Medical Ethics - as Required of MD's

In My Humble Opinion
41

I wasn’t accusing you of using pain meds as sleeping pills, just telling you how you were coming across, in case maybe you were coming across the same way to the doctor.

Believe me there was a time when I would use anything to get to sleep when I was on my third night of sleeping only three hours. I had darvocet for migraines, and there were times I took a darvocet just to sleep. There were also times I took Benadryl.

I tolerated insomnia in my 20s, because when you are young, you can scrape through a day even when you haven’t slept at all, but you get worse and worse at it the older you get. I finally saw a doctor when I was 31. I spent six months on Ambien, and realized I couldn’t do that indefinitely, which led to temazepam (Restoril), and other benzos, and a few other things, until I finally asked for a referral to a psychiatrist who could do a sleep study.

Anyway, not sleeping and pain is a vicious circle. I’ve never had chronic pain, but any time I’ve been in pain, whether it’s a sprained ankle or a migraine, it can keep me up, and then being tired can make the pain worse, believe me, I have nothing but sympathy for you, which is why I was trying to be helpful is telling you how that information was coming across. I do understand that you are not using narcotics as sleeping pills, but I wanted to make you aware that it was possible you had given the doctor that impression.

I have a couple of cousins who are doctors, and one is as close to me as a sister; I do think that you aren’t being fair to doctors by assuming that Medicare patients are getting the short end of the stick. I really think my cousins care about all their patients. And I know my one cousin does pro bono work, because she is a pediatric orthopod, so she gets kids born into not-wealthy families with limb problems all the time, and poor kids break arms as often as wealthy ones. No kid ever goes untreated.

However, if trust has broken down with this doctor, then maybe it is time to find someone new. You have the right to find a new doctor for any reason.

42

Just pointing out that option was addressed (and dismissed) up thread:

43

This is what I thought. I have some temazapam prescribed to help me sleep in between night shifts. I was told that if used regularly they become ineffective. I’ve also found them to be ineffective anyway. I don’t notice any difference in my sleep between using them and not using them.

44

There are very good doctors, primary care and specialist alike, who take Medicare.

The “problem” is not DEA noise. The problem is that people, lots of people, are dying as a consequence of the way that pain has been managed. A decent doctor (whether or not the op has one) would be continually re-evaluating the balance of risks and benefits.

When the risks outweigh the benefits a decent doctor will taper and/or discontinue the medication.

Everything the op has written describes someone at major risks of death as a result of their use of prescribed medications.

Getting the op on lower doses of medication and coming up with a better less risky treatment plan is vital but cannot be done other than by cutting him off while he views getting his pills as the only approach.

I hope the PCP gives some naloxone to have on hand. Sorry but I really do think that op won’t accept that he needs a different approach and will not work to get the help he actually need. Given that, I hate to say it, and I know it sounds harsh, but our op is a dead man walking.

45

That’s one of the reasons I’ve been so blunt on this thread.

His attitude needs to change.

I don’t want to see this end how you describe, but I don’t know what else to do besides forcefully repeating the same thing or let it happen–and, as I mentioned up-thread, I’m not in a position where that sounds like a viable option to me.

Apologies to anyone who thinks I’ve come on a little strong here.

46

My former husband had CF, and shattered ribs as a result of coughing. He was on a LOT of medications, including many CNS depressants. He had a very similar attitude as the OP; not med seeking, but “I know more than the docs and will tell them what to prescribe/what tests to run.” He rarely followed doctors’ orders.

This behavior got him kicked off the transplant list, after he’d spent three months in the ICU nearly dead. It took us several months to convince the doctors to let him back on, and a lot of that was due to me strongly advocating for him.

OP, you need someone other than you interacting with the doctors on your behalf, and you need a serious attitude adjustment. A lawyer is not going to help you, and your continued attempts to obtain one instead of finding an advocate is, in effect, actively suicidal. If you want to die, fine, but at this point you can’t blame that on your doctor.

47

I have been battling sleep since circa 1964.

I have had no pain relief save Vicodin (hydrocodone) as far back as I can remember.

I do not tell (competent) professions of any sort WHAT or HOW to do their jobs.
I had too many managers who thought their CS 105 Intro to Programming in Fortran (you though I was going to say COBOL, didn’t you?) made them experts on system design/configuration/security.
Hello Delta Dental!
But: when I do find something that actually works, I see no reason to change.

The “Cut off the script and wait for them to come crawling” technique is not for life-and-death meds.
For those not familiar - lack of sleep is fatal.
I have gotten 3-4 hours the last 2 days and my hands are shaking.

I can’t go to UCD hospital or I will not sleep - they will not provide any meds the PCP is withholding as a bargaining chip. Which is what she did with the sleep meds.

Am I a dead man walking?
You tell me:
I spend 3-4 days in bed and get between .5 and 1.8 days of usable life.

Exactly how viable does that sound?

48

You say you don’t tell professionals how to do their job, but you are coming across in this thread as someone saying “give me pills or I’ll sue for medical abandonment.” I have no idea what other treatments you have tried for sleep issues, but there may be a safer, better way to treat that issue.

49

Tell me.

If you have something which works, why deny it to a patient who obviously is aware of the situation before a replacement is found?

The GOP’s “Repeal and Replace” is much the same - real long on the repeal, not so strong on replace.

Telling me that she had another MD contact their “Sleep Department” for “suggestions” does not do a damned thing for my sleep.
And why not actually refer me to this wonderful “Sleep Department”? Why a 3rd party with no knowledge of my trips to sleep departments, my trials of a dozen sleepers?

This is not Unisom.

This is my worst fear about accepting pills instead of the OTC (ugly in the extreme, but it worked) - that I would be at the whim of a MD/Druggist/Pharma company for sleep.

Does anyone not realize that this is not jet lag, it is not a 2 week long emotional turmoil, this is my EVERY DAMNED DAY FOR 50 YEARS LIFE!

Sleepers used to be barbiturates. Then benzodiazepines came out - much safer, but still nasty.
Then, circa 2005, the so-called “Z Drugs” (they have a “Z” in their chemical names) were to be the salvation for benzo users.
Then the insurance companies stopped paying for them. Ambien is the poster child of what went wrong with the Z drugs.

Nonetheless, UCD made a list of both opioid and benzo users. My name is on both lists. My “always wanted to be a doctor, but something went wrong” PCP panicked and I am suffering because she will not defend her prescriptions.
For the Record: I have been using benzo sleepers since 10/00 - 16+ years, I am already half-dead and my genes say the other half will catch up within 5-10 years.

Her panic - I suspect she was told to take the time off once her boss heard why I was hospitalized in critical (maybe not the Medical use of the term - I do not have full report) condition.
For those needing refreshment: my creatinine (Creatinine Clearance Blood Test: Purpose, Procedure, Results) was 4.25 - the diagnosis blamed the morphine my ever-loving PCP put me on. Max creatinine for healthy adults is 1.27. At 3.0 - where I suspect I am now - I’m getting damned good at predicting hemoglobin and eGFR and now creatinine levels - I get weak and light-headed.

In fact, she gave me morphine to replace dilaudid (hydromorphone) and still gave my dilaudid for breakthrough pain.
Dilaudid is much better tolerated than morphine.

You’ll never guess which she cut entirely while continuing morphine.
Under no circumstances should this person have prescribing rights to Sch II (opioids and a few others) drugs.

She treats symptoms - an kid’s ear ache? Fine. As long as the kid isn’t allergic to antibiotics.

50

Oh - my trip went ER - ICU - room on 8th floor.

I had an absolutely wonderful (and attractive) nurse undress me. I have no recollection.
When I first asked for the sleeper, she said “we go through this every night”.
Oh really? I had no recollection of being undressed, where my clothes were, or having had said anything to this nurse about meds, other than my constant moaning for morphine.

Yes, I AM scared shitless.

I now have a finger (left pinky) which goes crazy when the creatinine level rises. It is actually handy - how much will I be able to do today? Let’s see if I can bend this finger…

51

**Raven ** -

After 50 years,I have probably tried everything you can imagine and a few more.

There are few alive who know more about my sleep than I.

In 2000 my PCP started me on Valium- the baseline benzo.

It had an interesting sedative effect - which was gone before I could get undressed.

Does this give you an idea of what I mean when I say “I have enormous tolerance for all forms of CNS depressants”?

How about this one - last time I had surgery, the anesthesiologist (thank gawd I haven’t learned to spell that one) stopped by 2 times - before the surgery to ask what I call “the Lithium question”:
“Are you a drnkin’ man?” (if yes, lithium is added to the mix).
I warned him that I was going to be trouble. I don’t think he believed me.
After the ordeal, he stopped by again - just to tell me he had had a bitch of a time keeping me down.
“Told you so”.

52

You have been on benzos for nearly20 years, right? Do you think there have been no more treatments tested in 17+ years? I am not saying your doctor is good, i have no idea. But demanding an addictive substance instead of being willing to explore other avenue of treatment is not doing you any favors. Bragging about your tolerance to an addictive substance isn’t helping. Threatening to sue isn’t helping.

53

OP, other than drugs, what treatment avenues have you explored in the decades you’ve been dealing with this?

54

And yet you’ve done that repeatedly in the emails you posted here alone.

Ok? I mean, it’s nice to get an explanation, but you really aren’t owed one.

You also haven’t asked for one–you’ve just demanded that you go back to the way things were.

And so you’re doing everything in your power to ensure you don’t get any?

Makes sense. :rolleyes:

Bargaining chip? Seriously?

Unless you actually have evidence of that (which I can practically guarantee you don’t), this is just an example of how out of touch your thoughts on this matter are.

Not very–you should probably take your doctor’s advice & discuss the issue with her instead of demanding pills that you aren’t going to get.

Because it’s clearly not right for you. Are you even reading this thread? This has been pointed out repeatedly.

My guess is that she didn’t refer you directly because she knew you’d call them and demand pills, as you’ve done with every doctor so far.

You know what really “does not do a damned thing” for your sleep? Demanding pills instead of following the doctor’s suggestion that you discuss the issue so you can find a solution that may or may not involve pills.

Doing what you’re doing, as I’ve already explained, is just going to make it all the harder for her to justify giving you pills. Period.

Not to mention that she keeps asking you to discuss it and you keep replying with a rant about how you need pills and insisting that she’s not treating you. What’s she supposed to do with that? How does that give her any information at all about the problem?

So you basically admit that you were afraid that you’d become addicted to the pills & that you’re now addicted to the pills… And you think the doctor is **wrong **for cutting you off? Her ethical & legal obligation isn’t to keep supplying an addict with pills, it’s to make sure they don’t get them.

Whether she’s going about it the right way is debatable, but, even without everything else you’ve ever said, that one sentence just lost you whatever legal action that you thought you had.

Why do you keep repeating this? What does it have to do with anything? Are you saying that your doctor somehow didn’t know that you had medications that she personally prescribed?

If she wrote you the prescriptions & kept refilling them, she didn’t need a list to tell her that you were taking them.

Because, at this point, you’ve made it indefensible to continue giving you those pills. Frankly, you sound like a DEA undercover in the most blatant sting operation ever. If you keep digging like you are, you will never ever EVER get those pills or any like them again. I don’t know how many times that needs to be said, but you’re clearly not paying attention if you’re still talking like this.

I’m going to once again point out that, without proof, this seems like the words of someone who’s delusional & out of touch with reality. I don’t mean that to sound rude–you’re seriously lacking self awareness here.

This…this doesn’t even make sense.

An ear infection is caused by bacteria. Antibiotics kill the bacteria. Ergo, she’s treating the cause, not the symptoms. (Treating the symptoms would be having the patient take something for the pain and ignoring the root cause…)

Hey, wait, that parenthetical sounds familiar.

Oh, I know–that’s exactly what you want her to do with you (which she’s refusing)!

You say “I can’t sleep, give me pills so I can”

She says “No, how about we discuss why you can’t sleep?”

You say “NO, I NEED PILLS!!!”

One of those is about treating the symptom, the other is about treating the root cause behind it. You’re refusing to cooperate enough for her to do the latter and then complaining about how she isn’t doing it.

But all this is clearly for naught, as you’re just going to carry on regardless. You’ve ignored everyone in the thread up til now, so why start listening?

55

Just how many other avenues do you think i have NOT tried?

As stated, I hate having to take any pill.

White noise, teas, melatonin, self-hypnosis (I can stop hiccups with that) - sleep studies, how to use the bedroom (do nothing but sleep).

Oh - and z drugs, including ambien.

If I can find “gabapentin 300mg” for CKD itch, I can find pretty much every damned thing on sleep.

And I still come back to what works. Benzo (3 known to work) Z drug (2, including ambien in the 10 mg. 5 mg does not work).

Once I have better deal, I will happily stop the benzo, and the pain, and the blood pressure.
I already quit the damned antidepressant. Which may explain my reaction to PCP’s incompetence/malpractice cresting - just because I was neither dead nor alive for 3 days.

56

Here is one you may not have tried- finding and treating the root cause of the issue, instead of taking a pill.

You hate to take pills? How many threads have you started about " give me my pills!"

57

Did you not see the “talking to PCP caused a 10 point spike in BP”?

I have “discussed” this and several other things.
Her idea of “discussion” is:

She tells me what she will no longer prescribe
I tell her that I do not have a fall-back for that function
She:

  1. says “sucks to be you”
    or
  2. Print off a list of pain management docs and tells me to find one who will take me.
    The first 5 declined a Medicare case using Sch II drugs for 11 years. Surprise!

The part I cannot figure out; if she no longer wants to write the scripts, why does she still want to be my PCP?
She can’t be enjoying this any more than I am.

I was looking at docs in the Internal Medicine dept when this hell broke loose.

I am not going to quit until I get a legal opinion on the effect of my terminating the “relationship”.

My last job paid $60/hr. That is 120K annual. Her job classification starts at 127k.

I went into the new clinic and asked for an available MD who would write controlled scripts.

I suspect part of the problem is my switch from a very nice PPO policy to Medicare. Nobody is happy when a patient’s insurance payments are cut in half.

58

oh boy - good one - all I have to do is discover the “root cause” of puberty-onset insomnia.
Or, as UCD puts it “Idiopathic insomnia”. It means “having no identified cause known to medicine”

59

You seem awfully lucid for someone who is profoundly sleep-deprived and in an ICU.

60

For those playing at home:
the current list of "conditions:

The treatment plan is blank except for a list of prescriptions

OK - tell me how I should deal with this?

(and yes, death is an option)