Prescribing Decisions Take Place Amid “A Swirl of Imperfect Circumstances”

The opinion pages of The New York Times last week featured a succinct summary of the pain management balancing act confronting primary care practitioners in the US. The issues will be familiar to all readers of the Daily Dose. In “The Pain Medication Conundrum” Danielle Ofri, MD, an associate professor at New York University, relates the story of an office visit with a patient with diabetes, hypertension, obesity, and other health problems, including past heroin use, who also was now seeking opioid pain medication for back pain from a prior injury. Dr. Ofri’s observations provide compelling affirmation of the need for better pain education and for changes in public policy as regards treatment for chronic pain.

“For patients with chronic pain, especially those with syndromes that don’t fit into neat clinical boxes, being judged by doctors to see if they ‘merit’ medication is humiliating and dispiriting,” Dr Ofri writes. “It’s equally dispiriting for doctors. This type of judgment, with its moral overtones and suspicions, is at odds with the doctor-patient relationship we work to develop.” Dr. Ofri describes the patient consultation as an exercise in “sizing each other up,” and the deleterious effect of the conversation on their levels of mutual trust.

Read the complete article here.



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