘pain medicine’ subspecialty board certification. Internists, Family Medicine practitioners can get palliative medicine board certifications, as can pediatricians. That latter designation is aimed more at malignant pain, but some principles overlap.
I tend to prefer physiatrists as my pain specialist consultant of choice, but there are good anesthesiologists and neurologists out there that are up to the task, too.
Here’s a doc who runs a pain clinic who’s definitely not certified the Anesthesiology, Physiatry, or any other mainstream pain medicine board: http://www.milwaukeepainclinic.com/drFaber_DoctorOfOsteopathicMedicine.asp
NB: Nothing against osteopaths, I’ve gone to them myself in the past. But this guy runs his pain clinic his way. And probably does a better job than a lot of narcotic dispensers.
Ho. Lee. Crap.
Regards,
Shodan
I’m acquainted with about five pain clinics around my state. One is run by a semi-retired neurosurgeon, one is run by a doc without any board certification at all (not too unusual for older docs around here), and the rest are FP or IM. None of the docs, AFAIK, advertise themselves as having any sort of certification in pain management.
This could very well vary by state or region, but my description is the state of play in my area.
I know, right? And I hear these stories every day. It’s impossible to overstate what prescription drug abuse has done to our area. It’s hard to practice medicine here because you have to spend so much time dealing with drug seekers. And even so, the overwhelming majority of the diverted prescription meds around here don’t come from the local docs; they come from Florida.
Seriously, there’s a discount airline that just started doing cheap midweek flights from Lexington to various cities in Florida, catering almost exclusively to people flying down to midweek appointments with sketchy cash-only pain clinics. The flights are known locally as the “pill planes”.
I was at a CLE about how to be the guardian ad litem for children of parents with substance abuse issues recently. One of the speakers mentioned a great factoid, although I have yet to verify its truth. He said “The United States has approximately 5 percent of the world’s population, but uses 94 percent of the world’s Vicodin.”
I bet the return flights are a lot calmer than the flights down.
A double whammy: DoctorJ’s claims, and Shodan being left speechless. I am impressed by the latter:D, but depressed by the former. Every time I think I’m too jaded to be surprised, along comes someone who demonstrates I engage in extensive wishful thinking. (DoctorJ).
I’m sure you do know. But this is something that is just beyond my imagination, and not in a good way.
And what is depressing about it, is that I would have no idea that something like this could arise, and therefore that much less ability to come up with some kind of solution.
How can you deal with people who do things like this? The great temptation is to reject people who do this as not human at all. How can you think of clever ways to steal analgesics from a dying person? Especially systematically.
The mind boggles.
It’s like the hideous stories I sometimes read about women pimping their children to buy crack, or raping babies. What can you do with people who would do something like that? It’s hard to even think about them as human.
Some crimes I have what can only be called empathy. I can see, somehow, how I might do, I don’t know - shoot someone, or something. But this?
There was a long, incredibly bizarre thread a couple of weeks back where I said I couldn’t see who anyone would rape a disabled woman. This is sort of the same thing. How could you possibly do this, and be able to live with yourself? What excuse would be good enough?
Regards,
Shodan
This astonishes me as well, even though I could observe something similar in my last roommate. I threw her out when I discovered that she had a prison record for violence as well as other things—drugs, amongst them----and she swiftly found an older gentlemen who let her move in. Within days both he and his dying wife suffered ‘falls’ mysteriously in their one-story rambler, and their medications required refills. Because both people were competent it was a horror getting them help, but the family did throw her out eventually. After doing so they discovered social security numbers in amongst her possessions. By that time, I discovered that this roommate had been doing things out of my house, because people were showing up at the doorstep, and that some of those things had involved my medication because my prescription came up short.
When her true colors were exposed she was a thoroughly loathsome person, feeling tremendously wronged by anything that was asked of her, refusing to recognize that she had done anything wrong, but very good at constructing a facade that worked, so to speak, for a while. In one case, she had stabbed someone twenty seven times—for words. She also threatened to do that to me. If she was addicted I don’t know but she viewed other people as resources to be used and exhausted and then discarded. She grew quite angry if a person dared object to this. One of the things she did steal from me was pain medication for a fracture, which she used to get high. She apparently had quite a supply, because I found out afterward that she trolled ERs, with fake identities, trying to get drugs.
She had a friend with whom I was acquainted and they were very similar; they were both users of people as well as drugs. Everything was a scam. This friend’s parents had been addicts as well so I think one could feel some pity for her—from a safe distance.
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My biggest current annoyance in the Oxy epidemic is that several pharmacies have banned hoodies. (I mean other than the human suffering, and the rise in crime, and the actual social problems this creates*, I mean my biggest PERSONAL current annoyance.)
I have now been sick for ove 5 weeks, both ear drums have ruptured and wearing the hood of my hoodie over my touque (for those keeping score at home this is at least my second Canadianism in the last 12 hours, after gitch/gotch) has been one way to keep drafts out and me feeling better. One lovely day a few weeks ago I was still in a feverish state, had a migrane, and went out at 930pm to get some antihistimines and Tylenol #1s. I was wearing my hoodie and sunglasses.
First I was asked by the security guard to remove hood and sunglasses. I did so, feeling bad I had ignored the sign at the door. Then I was flat out refused the sale of the T1s. They stated “we are out of them”. Um no, you are the largest pharmacy in town and open 24 hours. They did not have generic acetaminophen/codine tablets either.
I realized what I must look like and went to another store, with my hood down and no sun glasses. I got what I needed there. I am not even upset at the store. How are they to know I am a nurse and not another person ready to hold up a pharmacy? My aunt is a pharmacist and she (her store when she was working) was robbed last fall for oxycodone, so I am aware. It is just sad.
- I brought my son to school late one day after he had a medical appointment. In the parking lot the parent of another child offered to sell me oxycodone.
All due respect, I would tend to see the eradication of hoodies from the planet as a rare silver lining of the drug scourge.
Im not really a fan either, but when I am sick I have this really comfy one I wear, and its an extra layer around my ears.
When I am well that thing is neve seen out of the house.