Blog | Monday, July 24, 2017

Why I won't prescribe pain medicines

It may seem strange that a gastroenterologist like me does not prescribe pain medicines. Let me rephrase that. I don't prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don't. Here's why.

I believe that one person on the health care team should manage the pain control. In my view, this should be the attending hospital physician or the primary care physician in the out-patient setting. There should not be several consultants who are prescribing pain medicines or changing doses of medicine prescribed by another physician. With one physician in charge, the patient's pain is more likely to be managed skillfully while the risk of fostering drug dependency and addiction is lessened. We all know addicted patients who obtain medicines from various physicians and emergency rooms. It's cleaner when a patient on pain medicines knows that a single physician is in charge of managing this issue.

While my argument of single physician authority can be applied to other medical conditions, this is even more important with narcotic agents. For example, if a patient has an internist a cardiologist and a kidney specialist, only one of them should be managing the patient's high blood pressure, at least in my view. Since narcotics and related medications have addictive potential, it is even more important to have a limited prescribing source for patients.

When I am seeing patients with abdominal pain, particularly in the hospital, I'm often asked for narcotics or to increase the dose or frequency of pain medicines that were already prescribed. I counsel these patients that the attending physician is in charge of this and that the patient should discuss the request with this doctor.

Other gastroenterologists and medical consultants may approach this issue differently. I'd love to hear from them or from patients who have faced this issue.

We can all agree that pain is the enemy. But, the medical profession in its zeal to eliminate it, has contributed to the ravages and suffering of drug addiction. In my state of Ohio, we lose thousands of our people every year to drug overdoses. For many of them, their tortured path toward agony started with a medical prescription prescribed by a doctor like me.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.