"Big Brother" and Health Care Workers

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Disce Pati
Regular Member

Date Joined Apr 2008
Total Posts : 61
   Posted 4/16/2008 6:44 PM (GMT -6)   
I read the rules concerning posting "copyrighted" material and I really didn't get an answer to my question concerning if acceptable referencing to published material in peer-reviewed is appropriate here. Because of this I will not offer direct quotes as I am used to doing (in academia, if you discuss someone's research you are suppose to directly quote them with full reference to the author, publication etc and refrain from paraphrasing etc). Instead I will summarize the information and just mention that I did my best not to change the meaning of the information nor did I intentionally take it out of context. I have the full article available if anyone wishes to read the entire thing - you can let me know and we can figure out how to exchange email addresses so I can send it to you as pdf.

The following information was published in a February 2008 (almost as up to date as possible) in a journal for nurse practitioners - higher level nurses. The title described the research as looking at how social and political factors influence whether narcotics will be prescribed for chronic pain.

This study is based on face-to-face interviews with NPs as well as evaluation of written surveys. Questions were asked concerning the willingness to prescribe narcotic pain medications for chronic pain. The conclusion made was that NPs prescribing decisions are not done with the best interest of the patient as the priority but that social and political pressure has created a situation that makes NPs "ulikely" to fulfill their ethical responsiblities to their patients.

This study found that the NPs were extensively concerned with acting in their own best interest: because they perceive opioids as adding a burden to their workload (the fear of the DEA, the "inherent risk" of the drug, etc) they opt to either never prescribe narcotics or to severely limit when and how many and which type is prescribed (for example, many indicated that they will "never" prescribe oxycodon, vicodin etc). The interviewed NPs did not see this practice as being based on ethical decisions - as in are they doing what is in the best interest of the patient or themselves.

The authors concluded that it was the NPs best interest that won out over what is best for the patient and that this is because of society and political pressure as well as inadequate education of the risks and benefits of narcotics themselves.

Interestingly, the article stated that once a NP decides that there is a pain condition that they are most likely to prescribe what they have personal experience in taking themselves, for example. One nurse was quoted that because she was ini "la-la" land for an entire day after taking a narcotic pain med she will rarely prescribe for others. Some NPs stated they will never prescribe opioids because everyone gets addicted to them or because the clinic they work at will not allow them to. Here is what one nurse stated in the interview about prescribing narcotics for chronic pain: "If you have someone on a narcotic long term, it gets people's attention even if it is justified, so I feel like I am under the microscope when I prescribe those drugs."

All the nurses who participated in the study believed that they "had a responsibility to protect society....from what they [see] as the evils of drug abuse and diversion."

The following statements are direct quotes because the information is so important that I do not want to risk mis-representing it in any way - pay particular attention to the last paragraphed quoted, to me this is the most chilling:

"The sense of responsibility to society is in direct conflict with the interests of patients in pain because it necessitates that prescribers view them as potential criminals and forces clinicians to evaluate their patients in such a way as to destroy the traditional trusting nurse–patient relationship."

"The DEA refers to the problem of promoting pain relief and preventing abuse of pain medication as a balancing act. It can be more accurately described as a power struggle. The patient, in this context, is powerless. The DEA holds power, exercised by its investigative and prosecutorial functions, over all practitioners who prescribe controlled substances. The
clinician, motivated by the power of fear, exerts power over the patient in the form of refusal to prescribe
opioids or by imposing behavioral conditions for pain relief. As a result of the political and social contexts of
practice, chronic pain patients, by virtue of their diagnosis, are perceived as potential threats to the nurses who treat them; as a result, both the nurse and the patient can be seen as victims of the context of their relationship."

Oh well, I gotta go...I am happy to continue this discussion later!

Veteran Member

Date Joined Nov 2007
Total Posts : 6795
   Posted 4/16/2008 6:57 PM (GMT -6)   
Thanks, Disce! Sadly, I think this reflects the experience of many of us whether it be with NP's or PCP's or even other specialists. I was just reading an article from Medline on older patients and pain management and the term "opiophobia" was used in reference to how many health care professionals feel about prescribing opiates.

This is such a complex and tough issue. And some of us who are also health care professionals understand the pressures those who prescribe are under, but still, with increasing evidence about how untreated or undertreated chronic pain destroys the body, mind and lives we ought to be able to make some dents somewhere. But everytiime I see the commercials on tv about teenagers going to their parents' medicine cabinets to get their drugs I want to throw something at the tv. We need a public relations campaign for CPP's, but I know that takes a lot of money. Anyone know any millionairres?

By the way, I'm not sure but I think it might be ok to provide the complete reference, or a link to the original article. I think the problem came with reprinting the entire article.

Post Edited (PAlady) : 4/16/2008 6:02:46 PM (GMT-6)

Veteran Member

Date Joined Dec 2006
Total Posts : 649
   Posted 4/16/2008 9:33 PM (GMT -6)   
The last sentence about the "Power struggle" is absolutely correct. Disgusting and disheartening, but right on the money. I only wish I had a solution to the problem. :-(
Living in the Republic of Texas minus a gallbladder, a couple of cervical discs, appendix, uterus, and 18" of colon; but still alive and living with my husband, 2 dogs, 1 cockatiel, 1 quaker parrot and 2 gold fish. 

Regular Member

Date Joined Mar 2007
Total Posts : 413
   Posted 4/16/2008 11:18 PM (GMT -6)   
This topic always frustrates me b/c if you are a health care professional w/any substantial experience, you know exactly who is drug seeking and who is a legitimate pain sufferer--it looks different, feels different and smells different (right PAlady). Personally, I think (maybe) just like the pharmacists who do not want to distribute birth control b/c of personal/moral reasons, some providers don't "approve" of it.

Veteran Member

Date Joined Nov 2007
Total Posts : 6795
   Posted 4/16/2008 11:34 PM (GMT -6)   
That's a good point, Big Lucy. I'd say in the overwhelming majority of the cases you know the difference, at least those of us maybe used to assessing the "whole person". The main complication is with people who have legitimate pain but have also become (or already were) addicted and abusing drugs of some form. Then there's more sorting to do.

Post Edited (PAlady) : 4/16/2008 10:37:19 PM (GMT-6)

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