An MD with Specialty i’me trying to track down here & would swear I’ve subscribed to - wrote a brilliant post in regard to what his perception is - That it’s really about reducing or even Controlling Women's’ Autonomy in General.. Myself ? Simple Observation might reveal ‘having God on your side’ & an OverDose or Addiction to Political Partisanship for Profit’ seems a commonality among so many who realistically are Just Hired Public Servants ! Theoretically Representing the Dreams Needs & Wishes of their local Constituents & Tax Payers .. 🦎🏴☠️
Or medical professionals make the decisions, and insurance companies save money by laying off all the claim benefit managers and simply paying for what they said they’d pay for.
The Crescent City Dr was also bad, she was a Navy reserve Physician working in a rural area, as you wrote.
I left the ER figuring the meds would work. About three days later, while driving south on I5, near Mt. Shasta, I had such a violent coughing spell that I almost blacked out.
My wife never had a trace of this because she had received DPT shots as a little girl.
Thanks for pointing that out to me, yes, I actually had two Doctors who missed-the-mark.
Great essay Dee! I read with interest as a nurse who is exposed to patients with substance use disorders. I’m glad to have seen the terminology become kinder and a lot of the stigma has been reduced. There is still a ways to go.
Thanks so much for sharing your experience and valuable perspective.
Thanks Kristin! All I can do is share my own experiences—and you have—and any greater judgements are based on that experience. I’m deeply entrenched with Hazelden Betty Ford as a consultant and donor and alumnus—and it shows me the struggles from the inside—and they’re the best in the business.
Resonates, Dee. I was fortunate to find sobriety in the wild, literally the jungle of Costa Rica. But I've known enough people to know how differently our darkest places can seem. It's all the same in the way become intolerant of ourselves, I suppose.
Chiming in because I saw that you chimed in on a comment I made elsewhere, then found your Substack, and was like, "Hey, I relate to this topic!" But this piece caught my eye above all the rest for one reason.
It's no guarantee that anyone will inform folks in recovery that doctor's might prescribe narcotics unaware of the consequences. Like, they've never asked me if I'm in recovery or have a history of use when going in for surgery, not in Costa Rica, and not where I live now in Mexico.
Thankfully, I know enough about "scripts" from my own history with "ab-usage" to know I needed to stay vigilant. More than once I've had to inform a doctor, "No. I cannot take that. It's narcotic and I'm in recovery."
And then the expression on their faces. It's priceless. Like, "Yes, but this is medicine, sir."
Thanks Damon for finding me and for weighing in. I appreciate it.
I love the—if I may—clueless look on the doctor’s face that you describe. “These highly addictive narcotics that have literally ruined millions of lives are medicine don’t you see?” 🤣😳
It would be infuriating if I didn’t know better. Sadly, I am at that age where it seems like I have an endless series of surgeries ahead. Gotta stay sharp and remember pain is okay to feel.
When my son was in the early stages of his substance abuse disorder, he visited one of the GPs in the practice where my family are patients.
That doctor glibly prescribed ritalin, which my son promptly abused. I was not impressed, to say the least. I think the SAD was something the doctor was aware of. He failed my son, who was busily failing himself in a thousand ways already.
Prefer the short version Dee ? Might suggest simply revising the Title
‘Why are Family Physicians Ill Prepared To Manage Patients With Addiction ?’
The Post itself remains an exceptional & personal ‘Case History.. & period of your life !
We both were bartenders dude .. & apparently highly adept drinkers rockin th casbah
PS for your readers - i’m Canadian - & would say the majority of my Educational & Corporate Motion Picture Production was CME - Accredited Continuing Medical Education for Healthcare Professionals - & the majority of that being related to Differential Diagnosis & Treatment of Mood Disorders
I’m all about Best Practices & Exemplars Dee & hate to inform you that ‘Privatization of Medical Services is more & more seen by Specific & identifiable ‘Political Factions’ as the Highway to Wealth & Profit & Altruism be damned !
‘takin no prisoners - & never shoot the messenger ! 🦎🏴☠️🇨🇦
Thanks for your comment friend. None of us have figured out healthcare as a nation. The public option has its benefits of broader coverage and private options have higher treatment levels. We in the US are caught between options and neither is serving adequately. When the government or insurance companies are making treatment decisions due to cost—ahead of clinicians—patients lose.
.. we need need better ‘words, terms, phrase & concise context Dee
There’s real reasons why i’m using ‘situational ethics’, or ‘aspirational transparency’ more & more & have now curbed & cured my ignorant habit of demeaning nature’s creatures re corrupt political partisanship.. like why would I demean pigs or snakes when ‘parasitism’ is clearly involved & perfectly apropos - in which case I may utilize ‘lamprey eel, sea lice or intestinal worms as reference - creatures that ‘attack & consume the host’
In 1956, the AMA pronounced alcoholism a “disease”…and mostly walked away from it (explanation to follow) and in 1987, they made a similar declaration for substance use disorders.
1. Their pronouncement compelled Health Insurance to cover the “disease.”
2. It helped shift the stigma from “a weak-willed” person to a “diseased” person.
Exactly what do I mean when I say “walked away” from the treatment? Give me a few sentences, lend me your eyes & ears.
Even before the publication of the DSM-5, in which the language changed & shifted the cause to the substance (instead of the self-administrating user), thousands of former “diseased” people who “recovered” & obtained Masters degrees became the first-line, non-medical personnel who received much of the insurance payments in the form of salary for “treating” addiction (a term that also is not PC now).
I personally know three stories of people who “recovered” and one was through Betty Ford. In all three stories, yes, Physicians are at the apex of the “treatment” pyramid. They prescribe medicines, and perform other duties that satisfy insurers who issue payment. Ask yourself, you know how much you paid, you know how many hours you were there - so, please estimate the number of hours you had with a Physician who “treated”your disease? Compare that to “treatment” rendered by Physicians when the disease is cancer or diabetes?
I am not a Doctor, I have a Masters in Forensic Sciences, took coursework in Drugs of Abuse, Forensic Pathology & worked Narcotics for six years as a Detective. Since Prince’s death in April, 2016, I updated my reading to include the synthetic opioids as it was Prince’s self-administration of Fentanyl (according to the Toxicology Report I obtained) that slowed his respiration and heart-rate to zero. Because of Prince’s death, I started blogging in May 2016.
Dee, May I take another stab at answering your question. Before taking a vacation in which we toured the West coast from San Diego to Vancouver, BC, we attended a catered picnic in Va. During the following week I started waking up with a cough that got the air out of my lungs, but I was prevented from inhaling. I visited my family Doctor and he was confounded, I even described how the phlegm was clear and viscous; still confounded, no meds prescribed.
On the vacation, things got worse, I would awake at 0300 and have wicked coughing fits. We went to a Hospital in Crescent City, Ca and the ER Doctor diagnosed bronchitis and ordered medicine. The medicine did not help. I returned to Virginia and found my way to a Physician in England who had a website for self diagnosis and the site featured a baby’s cough (Pertussis) as well as the cough of an adult. His first two diagnosis steps were these:
1. Are you between the age of 1-100?
2. When you cough, do people around you think that you are going to die?
He then reported that the Chinese refer to Pertussis as “the 100 day cough.” Scientifically, the Doctor indicated that the correct medicine - administered in the first day - can have success in controlling the cough. If the 10 day window closes, one is looking at 100 days.
I was convinced and I reported my Pertussis to the state Board of Health. They subsequently notified me that I had been on the first wave of an epidemic in Virginia. I also learned that California had an epidemic the same year.
A month or two later, I had a scheduled visit with my same, young, Doctor. When he entered the room, he asked me, “You don’t like me, do you.” I responded, “it is not a question of liking you. I came to you with a wicked cough and you could not diagnose it, I had to conduct the research, find a Doctor with a website and listen to coughs and self-diagnose, then report to the State Board, then learn of a small, Virginia, epidemic.” The Doctor responded, “They do not teach us that in Med-School, they teach us that we need to inoculate infants with the DPT shot/series and everything will be taken care of.”
I returned home and dug some more, I found that Pertussis vaccines began, in the U.S. in 1952. My wife, born in ‘57 in Japan, was routinely inoculated. I was born in the late 1940s. I was never inoculated. I also learned that I am no longer exposed to Pertussis.
Some time later, the Doctor moved-on, I never complained to superiors, Boards, anyone. I only provided info to the state Board of Health so they could put a pin on the map in Fairfax County. I started reading about the epidemic months later in local news.
The Doctor was a good guy. He listened closely to my description of my symptoms, however, I could not cough on demand. He stated that he was ill-equipped for producing a diagnosis - this was around 2008.
In 2008, Fairfax County was poised to cross the 1M mark for population. This Dr. was in the heart of a dense population, 20 miles from Medical Schools like GWU and Georgetown & the expanding IINOVA hospital/health care system. The Population of Fairfax County is now around 1.2M.
Further legal changes in USA to untie clinicians hands would help some. Methadone clinics and associated prescribing rules are a failed medical experiment.
I am not an addict, but I know who are. I will say three things: 1. primary care doctors should be provided with comprehensive resources within their employer's system or highly recommended mental health/addiction programs- one friend was given withdrawal meds and benzos (I'm not kidding!) without any referral by his PCP; 2. there are a lot of options for medically-supported sobriety which is a fair way to get a solid head-start and avoid unnecessary suffering; 3. AA is a toxic system because fear-mongering and compliance keeps already heavily-laden people with more guilt/shame- created by and run by lay people for a very serious and debilitating problem. That would be like going to see the medicine man to have an appendix removed surgically. I'm sure he knows SOMETHING about a bad appendix, but that does not qualify him to cut into people.
This is really a joint effort between the medical community for the physical addiction issues and mental health professionals to deal with the intra/inter-personal issues that must be addressed if real sober living is going to occur. I think this is an issue with the way medical schools are run and it isn't about to change. It has to come from the students who want to heal, they have to choose to specialize. It is the same in the field of dietetics. Doctors are only required to take ONE introduction nutrition class when there is an entire field on the subject. Collaboration is also not a strong point among physicians, especially outside their normal practice.
So, to a certain extent, I think we need to be patient with physicians because they are locked into a system that gives them very little wiggle room. The face of medicine is now about the dollar more than about being a healer- they are paid to medicate. There ARE doctors out there who specialize, and people who need their help need to do their due diligence to find them. It is dismally frustrating in many areas of health care- PCP's, immune-related diseases, hormone regulation, pain control, bone doctors, eye doctors...and more and more often, we have the option to go outside the system to physicians practicing on their own.
I see a correlation in Judges and legislators attempting to control my reproductive health.
An MD with Specialty i’me trying to track down here & would swear I’ve subscribed to - wrote a brilliant post in regard to what his perception is - That it’s really about reducing or even Controlling Women's’ Autonomy in General.. Myself ? Simple Observation might reveal ‘having God on your side’ & an OverDose or Addiction to Political Partisanship for Profit’ seems a commonality among so many who realistically are Just Hired Public Servants ! Theoretically Representing the Dreams Needs & Wishes of their local Constituents & Tax Payers .. 🦎🏴☠️
Or medical professionals make the decisions, and insurance companies save money by laying off all the claim benefit managers and simply paying for what they said they’d pay for.
I’d be willing to pay out of pocket for quality medical care—as I did for my Betty Ford treatment pre-ACA.
Like it used to be 🤷🏻♂️
Thanks for republishing this Dee. Glad to read some of your earlier stuff. Lots to digest here.
Thank you sir 🫡
The Crescent City Dr was also bad, she was a Navy reserve Physician working in a rural area, as you wrote.
I left the ER figuring the meds would work. About three days later, while driving south on I5, near Mt. Shasta, I had such a violent coughing spell that I almost blacked out.
My wife never had a trace of this because she had received DPT shots as a little girl.
Thanks for pointing that out to me, yes, I actually had two Doctors who missed-the-mark.
Phil
Great essay Dee! I read with interest as a nurse who is exposed to patients with substance use disorders. I’m glad to have seen the terminology become kinder and a lot of the stigma has been reduced. There is still a ways to go.
Thanks so much for sharing your experience and valuable perspective.
Thanks Kristin! All I can do is share my own experiences—and you have—and any greater judgements are based on that experience. I’m deeply entrenched with Hazelden Betty Ford as a consultant and donor and alumnus—and it shows me the struggles from the inside—and they’re the best in the business.
Resonates, Dee. I was fortunate to find sobriety in the wild, literally the jungle of Costa Rica. But I've known enough people to know how differently our darkest places can seem. It's all the same in the way become intolerant of ourselves, I suppose.
Chiming in because I saw that you chimed in on a comment I made elsewhere, then found your Substack, and was like, "Hey, I relate to this topic!" But this piece caught my eye above all the rest for one reason.
It's no guarantee that anyone will inform folks in recovery that doctor's might prescribe narcotics unaware of the consequences. Like, they've never asked me if I'm in recovery or have a history of use when going in for surgery, not in Costa Rica, and not where I live now in Mexico.
Thankfully, I know enough about "scripts" from my own history with "ab-usage" to know I needed to stay vigilant. More than once I've had to inform a doctor, "No. I cannot take that. It's narcotic and I'm in recovery."
And then the expression on their faces. It's priceless. Like, "Yes, but this is medicine, sir."
Thanks Damon for finding me and for weighing in. I appreciate it.
I love the—if I may—clueless look on the doctor’s face that you describe. “These highly addictive narcotics that have literally ruined millions of lives are medicine don’t you see?” 🤣😳
It would be infuriating if I didn’t know better. Sadly, I am at that age where it seems like I have an endless series of surgeries ahead. Gotta stay sharp and remember pain is okay to feel.
Indeed.
When my son was in the early stages of his substance abuse disorder, he visited one of the GPs in the practice where my family are patients.
That doctor glibly prescribed ritalin, which my son promptly abused. I was not impressed, to say the least. I think the SAD was something the doctor was aware of. He failed my son, who was busily failing himself in a thousand ways already.
I’m sorry you went through that. It’s not an uncommon experience. 😪
Prefer the short version Dee ? Might suggest simply revising the Title
‘Why are Family Physicians Ill Prepared To Manage Patients With Addiction ?’
The Post itself remains an exceptional & personal ‘Case History.. & period of your life !
We both were bartenders dude .. & apparently highly adept drinkers rockin th casbah
PS for your readers - i’m Canadian - & would say the majority of my Educational & Corporate Motion Picture Production was CME - Accredited Continuing Medical Education for Healthcare Professionals - & the majority of that being related to Differential Diagnosis & Treatment of Mood Disorders
I’m all about Best Practices & Exemplars Dee & hate to inform you that ‘Privatization of Medical Services is more & more seen by Specific & identifiable ‘Political Factions’ as the Highway to Wealth & Profit & Altruism be damned !
‘takin no prisoners - & never shoot the messenger ! 🦎🏴☠️🇨🇦
Thanks for your comment friend. None of us have figured out healthcare as a nation. The public option has its benefits of broader coverage and private options have higher treatment levels. We in the US are caught between options and neither is serving adequately. When the government or insurance companies are making treatment decisions due to cost—ahead of clinicians—patients lose.
.. we need need better ‘words, terms, phrase & concise context Dee
There’s real reasons why i’m using ‘situational ethics’, or ‘aspirational transparency’ more & more & have now curbed & cured my ignorant habit of demeaning nature’s creatures re corrupt political partisanship.. like why would I demean pigs or snakes when ‘parasitism’ is clearly involved & perfectly apropos - in which case I may utilize ‘lamprey eel, sea lice or intestinal worms as reference - creatures that ‘attack & consume the host’
The giant worms in “Dune” come to mind. Where’s my thumper?!?! 😳😳
Thanks for weighing in. 🙏
I’m in agreement with most of what you commented with the exception of your opinion of AA.
In 1956, the AMA pronounced alcoholism a “disease”…and mostly walked away from it (explanation to follow) and in 1987, they made a similar declaration for substance use disorders.
1. Their pronouncement compelled Health Insurance to cover the “disease.”
2. It helped shift the stigma from “a weak-willed” person to a “diseased” person.
Exactly what do I mean when I say “walked away” from the treatment? Give me a few sentences, lend me your eyes & ears.
Even before the publication of the DSM-5, in which the language changed & shifted the cause to the substance (instead of the self-administrating user), thousands of former “diseased” people who “recovered” & obtained Masters degrees became the first-line, non-medical personnel who received much of the insurance payments in the form of salary for “treating” addiction (a term that also is not PC now).
I personally know three stories of people who “recovered” and one was through Betty Ford. In all three stories, yes, Physicians are at the apex of the “treatment” pyramid. They prescribe medicines, and perform other duties that satisfy insurers who issue payment. Ask yourself, you know how much you paid, you know how many hours you were there - so, please estimate the number of hours you had with a Physician who “treated”your disease? Compare that to “treatment” rendered by Physicians when the disease is cancer or diabetes?
I am not a Doctor, I have a Masters in Forensic Sciences, took coursework in Drugs of Abuse, Forensic Pathology & worked Narcotics for six years as a Detective. Since Prince’s death in April, 2016, I updated my reading to include the synthetic opioids as it was Prince’s self-administration of Fentanyl (according to the Toxicology Report I obtained) that slowed his respiration and heart-rate to zero. Because of Prince’s death, I started blogging in May 2016.
Substanceabuseforparents.blogspot.com
Praise God you went to Betty Ford!
Thanks Phil for your impassioned response. I will definitely check your blog. And yes—praise Betty!
Dee, May I take another stab at answering your question. Before taking a vacation in which we toured the West coast from San Diego to Vancouver, BC, we attended a catered picnic in Va. During the following week I started waking up with a cough that got the air out of my lungs, but I was prevented from inhaling. I visited my family Doctor and he was confounded, I even described how the phlegm was clear and viscous; still confounded, no meds prescribed.
On the vacation, things got worse, I would awake at 0300 and have wicked coughing fits. We went to a Hospital in Crescent City, Ca and the ER Doctor diagnosed bronchitis and ordered medicine. The medicine did not help. I returned to Virginia and found my way to a Physician in England who had a website for self diagnosis and the site featured a baby’s cough (Pertussis) as well as the cough of an adult. His first two diagnosis steps were these:
1. Are you between the age of 1-100?
2. When you cough, do people around you think that you are going to die?
He then reported that the Chinese refer to Pertussis as “the 100 day cough.” Scientifically, the Doctor indicated that the correct medicine - administered in the first day - can have success in controlling the cough. If the 10 day window closes, one is looking at 100 days.
I was convinced and I reported my Pertussis to the state Board of Health. They subsequently notified me that I had been on the first wave of an epidemic in Virginia. I also learned that California had an epidemic the same year.
A month or two later, I had a scheduled visit with my same, young, Doctor. When he entered the room, he asked me, “You don’t like me, do you.” I responded, “it is not a question of liking you. I came to you with a wicked cough and you could not diagnose it, I had to conduct the research, find a Doctor with a website and listen to coughs and self-diagnose, then report to the State Board, then learn of a small, Virginia, epidemic.” The Doctor responded, “They do not teach us that in Med-School, they teach us that we need to inoculate infants with the DPT shot/series and everything will be taken care of.”
I returned home and dug some more, I found that Pertussis vaccines began, in the U.S. in 1952. My wife, born in ‘57 in Japan, was routinely inoculated. I was born in the late 1940s. I was never inoculated. I also learned that I am no longer exposed to Pertussis.
Some time later, the Doctor moved-on, I never complained to superiors, Boards, anyone. I only provided info to the state Board of Health so they could put a pin on the map in Fairfax County. I started reading about the epidemic months later in local news.
The Doctor was a good guy. He listened closely to my description of my symptoms, however, I could not cough on demand. He stated that he was ill-equipped for producing a diagnosis - this was around 2008.
https://www.vdh.virginia.gov/content/uploads/sites/13/2016/02/Pertussis.pdf
I hope that the Doctor is thriving and continuing to learn, as I do.
Realizing that a small town GP doctor’s job is complex—that’s quite a spooky story.
In 2008, Fairfax County was poised to cross the 1M mark for population. This Dr. was in the heart of a dense population, 20 miles from Medical Schools like GWU and Georgetown & the expanding IINOVA hospital/health care system. The Population of Fairfax County is now around 1.2M.
Ahh. I thought you were referring to the Crescent City doc.
Outstanding .. your background astonishes ! I must visit ! 🦎🏴☠️🇨🇦
Further legal changes in USA to untie clinicians hands would help some. Methadone clinics and associated prescribing rules are a failed medical experiment.
Harm reduction in general 🙄
I am not an addict, but I know who are. I will say three things: 1. primary care doctors should be provided with comprehensive resources within their employer's system or highly recommended mental health/addiction programs- one friend was given withdrawal meds and benzos (I'm not kidding!) without any referral by his PCP; 2. there are a lot of options for medically-supported sobriety which is a fair way to get a solid head-start and avoid unnecessary suffering; 3. AA is a toxic system because fear-mongering and compliance keeps already heavily-laden people with more guilt/shame- created by and run by lay people for a very serious and debilitating problem. That would be like going to see the medicine man to have an appendix removed surgically. I'm sure he knows SOMETHING about a bad appendix, but that does not qualify him to cut into people.
This is really a joint effort between the medical community for the physical addiction issues and mental health professionals to deal with the intra/inter-personal issues that must be addressed if real sober living is going to occur. I think this is an issue with the way medical schools are run and it isn't about to change. It has to come from the students who want to heal, they have to choose to specialize. It is the same in the field of dietetics. Doctors are only required to take ONE introduction nutrition class when there is an entire field on the subject. Collaboration is also not a strong point among physicians, especially outside their normal practice.
So, to a certain extent, I think we need to be patient with physicians because they are locked into a system that gives them very little wiggle room. The face of medicine is now about the dollar more than about being a healer- they are paid to medicate. There ARE doctors out there who specialize, and people who need their help need to do their due diligence to find them. It is dismally frustrating in many areas of health care- PCP's, immune-related diseases, hormone regulation, pain control, bone doctors, eye doctors...and more and more often, we have the option to go outside the system to physicians practicing on their own.