5 ms·

bribes - or payments?

by oleg123 9y ago

diogenescynic 9y ago
In America it's all the same. Or you can call it 'lobbying' if you really want to dress it up.
- deelowe 9y ago
  Doctor's aren't public officials. So no, you wouldn't call it that.
  - alexandercrohde 9y ago
    Doctors have taken an oath and have a public responsibility. They are liable for bad medical behavior (particularly if deliberate) [malpractice]. So let's not quibble over semantics.
    - dragonwriter 9y ago
      > They are liable for bad medical behavior (particularly if deliberate) Malpractice is in many senses a reduced standard of negligence liability compared to that faced by the general public, since it turns on established professional practice in the field not objective reasonableness in the circumstances.
    - outside1234 9y ago
      Believe it or not, this grew out of the threat of lawsuits if they DIDN'T prescribe opioids because they were ignoring the "5th vital sign" (pain). The real culprits here are the corporations - they should be liable for paying for the treatment of the folks addicted to the drugs they pushed.
      - alexandercrohde 9y ago
        Well if the root is the corporation, I think civil suits have proven ineffective at preventing such abuses. I wonder if the answer may be criminal suits and a greater emphasis on whistleblowing. Most people I know would rat out their company's immoral/illegal behavior for a million dollars.
      - smackingly 9y ago
        5th vital sign is urine output :) What is actually driving this is that income (and other hospital measures) is tied to patient satisfaction. Don't want to lose 30k/year because I didn't give the patient what they want. I'm an inpatient physician (ICU), so I never prescribe chronic opioids, but I am pretty liberal with them in the hospital. And no, I've never received a Panera lunch for the privilege of hearing about OxyContin. It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. Maybe we should simply ban the use of chronic opioids for non-cancer pain (or other similar etiologies). When I was a resident, I made all my patients sign an agreement that I would not prescribe chronic opioids unless they had metastatic cancer, were otherwise in a hospice facility, or I made a special exception. Don't sign? Then you find another doctor. I realize that will evoke some strong emotions from some of you, but you don't see the everyday begging from patients for more opioids when they obviously don't need them. Some people with legit use-cases will suffer under such a scheme. And that could drive up the use of heroin. There's no easy solution to this problem.
        DanBC 9y ago
        > 5th vital sign is urine output :) US doctors began prescribing many more opioids after a campaign by the VA describing pain as the 5th vital sign. Doctors began having to ask people about pain, which meant they had to treat that pain. The VA also said that opioids are not addictive when used to treat pain. They're not so addictive when used to treat acute pain, but they're more addictive when used to treat chronic pain. Very many more people got opioids to treat chronic pain because of this campaign. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ > It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. A lot of americans get opioids from doctors. https://www.cdc.gov/drugoverdose/data/prescribing.html https://www.cdc.gov/drugoverdose/data/prescribing.html > An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings > However, primary care providers account for about half of opioid pain relievers dispensed. Some states have between 93 and 143 opioid prescriptions per 100 people!!

bribes - or payments?

diogenescynic 9y ago

In America it's all the same. Or you can call it 'lobbying' if you really want to dress it up.

deelowe 9y ago
Doctor's aren't public officials. So no, you wouldn't call it that.
- alexandercrohde 9y ago
  Doctors have taken an oath and have a public responsibility. They are liable for bad medical behavior (particularly if deliberate) [malpractice]. So let's not quibble over semantics.
  - dragonwriter 9y ago
    > They are liable for bad medical behavior (particularly if deliberate) Malpractice is in many senses a reduced standard of negligence liability compared to that faced by the general public, since it turns on established professional practice in the field not objective reasonableness in the circumstances.
  - outside1234 9y ago
    Believe it or not, this grew out of the threat of lawsuits if they DIDN'T prescribe opioids because they were ignoring the "5th vital sign" (pain). The real culprits here are the corporations - they should be liable for paying for the treatment of the folks addicted to the drugs they pushed.
    - alexandercrohde 9y ago
      Well if the root is the corporation, I think civil suits have proven ineffective at preventing such abuses. I wonder if the answer may be criminal suits and a greater emphasis on whistleblowing. Most people I know would rat out their company's immoral/illegal behavior for a million dollars.
    - smackingly 9y ago
      5th vital sign is urine output :) What is actually driving this is that income (and other hospital measures) is tied to patient satisfaction. Don't want to lose 30k/year because I didn't give the patient what they want. I'm an inpatient physician (ICU), so I never prescribe chronic opioids, but I am pretty liberal with them in the hospital. And no, I've never received a Panera lunch for the privilege of hearing about OxyContin. It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. Maybe we should simply ban the use of chronic opioids for non-cancer pain (or other similar etiologies). When I was a resident, I made all my patients sign an agreement that I would not prescribe chronic opioids unless they had metastatic cancer, were otherwise in a hospice facility, or I made a special exception. Don't sign? Then you find another doctor. I realize that will evoke some strong emotions from some of you, but you don't see the everyday begging from patients for more opioids when they obviously don't need them. Some people with legit use-cases will suffer under such a scheme. And that could drive up the use of heroin. There's no easy solution to this problem.
      - DanBC 9y ago
        > 5th vital sign is urine output :) US doctors began prescribing many more opioids after a campaign by the VA describing pain as the 5th vital sign. Doctors began having to ask people about pain, which meant they had to treat that pain. The VA also said that opioids are not addictive when used to treat pain. They're not so addictive when used to treat acute pain, but they're more addictive when used to treat chronic pain. Very many more people got opioids to treat chronic pain because of this campaign. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ > It's an extremely complex and difficult problem. I think doctors are taking too much of the blame. A lot of americans get opioids from doctors. https://www.cdc.gov/drugoverdose/data/prescribing.html https://www.cdc.gov/drugoverdose/data/prescribing.html > An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings > However, primary care providers account for about half of opioid pain relievers dispensed. Some states have between 93 and 143 opioid prescriptions per 100 people!!