How would you like your opiates served?

‘Your surgery was a success! I can give you a prescription for oxycodone for any pain you are likely to experience.’ Before I could say anything, my son – who accompanied me as my watchful advocate – said immediately, “She does not any opiates!” I was so pleased with my son. And a bit surprised with the doctor! I really like this young surgeon. I chose him because he came highly recommended by a trusted friend who is CEO of a hospital, and given his background, wanted his specialty for its more wholistic approach to pain. After several consultations, tests and discussions about possible steps forward, I chose surgery as the one that made most sense with me. This doctor is young, but given my age, from here on out, most people are going to be younger! I trusted him. And given his age, his openness, his willingness to explore all options, his continual engagement with medical education…. I was surprised he offered the opiate straight up. One that is not as terrifying perhaps as fentanyl, but still a narcotic with a possibility of dependence and linked to potentially harmful side effects such as respiratory arrest. What should he have asked? What should all doctors ask? ‘Tell me what you currently take for pain. How do you feel about that? Do you think that would work for this surgery?’ The doctor could discuss also how much one can take. If already taking an inflammatory, is it OK to increase the amount for a short period of time? It is OK to ask if the patient wants to consider a stronger pain medication, possibly a mild narcotic, but only after this discussion which also needs to include if the patient lives alone, if the patient drinks alcohol (I would rather take an Aleve and have a glass of wine at night!), a review of other medications. It just takes education. I would like to think that most doctors are open to this. At one time, doctors were accused of not prescribing pain medications enough, to be insensitive to patients’ pain. It is regrettable the rush to the other end of the pendulum. This is exacerbated by the ability to get narcotics on line at the alarmingly high growing number of illegal on-line pharmacies who will deliver even Fentanyl without a prescription. Remember, we are in partnership with our doctors! When I wrote my book, Stand in the Way: Patient Advocates Speak Out ( one of the patient advocates I interviewed said that it is our responsibility as both patients and consumers to educate doctors. No one will doubt the unique training doctors get in medical school most of us do not have; that does not come with a certificate that they know everything. They need help; they need our help.

Too many pain pills after surgery: When good intentions go awry

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