Ippel: Pain Medicine and Book Covers

May 15, 2015

by Bruce Ippel, M.D.

The word “can’t” in the catchphrase “you can’t tell a book by its cover” not only can mean beyond difficult but also illegal or nearly so — at least here in these Newnited States where it’s now called profiling and is prohibited.

For example, even though the “sex industry” is illegal most places, a seductively dressed gal struttin’ her stuff on certain street corners is not to be arrested or even questioned as a prostitute — or being female for that matter. S/he, until proved otherwise, is just looking to meet new friends.

But you may encounter profiling that is not only encouraged it’s often mandated — my patients, for example. I’m a family doc, and I have learned that you really can’t tell a book by its cover. I have a number of honorable, law-abiding, pleasant patients who look like scumbags. Some also talk like scumbags, but when you get to know them and what makes them tick . . . well, their good stuff is an open book.

Still, I live in the real world. I’ve learned that most people who look and act like scumbags fit the profile; they are scumbags. My office usually bows out of doctoring them pretty quickly. I’ve been blessed with a nearly clairvoyant staff.

But my patient lookalikes, they’re at risk — at the pharmacy. And it’s not the pharmacist’s fault, it’s all our fault for voting in lawmakers who think we can control behaviors by making them illegal. (I’m pretty sure God knew the Ten Commandments weren’t going to keep the Israelites from screwing up.)

A quarter century ago, we docs were loath to treat chronic pain with the strong stuff. It was a slippery slope; drug addicts easily hid among the real patients. Then government made a law requiring us to give whatever it takes to slake the severe pain of any and every likely patient . . . or get your hind end sued off.

It created a toxic situation. Up sprung the first generation of pain clinics — real pain clinics doing good. Now, though, the medical policing boards, never strict, have their hands tied when a bad apple shows up giving too many Oxy’s to too many “patients.” There’s no meter for pain like there is for sugar. Treat bad pain or else. It’s the law.

The lawyers, to give left-handed praise, keep our food supply, cars and recreational equipment safer than anywhere in the world by suing any company foolish enough to make something not as safe as humanly possible. But they have an uphill climb making any case against the medical industry’s bad apples because of that law.

Re-enter profiling. Rather than fix a bad law (I have suggestions), our elected officials do what they always do: add another layer of bureaucracy.

Now it’s the pharmacist’s turn. Our government punishes the drugstore chains for not second-guessing the doctors — sort of like if you go to the corner station to gas up and they refuse because you gas up too often or your car isn’t clean enough. You can get refused at the pharmacy window with a valid Rx and cash money for similar judgments by the store’s pharmacy tech. It’s called “due diligence.”

For any prudent business must protect itself by exercising such due diligence. Here in Indiana, the pharm-tech can lose his job if he fills Rx’s for people who might fit the wrong profile. You might not get your legitimate pain or other medicine if anything about it or you is “suspicious.” The definition depends on who is at the window. (My daughter-in-law was refused an antibiotic Rx because it was written by a prescriber who happened to work in my office.)

I tell these patients to cool down and go to a different pharmacy on a different day. It’s not common, but it is random and frustrating for everyone involved. Next time they show up at that window, they should try to look more like Tom Sawyer than Fifty Shades of Grey.

Bruce Ippel, M.D., is a solo rural family physician in central Indiana and an adjunct scholar of the foundation. He and his wife of 42 years have 10 children. For the last 38 years, Dr. Ippel has run a private “hardscrabble” clinic serving the under-served.

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