• Ronald Chapman, LL.M.

Pain Management Physicians: 4 Helpful Reminders Before You Refuse, Reduce or Discharge



Here are four helpful reminders for pain management physicians before refusing, reducing or discharging a patient who is on opioid medication.

For regular healthcare defense updates follow "the Healthcare Defendant" on Twitter @healthcaredef


1. Addiction is Not a Crime Its a Disease


Addiction is not a crime, it's a disease. Dependence is a common occurrence when any patient is on a long term stable dose of opioid medication. Signs of addiction must not be punished, but rather, should be treated as any other disease - with treatment. The proper course of action is to treat a dual diagnosis patient for addiction and pain. As a last resort, referral to an addiction medicine clinic may be helpful. When pain management providers discharge patients who present with signs of addiction instead of assisting them - its actually evidence that the provider is not legitimate and fearful of government interaction. It tells investigators and regulators that the doctor does not care enough about the patient to ensure their dual diagnosis is treated.


2. Fear is Not a Substitute for Medical Judgment


Many prescribers cite CDC guidelines or the DEA as a reason that they need to reduce a patient's medication or decline to prescribe an appropriate dose of pain medications. This is akin to telling a patient "the Government is making me do it". This type of treatment utilizes fear instead of compassion and misunderstands the fundamental reasons doctors are being targeted during the opioid epidemic. Providers are not being targeted for their compassion, they are being targeted for abandoning patient care and adhering to poorly documented cookie cutter treatment modalities. Prescribers who listen to their patients, prescribe an appropriate dose of medication, followup at regular intervals, progress treatment using multiple modalities, and properly document - are easily defensible regardless of the dose of medication or "MME".


3. Discharge is a Last Resort


Discharging a patient should only be done when the provider is convinced that the patient has engaged in drug diversion and the patient does not actually need the medication. This can be the result of multiple negative urine drug screens or an admission of sale of the medication, etc. Signs of dependence, addiction, overuse, dose escalation, etc. are signs of psuedo-addiction and may actually be a symptom of a greater pain problem. These signs must be well documented and handled appropriately. To be blunt, summarily discharging every high risk patient is harmful and lazy. Furthermore, it's actually a sign that the provider may not be legitimately providing patient care.


4. Under Treatment is Malpractice


When a patient comes into your office seeking treatment and establishes a physician patient relationship with a provider, the provider takes on the obligation to treat the patient in accordance with ethical standards and the Hippocratic oath. This means that the patient is entitled to an individual assessment of his or her condition and individualized treatment. Under-treatment for fear of exceeding federal "recommendations" such as the CDC guidelines is malpractice. Leaving a patient in pain for fear of government investigation, board complaint, or scrutiny is improper. Physicians have a duty to individually assess and treat pain and if the physician does not feel comfortable doing so, he or she should refer the patient to a provider who can.


For regular healthcare defense updates follow "the Healthcare Defendant" on Twitter @healthcaredef


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