The Cure For Doctor Addiction!

Last week Doctor D told you about the dangers of doctor addiction. Today he's going to give you a twelve (actually 5) step program to save junkies!

Doctor Junkies feel an irresistible compulsion to see an MD every time they feel any physical discomfort form their bodies, resulting in risky tests and medicines as well as financial ruin for junkies and the healthcare system. While some responsibility for the problem rests with the junkies themselves, a lot of the blame for this can be laid on doctors who can be dealers and enablers for this deadly addiction.

Doctors are aware of the junkies in their lives. If you hang out with doctors (or read their blogs) you hear them complaining about junkies hitting them up for unnecessary care. "This patient of mine called an ambulance for a stubbed toe!" We gripe about our junkies, but we don't often propose solutions to improve the system that created this problem.

Well, today Doctor D is going to change that!

Doctors must take action to stop this madness before it gets out of control!

Here is Doctor D's plan to deliver our patients from the sad bondage of addiction to unnecessary medical care and lead them to the promised land of wellness!

1) Preach the Natural Healing Power of the Body.

Here's a big secret we don't often tell patients: the human body has an almost magical power to cure itself when infected and heal itself when injured! Who knew? In fact, before modern medicine this secret self-healing power of the body was the only thing that cured sick humans, and believe-it-or-not the human race survived. Modern patients and modern doctors often forget the human body has the ability to heal itself. Doctors are trained to intervene in the rare situations when body's own self-healing fails, but before long we find ourselves intervening when the body is doing a fine job on it's own because we only thing of medical cures not the body's own self-healing.

Doctors need to be spokespeople for the body's own immune system! We should spread the word about the body's abilities. We must acknowledge that even in our "medical miracles" the body does most of the healing on its own.

If MDs preach the amazing healing ability of the body, doctor-junkies will believe their body can handle that runny nose a few days without running to a doctor.

2) Grow a Pair and Don't Piss Your Scrubs at the Mention of Lawyers!

Most docs could easily educate patients on what symptoms usually aren't serious. Heck, we could give you a handout of all the symptoms that don't require a doctors visit if they are short lived: runny noses, coughs, joint aches, low-grade fevers, diarrhea, feeling yucky, etc. We could alleviate your anxiety with one therapeutic dose of knowledge.

Why don't we?

Doctors are terrified the information we give out will be used against us by blood-sucking lawyers.

We won't tell you to stay home with that runny nose because a nasal drainage could also be a symptom of a one in a million cerebrospinal fluid leak. We get terrified of missing zebras, so we kill a lot of horses. Fear of missing a rare diagnosis drives MDs to do irrational and dangerous things. We whip up doctor-junkies into a panic over their harmless symptoms and send them like lemmings over the cliff of over-doctoring.

Medicine is about taking risks. We risk your life every time we write a prescription or order a test. We should also be willing to take a risk by not doctoring conditions that are likely benign. There is risk either way, over-treatment protects us from lawyers, so physicians kill lots of doctor-junkies every year with big work-ups that are solely done to satisfy lawyers. Since we take risks either way, then we should practice with common sense and share our reassuring knowledge that most mild symptoms aren't dangerous with patients.

If blood-sucking lawyers want to sue me for using common sense, fine! Bring it on, bitches! Doctor D is ready!

3) Believe in prevention

Proper primary care can often prevent illness or catch it before it becomes serious. Fighting disease is only a secondary goal of medicine. Preventing serious illness is the real goal of primary care.

What does this have to do with doctor-junkies?

Doctor D has noticed a pattern that the MDs that give out the most unnecessary care to doctor-junkies are the same ones that suck at keeping their patients up to date on their preventive care. Coincidence? Nope.

Dangerous Doctorphilia is a need for the reassurance of receiving medical care. Preventative care fills this need in the safest possible way. Preventative care recommendations are constantly evaluated to insure their benefits far outweigh their risks. Appropriate preventative care and regular physicals can rehabilitate a former junkie. Their body has been checked for and vaccinated against most common problems. With prevention in their lives patients can have the confidence to weather minor symptoms without running to the ER.

4) Talk About the Risks of Medical Care.

Most patients don't realize that even appropriate medical care can be dangerous. Doctor-junkies love pills, and tests, and X-rays. The more the better! I've had junkies accuse me of trying to deny them the good stuff they are due when I'm just trying to protect them. "Order more, doc. I've got insurance!" WTF?

The best time to educate patients is when we are do appropriate interventions.

Many people at some point in their lives get a serious illness that requires aggressive care. If the power modern medicine helped their serious illness, they assume the same weapon should be used on their minor symptoms.

So, Doctor D actually educates people about the risks of care when he is giving it appropriately, "Antibiotic have some very real risks and I wouldn't give them if I didn't think your infection was serious." A word like this can save a patient from the frustrating and dangerous life of a doctor-addict who will beg for antibiotics every time they get a cold.

5) Educate Fearlessly!

Ultimately the cure for doctor-addiction is education. Instead of laughing at doctor-junkies' errors MDs should show them the light. Most doctor-junkies aren't stupid or irrational, they are just misguided about the proper use of medical care. It will take time and a bit of risk for doctors to show junkies a better way, but it is worth it.

After all, they are our junkies. Who is going to help them if not for doctors?

What do you think? Do you think this plan could will stem the tide of doctor-addiction? Have you ever had a doctor educate you on the power of your immune system or the risks of medical care? Did it help you avoid unnecessary medical care later?

As always Doctor D loves to hear your thoughts in the comments!

Doctored to Death?

What is a Doctor Junkie?

A commenter on the Medical Mafia post brought up the subject of doctor-junkies, and readers seemed fascinated by the idea.

Yes, doctor-junkies are real and they are everywhere!

Just as Doctorphobia is hazardous to your health, Doctorphilia can be equally disastrous.

Any regular reader of AskAnMD is aware that while MDs are useful, we can also be dangerous. An addiction to doctor-visiting will lead to lots of risky tests and medicines you don't need. Too much doctoring can take you to an early grave and make you miserable on your way there.

Who are these Doctor-Junkies?

Doctor-Junkie: (n) -a person who believes that every uncomfortable or unusual physical sensation must be evaluated by a doctor.

While most hypochondriacs are doctor-junkies, not all junkies are hypochondriacs. Some doctor-junkies aren't paranoid they have a horrible illness, but just feel every little thing must be "checked out."

Dangerous Doctorphilia is often an inherited condition. Doctor-junkies start out as those kids whose parents rush them to a doctor every time they sneeze or scrape their knee:

Once a mother brought her child to Doctor D's ER because the toddler had made an especially loud sigh. "A sigh?" I asked. "Yes, like this" and she made a sighing sound "so I just wanted you to check his lungs." Doctor D assured mom that we all sigh on a regular basis, but perhaps this sigh was louder because of her child's frustration that he had a mother with nothing better to do than gauge the volume of his sighs. She demanded a Chest X-ray just to make sure. Then Doctor D let out a loud sigh of his own.

You would think after a childhood spent in ER and clinic waiting rooms that someone would want to escape the world of needles and medicines, but the junkie is hooked by the time they reach adulthood. Any runny nose or sore muscle and the doctor-junkie gets that overpowering urge to visit somebody in a white coat quick. The doctor-junkie isn't satisfied with just an exam and reassurance, "No doc, I've been waiting a long time to see you so give me the good stuff—lab tests, X-rays, and lots of pills!"

To the doctor-junkie no symptom is too mild or too brief: every physical discomfort needs blood work and prescription medicine ASAP. If you doctor's office is on lunch break then junkies call an ambulance for that mild sense of nausea!

In addition to wasting billions of dollars, all those visits likely shorten the lives of the junkies. Radiation from imaging studies leads to cancers. Lab studies eventually uncover benign abnormalities that junkies need fixed. Junkies get some really nasty side effects from meds, because they've often been prescribed every medicine in the pharmacy.

Rather than forcing the junkie at rock bottom to change his ways, being harmed by healthcare has the opposite effect: a doctor-junkie who is sick from over-doctoring feels the compulsive need for more and more and more.

Who is to blame for this epidemic of Doctorphilia?

Doctors!

Yup, it's us. We have the stuff that junkies crave, and docs give out unnecessary care like candy till we get everybody hooked.

Why shouldn't we? Docs get paid to see people whether they are really sick or not. A proper exam followed by educating a concerned patient is difficult and time-consuming, while ordering tests and writing prescriptions is just so quick and easy. Doing unnecessary care and writing unnecessary prescriptions keeps patients happy with us because they feel they are getting something done.

Plus, it's nice to feel needed.

I know a doctor who shall remain nameless that gives antibiotics to every single person with a runny nose. Now almost all runny noses are caused by mild viruses that cannot be cured by any medicine. Dr. Zpack gives everybody a useless antibiotic and they all assume that the medicine worked when the symptoms resolve on their own. His patients are apparently unaware that human beings have immune systems. Dr. Zpack's junkie patients love him because he always "cures" their infection, and it's good business for him because half his visits are simple colds he can easily "fix" with one prescription. When Dr. Zpack's office is closed his patients panic and rush to the ER at the first cough. He's a nice old doc, but who knows how many superbugs and dangerous reactions have originated with Dr. Zpack's prescription pad?

The fact that doctors give out unnecessary care immediately legitimizes it. Patients accept that it must be safe and necessary if doctors order it. Some patients casually dabble in being over-doctored, but some susceptible patients fall over the edge into full-fledged addiction.

The Addiction Gets Ugly:

It's a win-win situation for the dealer and the junkie until something goes wrong: The junkie gets too demanding or overdoses on unnecessary care resulting in an iatrogenic injury. Then Dr. Dealer freaks out and cuts off the junkie cold turkey.

Doctor D has seen it too many times: panicked patients in withdrawal from over-doctoring pitching fits in the ER that they have to wait an hour to be seen for their runny nose.

Recovery:

Coming to Doctor D's office (or his blog) is like detox for doctor-junkies. Appropriate medical care is often a shock to the doctor-junkie's system. Doctor D has to explain to recovering junkies that the human body is actually capable of healing itself. Who knew?

Fortunately Doctor D has a 12 step program for the Doctor-Junkie epidemic. Tune in next week for my prescription for curing the over-doctored!

What do you think? Have you or loved one ever suffered from Dangerous Doctorphilia? How did you recover? Do you blame MDs for this problem?

Did you miss Doctor D? Where were you when you first heard the word iatrogenic? What other irreverent medical topics should this blog tackle?

As always, Doctor D loves to hear your thoughts and stories in the comments!

Pills and Suspicions (Controlled Drugs)

A question Doctor D gets asked a lot:

Why are doctors so stingy with medicines that make me feel better?

Yeah, I have to admit doctors are totally difficult when it comes to certain pain and anxiety medicines. You show up in a doctor's office and request a medicine that has worked for you in the past and suddenly you get read the riot act and treated like a criminal. Weird isn't it?

Doctor D admits that he does this too. It's not because he doesn't care. D went into medicine because he cares. He has just learned to be cautious over the years.

These medicines are very powerful. Some people really do require them when other meds just won't work, but they can also get you high or even make you stop breathing. Every MD has seen these medicines destroy people's lives.

Heath Ledger and Michael Jackson kicked the bucket because of medicines like this, and Doctor D can guess what's probably gonna show up in Brittney Murphy's toxicology report.

But forget about celebrities, these medicines harm regular folks every day. There was the young mother that broke down in Doctor D's office saying she can't make it though a day without buying pills off the street, and the high school freshman that died of an overdose after spending her birthday money on pills to party with her friends. You don't forget patients like those.

It's one thing to see somebody hopelessly addicted to alcohol or die of a cocaine overdose. It is really sad.

But with prescription drugs it's different. I'm the supplier of drugs that are killing local kids and ruining families. You can see why I get nervous about every prescription for a controlled substance I write.

I totally want to help people in pain. Unfortunately that compassion makes me a sucker for manipulative people. I wish that I could believe what every patient says they need, but if I gave everything that was requested of me I would most certainly end up killing someone. Therefore Doctor D uses very conservative prescribing practices to make sure he has obvious medical reasons for every prescription he writes.

This sucks for patients with legitimate needs who use these medicines responsibly. The behavior of the bad apples causes good people with real needs to be treated like criminals.

Sorry! Doctors hate to act like cops, too, but the very serious drug problem puts us all in positions we don't like.

Please be patient with us. Doctors really want to help people, so if you are honest, patient, straightforward, and work with the system you will usually be taken care of. But doctors are edgy about these meds so please don't react with anger or game the system. I understand your frustration, but acting out won't help you. It will send up red flags that may get you banned from every getting strong medicines.

What do you think? Are doctors too hard on patients who need controlled drugs, or do you find the restrictions reasonable? Have you ever been mistreated when you asked for medicines? ...or known someone who was addicted to pills? Doctor D would love to hear your thoughts in the comments!