The prescription drug crisis: Et tu, Washington?

Jason Fodeman Physician
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The tragic death of Whitney Houston has once again shined the spotlight on the abuse of prescription drugs and the doctors who prescribe them. Legislators, experts and pundits are blaming physicians for liberally prescribing narcotics, but an honest debate must also examine how government policy has helped foster this crisis.

The abuse of prescription medications is not limited to Rodeo Drive and the Upper East Side. It is a national problem. From Crenshaw to Harlem, and practically everywhere in between, it plagues the practice of good medicine in both the inpatient and outpatient settings.

Inevitably, doctors with the power to prescribe these medications have found themselves at the center of the storm. Are physicians avaricious enablers looking to profit off the addiction of others or are they merely pawns desperately trying to stay afloat navigating the system legislators and regulators have established?

In a health care system dominated by the price controls of Medicare and Medicaid, physicians can increasingly only make a living by cramming more and more patients into the schedule. Time is at a premium and this translates into appointments with only minutes of actual patient face time.

It takes only seconds to write the prescription, but can take 10, 20 or 30 minutes for physicians to try to convince a patient that he or she does not need narcotics. Often the pain would be better treated with anti-inflammatory medications or more conservative measures, such as warm compresses and physical therapy.

A reimbursement system that rewards quantity at the expense of quality does not grant doctors the time for these important discussions. Not only are physicians financially punished for resisting, but these efforts actually take away time from other patients and could ultimately jeopardize their care.

Today’s litigious society also puts pressure on physicians to prescribe. Providers are always fearful of being sued and a patient who is upset after not being prescribed potent pain killers is much more likely to sue than a happy one.

Hospitals are also fearful of lawsuits. Drug-seeking patients exploit this by filing complaints with nurse managers, supervisors and administrators when they are not prescribed narcotics. Physicians are then questioned about these “incidents” and forced to waste time, energy and effort defending their decision to do the right thing. This is a distraction from patient care. It is a frustrating hassle that could have easily been prevented if the doctor had just caved and ordered the pain medicine in the first place.

Legislation that would tighten the noose with new narcotic oversight, fees, paperwork and stiffer penalties is not the answer. This would likely do more harm than good for patients and could ironically exacerbate some of the pressures compelling physicians to over-prescribe pain medications.

Like any profession, of course, there are a few bad apples in medicine and sufficient legislation already exists to hold them accountable. Conrad Murray crossed the line in his treatment of Michael Jackson. He was convicted and will spend the next four years in prison. This, however, is the exception. Most physicians are hard-working individuals trying to practice quality medicine and make an honest living on the government’s terms.

While the dust has yet to settle on the current tragedy, those politicians and regulators calling for the heads of the doctors involved should take a long hard look in the mirror at the role they have played in creating the prescription drug crisis.

Jason D. Fodeman, M.D. is an internal medicine resident.