Friday, July 15, 2005

Narcotic Nightmare

It seems that more and more of my time at work is taken up by patients in need of narcotic medications. As the "middle-man" between my patients and their providers at the clinic, I negotiate contracts around the use of narcotics and monitor patient's side effects, pain levels, and adherence to our agreements. While many people are sincerely in pain and certainly need narcotics to ease their suffering, there are always some whose motivations seem slightly dubious and cause confusion and difficulty for their providers. A history of substance abuse also complicates the picture and makes treating pain more challenging. It's times like these that I give thanks that I'm not a Nurse Practitioner and have no prescriptive authority. Put into the position of listening to a patient's complaints and assessing their needs, I know that I would be a soft touch, always erring on the side of believing a patient, even if my intuition led me to think otherwise.

Pain is widely under-treated in this country and I'm happy to assist in managing patients' pain, but it is admittedly a confusing and trying ordeal at times. While pain advocates in the medical world are pushing for more recognition of pain as the "fifth vital sign" (after temperature, pulse, respirations, and blood pressure), it is still not always clearly seen by providers and is treated with less than germaine levels of attention.

Many of the docs at the clinic only work part-time, so I often find myself negotiating for narcotic prescriptions when my patients call for refills. Add to that the fact that patient's charts are often MIA at the the clinic, making documentation and double-checking of doses even harder. I think I can say that this is my least favorite aspect of my job, one which causes me endless distress and cognitive dissonance. The fact that I started writing this entry just before midnight on a Friday underscores the notion that it weighs heavily on my mind.

I'd like to write about this some more in future, but send this missive out into the cyber-ethers to allow myself to let it go for my long, four-day weekend. A short vacation is in order and I must clear my mind of static.
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