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Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. Anyway if it's really 100x more potent than morphine y

by WJW 6y ago

Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. Anyway if it's really 100x more potent than morphine you'd think any person that did have it in their bloodstream would not be all that capable of stating that they have not had their medication yet.

klyrs 6y ago
This is one of the most pernicious aspects of the opioid crisis. Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Number one criteria seems to be that the patient is requesting medication. In so many cases, the patient is the most reliable source of information... but when it comes to pain management, the patient is not to be trusted.
- akiselev 6y ago
  Our attempts at solving the problem even seems to drive the expert doctors who are actually qualified to do so out of the field. The prescription mills force heavy handed regulations that spook the insurers and hospital legal teams, which leaves two extremes: on the one hand are doctors who can't empathize with the patient and are super strict with any sort of scheduled medication and on the other are doctors whose offices don't see enough patients taking those drugs (or even a single problematic case), so they neither know nor care about the risks and give the drug out freely. Since their numbers are so low, no one thinks to bring up the issue. The doctors who are most qualified in making the determination are often the ones with the most legitimate patients taking those drugs but all the legal teams and regulators are completely incapable of differentiating them from the prescription mills (excuse me, "pain management centers").
- ReactiveJelly 6y ago
  > Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo... Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.
  - deleted 6y ago
    [deleted]
  - watertom 6y ago
    Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.
    - intricatedetail 6y ago
      Some doctors take pleasure in telling patients in pain that they make it up and suggest they are just drug junkies looking for a hit.
      - brooklyndude 6y ago
        I have worked with with healthcare professionals for decades, have never once met seen an MD or nurse take pleasure in seeing a patient in pain. I’ve interviewed over 10,000 people to date. We live in two different computer simulations I guess.
  - thaumasiotes 6y ago
    > Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. It's much stupider than that. Addicts want the drug. So all of the indicators of addiction are actually indicators of wanting the drug. So anyone who wants the drug is, ipso facto, an addict. There's no element of addicts trying to look more genuine. Look at that list of red flags: - Complaining of a need for a drug. - Asking for more of a drug. - Asking for a particular drug by name. - Sometimes taking a drug on your own initiative.
    - klyrs 6y ago
      Moreover, addicts suffering withdrawal are... suffering. This is the reason I put quotes around "genuine" in my original comment. The distinguishing factor between suffering from withdrawal and suffering from another source of pain is a moralizing judgement call on the doctor's part.
- corobo 6y ago
  I understand where they're coming from but could they not loosen the rules for the person who has a clearly visible injury? Could they not check the chart? Is there even a chart anymore?
  - klyrs 6y ago
    There's plenty of chart, but far more hubris. In my experience, everybody writes in charts, but the rare doctor who reads them is a saint.
    - corobo 6y ago
      Personally I'd be focused there than making sure addicts don't get a bit of free medication.. that's bizarre and quite scary.
martinmunk 6y ago
100x more potent just means you will give 1/100 the dose for the same effect. Around here, fentanyl is used in ambulances. Biggest side effect is it can stop your breath if it’s more than the dose given in lollipops (field-style first aid thing), so you have to keep an eye on the patient.
nickjj 6y ago
> Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. You'd be surprised at how questionable hospital care is run in NY, even with $450 / month insurance with a high deductible. To protect the privacy of the person I know, here's a story from 2-5 months ago: - Person A goes into doctor's office for something pretty common - Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms - Person A gets the scan - Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous - Person A books surgery - Hospital gives prep instructions to be performed by Person A 48 hours before surgery - Person A does everything and goes in for surgery - Person A is prepped for surgery and is put under anesthesia - Surgeon comes in and looks at the scan in the operating room - Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer - Person A is wondering how the surgery went after coming to from being put out - Nurse says no surgery was done and even she was able to look at the scan and see nothing was wrong - Person A is told to go home and wait 4-6 weeks to self heal So let's ignore thousands of dollars in bills (deductibles). All of this could have been avoided if someone actually looked at the results of the scan before going through the motions of putting someone under anesthesia and a massive amount of stress. That's only 1 of many stories. In another case someone I knew had their blood drawn twice in the hospital because the 2nd nurse didn't believe them when they said they just got their blood drawn by another nurse 10 minutes ago. The vials were literally next to them, about 3 arm's lengths away.
- noir_lord 6y ago
  Over here in the UK they generally mean well, almost without fault every one of my specialists, doctors and nurses have been awesome. That said man do they fuck up, most recently was a fun one, I had a scheduled appointment, turned up for it, doctor was in his treatment room seeing patients, forgot to see me and went for lunch. I mean it's minor but I'd checked in, the computer had me as waiting but he'd looked at the list, not seen me and went for lunch - I spoke to the nurse told her I didn't mind waiting while he ate and she tracked him down, he was incredibly apologetic (unnecessarily so, shit happens). It's inevitable in a system as complex as healthcare that mistakes are going to be made but we probably should assess the proximal causes much like the airlines/plane manufacturers did to reduce the incidence.
trhway 6y ago
>Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. i somehow think that a medical doctor should be able to tell whether a person has an opioid [at least in a pain relieving dose] in their system.
- deleted 6y ago
  [deleted]
sk5t 6y ago
FWIW, I had a pretty bad bicycle accident and was administered morphine, dilaudid, and fentanyl (in that order) at various times in the hours following. Only dilaudid had any affect at all on my clarity of thought.
refurb 6y ago
if it's really 100x more potent than morphine you'd think any person that did have it in their bloodstream would not be all that capable of stating that they have not had their medication This is off topic, but when a drug is 100x more powerful, they just give 100x less of it. So whether you get morphine or fentanyl the effect is approximately the same - and that's intentional.

by WJW 6y ago

klyrs 6y ago

This is one of the most pernicious aspects of the opioid crisis. Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Number one criteria seems to be that the patient is requesting medication. In so many cases, the patient is the most reliable source of information... but when it comes to pain management, the patient is not to be trusted.

akiselev 6y ago
Our attempts at solving the problem even seems to drive the expert doctors who are actually qualified to do so out of the field. The prescription mills force heavy handed regulations that spook the insurers and hospital legal teams, which leaves two extremes: on the one hand are doctors who can't empathize with the patient and are super strict with any sort of scheduled medication and on the other are doctors whose offices don't see enough patients taking those drugs (or even a single problematic case), so they neither know nor care about the risks and give the drug out freely. Since their numbers are so low, no one thinks to bring up the issue. The doctors who are most qualified in making the determination are often the ones with the most legitimate patients taking those drugs but all the legal teams and regulators are completely incapable of differentiating them from the prescription mills (excuse me, "pain management centers").
ReactiveJelly 6y ago
> Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo... Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.
- deleted 6y ago
  [deleted]
- watertom 6y ago
  Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.
  - intricatedetail 6y ago
    Some doctors take pleasure in telling patients in pain that they make it up and suggest they are just drug junkies looking for a hit.
    - brooklyndude 6y ago
      I have worked with with healthcare professionals for decades, have never once met seen an MD or nurse take pleasure in seeing a patient in pain. I’ve interviewed over 10,000 people to date. We live in two different computer simulations I guess.
- thaumasiotes 6y ago
  > Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. It's much stupider than that. Addicts want the drug. So all of the indicators of addiction are actually indicators of wanting the drug. So anyone who wants the drug is, ipso facto, an addict. There's no element of addicts trying to look more genuine. Look at that list of red flags: - Complaining of a need for a drug. - Asking for more of a drug. - Asking for a particular drug by name. - Sometimes taking a drug on your own initiative.
  - klyrs 6y ago
    Moreover, addicts suffering withdrawal are... suffering. This is the reason I put quotes around "genuine" in my original comment. The distinguishing factor between suffering from withdrawal and suffering from another source of pain is a moralizing judgement call on the doctor's part.
corobo 6y ago
I understand where they're coming from but could they not loosen the rules for the person who has a clearly visible injury? Could they not check the chart? Is there even a chart anymore?
- klyrs 6y ago
  There's plenty of chart, but far more hubris. In my experience, everybody writes in charts, but the rare doctor who reads them is a saint.
  - corobo 6y ago
    Personally I'd be focused there than making sure addicts don't get a bit of free medication.. that's bizarre and quite scary.

martinmunk 6y ago

100x more potent just means you will give 1/100 the dose for the same effect. Around here, fentanyl is used in ambulances. Biggest side effect is it can stop your breath if it’s more than the dose given in lollipops (field-style first aid thing), so you have to keep an eye on the patient.

nickjj 6y ago

> Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. You'd be surprised at how questionable hospital care is run in NY, even with $450 / month insurance with a high deductible. To protect the privacy of the person I know, here's a story from 2-5 months ago: - Person A goes into doctor's office for something pretty common - Doctor requests cat scan or MRI (I forgot which one is which) based on symptoms - Person A gets the scan - Doctor evaluates results and says to book surgery in a hospital ASAP as it's probably cancerous - Person A books surgery - Hospital gives prep instructions to be performed by Person A 48 hours before surgery - Person A does everything and goes in for surgery - Person A is prepped for surgery and is put under anesthesia - Surgeon comes in and looks at the scan in the operating room - Surgeon says this scan is nothing to worry about and surely doesn't warrant surgery and it's not a tumor or cancer - Person A is wondering how the surgery went after coming to from being put out - Nurse says no surgery was done and even she was able to look at the scan and see nothing was wrong - Person A is told to go home and wait 4-6 weeks to self heal So let's ignore thousands of dollars in bills (deductibles). All of this could have been avoided if someone actually looked at the results of the scan before going through the motions of putting someone under anesthesia and a massive amount of stress. That's only 1 of many stories. In another case someone I knew had their blood drawn twice in the hospital because the 2nd nurse didn't believe them when they said they just got their blood drawn by another nurse 10 minutes ago. The vials were literally next to them, about 3 arm's lengths away.

noir_lord 6y ago
Over here in the UK they generally mean well, almost without fault every one of my specialists, doctors and nurses have been awesome. That said man do they fuck up, most recently was a fun one, I had a scheduled appointment, turned up for it, doctor was in his treatment room seeing patients, forgot to see me and went for lunch. I mean it's minor but I'd checked in, the computer had me as waiting but he'd looked at the list, not seen me and went for lunch - I spoke to the nurse told her I didn't mind waiting while he ate and she tracked him down, he was incredibly apologetic (unnecessarily so, shit happens). It's inevitable in a system as complex as healthcare that mistakes are going to be made but we probably should assess the proximal causes much like the airlines/plane manufacturers did to reduce the incidence.

trhway 6y ago

>Really seems like a "hey nurse did this patient have their fentanyl yet?" would have resolved this issue. i somehow think that a medical doctor should be able to tell whether a person has an opioid [at least in a pain relieving dose] in their system.

deleted 6y ago
[deleted]

sk5t 6y ago

FWIW, I had a pretty bad bicycle accident and was administered morphine, dilaudid, and fentanyl (in that order) at various times in the hours following. Only dilaudid had any affect at all on my clarity of thought.

refurb 6y ago

if it's really 100x more potent than morphine you'd think any person that did have it in their bloodstream would not be all that capable of stating that they have not had their medication This is off topic, but when a drug is 100x more powerful, they just give 100x less of it. So whether you get morphine or fentanyl the effect is approximately the same - and that's intentional.