"Hey, you're a doctor. What's this rash on my back?"
"Oh, you're a doctor? Hey, why does my knee hurt when it rains?"
"So you're a doctor! Well you see I have this, uh, friend, and he...no it isn't me, I swear! Anyway, this friend of mine has had a problem with...do you think you could get him some Viagra?"
Get the idea? Most of the questions I get are completely unrelated to my field of expertise, which mostly has to do with either holes or sick organs inside the abdomen. Some, however, are relevant, and one I got recently from a reader named Miss A (not her real name) is particularly germane:
Hey Doc, I've been reading your FML posts for a while and graduated to your blog a few nights ago (which by the way is great reading material when your brain refuses to turn off and allow sleep), and I've noticed you have a few posts about drug seeking. My questions are, when is it ok to ask for medication, when is it ok to ask for stronger medication, and how do you approach the topic with your doctor?Asking for medication is always tricky as some of my patients have found out. The problem with pain is that it's 100% subjective. There is no test I can run on you that proves that you are in agony. There are warnings that most people emit unconsciously that we can easily detect that tell us that you're in bullshit mode. So having said that, here are some answers that may help.
Thanks for your time and opinions. Miss A
When is it ok to ask for medication? It's always ok to ask for pain medicine. That doesn't mean you'll get any, but if you're in pain, let someone know.
When is it ok to ask for stronger medicine? This is where you start to get into that grey zone. There are some lines that we hear over and over, and all of them raise huge red flags.
"I can only take XXXXX. It's the only one that works for me." If you start off by demanding a certain narcotic, especially one that has a side effect of euphoria, chances are very good you will NOT get it from me. Morphine, demerol, codeine, hydromorphone, fentanyl, and heroin all work the exact same way by binding to the exact same receptor. Their chemistries are all a little different, so they work to varying degrees. But if one of them works, chances are another one will work too.
"I'm allergic to all of the over-the-counter medicines." Sure you are. I can say with 99.99% certainty that isn't true, because the chance of actually having an allergy to paracetamol (Tylenol), aspirin, ibuprofen, and naproxen is very near 0. And the people who are supposedly allergic to them usually aren't quite sure what the allergy is ("Uh, they all make me sick"). Sorry, but nausea isn't an allergy.
"None of the over-the-counter medicines work for me." This is probably one of the biggest red flags. Of course they don't work - you've been abusing narcotics for so long, the only thing that WILL work is more narcotics.
"It all just hurts! I need pain medicine!" If you have no identifiable reason for having excruciating pain all over your body, we can rest assured that you aren't having excruciating pain all over your body. Yes, there are very rare disorders where very unfortunate patients have pain for no detectable reason. Fortunately for us (and unfortunately for you), these disorders are exceedingly rare.
How do you approach the topic with your doctor? Be open, honest, and frank. Don't be whiny, demanding, or aggressive. Let your doctor handle the details, and don't try to guide him in one direction. Understand that there are more and more non-narcotic analgesics available now than ever before, and if your doctor prescribes one for you, don't complain that it isn't Vicodin. Trust me when I tell you that you do NOT want to take narcotics for your chronic low back pain or your severe menstrual cramps. Once you start, it can be VERY difficult to stop - if you've ever seen a narcotic withdrawal scene in a movie, they are usually startlingly accurate.
I hope this helps not only the people with real pain who are seeking answers, but also the idiots who still think they are smart enough to con narcotics from me.
Wait a second...is Miss A tell me that this blog puts her to sleep? I suppose she can stop asking her doctor for sleeping pills now.