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!

Take The Bitter Pill? (Drug Side Effects)

From a reader:

"I am so tired of taking medications that seem to cause more problems than my diagnosed disease."

This is one of the trickiest problems in doctoring: all medicines have side effects. Doctors treat diseases, but we unintentionally cause a lot of suffering with our treatments.

Some medicines cause frequent side effects. Some medicines cause them only occasionally. Some patients very rarely get side effects. Some people seem to get a side effect from everything they take. Any one person's reaction to any one medicine is impossible to predict. It gets pretty complicated.

It's important to understand that having a side effect doesn't mean it was a "bad medicine." It may work great for lots of other people. You should also realize that a bad side effect doesn't necessarily mean you had an incompetent doctor. Doctor D can't count how many patients have told him, "I'm never going back to Dr. SoAndSo, because he gave me a prescription for a poison. It made me feel terrible." (Patients have probably said this about Doctor D too.) The doctor who diagnosed you and gave the medicine is often in the best position to help you approach the problem of side effects.

In the end, only you can decide if it is worth taking any particular medicine, but your doctor can help you understand the pros and cons of any medicine or treatment.

A few common situations involving medicines:

• Dangerous Disease, Few Symptoms: Some diseases like Hypertension cause almost no symptoms until it is too late. Lots of people stop blood pressure medicine for mild side effects just because they just cannot feel the pressure destroying their arteries. Low-symptom diseases like Hypertension, Type II Diabetes, and High Cholesterol kill millions even though we have lots of great medicines. People have a hard time taking medicine when they don't feel sick. If you have medicine side effects with one of the "silent killers" you really need to talk to your doctor about switching medicines. Going without any treatment is a bad idea.

• Benign Disease, Miserable Symptoms: A lot of conditions from the Common Cold to Fibromyalgia never kill anyone, but they can make you feel horrible. The symptoms are the disease and therefore if you can handle the disease better than the medicine the choice is obvious. Just be sure your doctor agrees you have a benign condition before making this decision.

• Bad Disease, Bad Medicine: This is always a difficult place to be. A horrible disease that is treated with medicines that make most people miserable. Many cancers fall into this category. Your doctor can help you understand the probable risks of the disease as well as the expected side effects of the medicine, but remember the decision is yours.

• Mixed Diseases: Some diseases cause some difficult symptoms now and often vary in the amount of long-term damage they cause. Rheumatoid Arthritis is an example of such a condition. Treatments are aimed at current symptoms, at long-term damage, or both. Decisions about medicines in such conditions are never as clear cut as the other diseases. If you have trouble tolerating a medicine, you should ask your doctor if stopping it would have any long-term ramifications.

All these decisions belong to you, but doctors are useful for educating you. If a medicine makes you miserable ask you doctor, ""I'd love to stop this med because of side effects, what might I risk by doing this? Are there other medicines that I could try?"

Have you ever quit a treatment that was working because of side effects? Was your doctor helpful in your decision-making process? Doctor D would love to hear your stories.