Cut and Run???
Cut and Run???
This has been one of the weirdest weeks in my life. . .
as far as the thoughts and feelings I have experienced. The predominant feeling has probably been fear and I know that if there were no fear at this time I would truly be out of my mind. The thought has dawned upon me that it isn't too late to cut and run. I could just tell every patient that I prescribe a pain medication to that I can't treat them anymore. I would still maintain over 80% of my practice. I could walk in to my hearing on August 20th and state to my accusers that the problem is solved, goodbye, hope I never see you again. No hard feelings, right? That could be the beginning of the end of my nightmare. I could then try and slip back into anonymity, even though there would still be many who would see me as that bad doctor from the smear attack who did all of those terrible things that time. At least my livelihood would be protected.
I have seen during the week that the vast majority of patients, pain and non pain related, continue to support and believe in me and actually do understand how the government and the media work together to exert their will and control for their own causes. Even those that don't understand things that clearly do understand the concept of standing for a principle and know the difference between right and wrong. I saw a patient a couple of days ago who had been referred to me from a local pain clinic to help him cope with the loss of his ability to earn a living and other stressors associated with having a chronic pain condition. This was the third or fourth time we had talked and he trusted me to manage all of his pain medications along with his antidepressant treatment. We ended up on the topic of illegal substance abuse and the negative impact it has on us all. The conversation ended with him commenting about that Dr. Evil that was on the news last week who had been dispensing narcotics to all of those patients without seeing them. That's when I realized how insane this whole thing has been. How could the very same patient entrust me with his very life and at the same time have a fear of a despicable monster that is also me? I think that moment reassured to me what is truth and what is not truth. It is not I who is the real enemy.
I contacted a leading expert in the War on Pain Doctors and educated myself more through his website and have begun to understand more about the politics of this whole thing. I don't really know how I got here and I'm not sure if I want to be here or not, but I am here. I was most disappointed from the learning that the Medical Board is not an organization of peer physicians but more so an organization more loyal to the DEA and the government. I realized that I walked right into their trap without any legal representation three years ago. I also realized that it's not much of a war when one side has all of the ammunition. At least the side of the doctors has truth with it when it isn't allowed to be smeared or tainted, which has become the primary job of the media. There are hardly any journalist who investigate enough to really seek the truth. At least the newspaper did make an effort to get my side of my situation. The TV news did no such thing. They just used the press release in the manner it was intended to be used, assuming the accused to be guilty as charged. That type of thing is scary enough when thought of as conspiracy theory. It can take on another dimension when it really happens.
Should I cut and run now and leave 20% of my patients to make it the best way they can? This could all be over in less than two months if I do. My self preservation instinct says that is absolutely what I should do. My core values and moral obligation, however, would never allow me to do such a thing. If I were truly a corrupt individual I would have money to buy fine lawyers and wouldn't really need to work anyway. Since my situation is quite the opposite I am going to conclude that maybe I am not wrong in taking a stance here. My patients have stood by me and I continue to pick up new patients daily. They are the reason I do what I do. I have to continue to let my conscience be my guide. Dr. King once said that a man not willing to die for something isn't fit to live. I don't plan to die but I think that phrase symbolically captures how I feel.
What's that light at the end of the tunnel?. . .
It could be the daylight of peace and tranquility or it could be the proverbial freight train of more and worse to come, or maybe just another mirage to extend hope a little while longer. I arose this morning to learn that a favorite comedian Bernie Mac was dead at age 50 and Senator John Edwards had confessed to the rumors in The National Enquirer putting his political career in ruins, for the time being at least. These shocking realities saddened me but also caused me to realize how blessed I am. In the past couple of years I have faced the threats and realities of divorce, foreclosure, bankruptcy, death of family, business failure... Every doctor fears the humiliation of being published in the quarterly newsletter of the Medical Board for facing disciplinary intervention. We all understand that is the way the profession polices itself since most physicians are quite conscientious and feel bad when they commit a regrettable act on occasion. For most it would be preferable to secretly spend thirty days in the County Jail than to endure unfair or unwarranted public scrutiny. I had prepared myself for the inevitability of making the Newsletter. I definitely was not prepared for newspaper and television news involvement. I never read the article nor saw what was reported on the evening news. Some who support me described it as B.S. It makes me feel good to know that not everyone is programmed to automatically accept everything they are fed at face value.
In order to move on with my career and my life it is important for me to speak for myself and make sure the record is set straight. Those who really know me are aware of my competence as a practitioner and my caring nature. There is really no power given to any human or group of humans capable of changing those two facts. The Medical Board became involved with my practice of medicine because of complaints from outsiders who drew their own conclusions to how I found it most appropriate to treat opioid dependence and chronic pain patients. Many would comment that you shouldn't have been treating them in the first place. My answer to that would be that if our health care system functioned as it is suppose to I never would have been treating such patients. Maybe so many other doctors would not avoid such patients if the inappropriate patients received appropriate intervention medically and legally. The real problem is not legitimate chronic pain patients. The real problem is the addict who has chosen to willfully engage in unlawful behavior. A person of such character has no regard for anyone but self and they deep down don't really even care for self or they would not choose such a self destructive pathway to live. I have little compassion for a person who is willfully dishonest and deceitful. Many have been discharged from my care once the truth became known. Such people are the other source of complaints and false information supplied to the Medical Board. Aside from that, the Board reviewed five of my charts dating back 1 to 2 years. During previous meetings with them I was told what was deficient in my documentation and what needed to change in the future to continue treating chronic pain patients. The Board left me believing that completing the Continuing Medical Education I took at Portland State would be sufficient to prevent them from going forward with any legal proceedings. They made a compilation of all I had told them in good faith and used charts they already knew were representative of the pre remedial situation to justify a public smear of my practice of medicine.
So what could be the worst possible outcome? That of course is easy to answer. I could lose my privilege to practice medicine permanently. Is that likely to happen? Absolutely not. Most of the Board's leverage comes from embarrassing a doctor publicly when they want that doctor to comply. After that, they tend to show a display of overwhelming force to show that doctor that he or she cannot possibly win against them. They have nothing to do with the actual practice of medicine but everything to do with who is allowed to practice medicine and what their scope of practice can entail. They mask everything behind protecting the public. In my case the main people protected by them are ones who regularly break the law. Others such as legitimate sufferers of pain from chronic conditions will be again told they can't be treated in the most appropriate manner because of intervention by their government agencies.
How much wrong have I really done? First of all, I don't really want to treat a lot of chronic pain patients. For the vast majority of patients I have prescribed an opioid to I think it is for the best for them to be treated elsewhere. Where that elsewhere is, I'm not sure. This catch 22 cannot be resolved by me. The pain clinics can go only so far with them, the orthopods and neurosurgeons would rather not be bothered, family docs don't have the time to address the addictive component associated with many of these patients' condition. A subset of patients found the perfect home with me and have done exceptionally well. They have found adequate relief to have their life back, to a degree. Without such relief some patients would consider suicide. To the Medical Board this would be preferable to me continuing their treatment. I'm sorry but that really bothers me. That's why I encouraged such patients to write the Medical Board themselves to express their feelings about their right to treatment being tampered with for bureaucratic purposes. Some patients simply do need a medication such as methadone to control their chronic pain. I think it is probably unethical to deprive them of the treatment they need in the name of protecting them. As Dr. Deluca with the Pain Relief Network has stated in his video interview, few people in America receive the true standard of care for chronic pain for the simple reason that the average doctor fears the repercussions for attempting to provide such treatment to the degree that may be necessary. I feel if I had never prescribed methadone for chronic pain treatment the Board would never have taken things this far. The DEA is a federal institution and could only charge me for a criminal act or for using narcotics for non medical use or for treating substance abuse disorders without the proper licensing. Physicians usually use certain narcotics for the treatment of a diagnosis of a chronic medical pain condition. This is perfectly legal in the United States. But... the State Medical Boards make the criteria for what is deemed a legitimate medical condition. Most doctors are not aware of the detailed criteria in the policies until it's too late. By that time the Boards can have enough against a particular doctor to use against them in any way they see fit to suit their purposes. In my case, the remediation done as requested was irrelevant but it would give them justification to allow me to continue treating pain patients if that was their desire. They hold all of the cards.
I have been advised against going through with the hearing for it would more than likely be pointless and could make things worse in the long run. However, if I had the legal backing and finances I think the cause is worthwhile to fight for. Without such support no individual citizen can expect to beat the State. That much has become clear to me. The norm in such a case as mine is have a consent order issued that allows the Board to feel it has acted sufficiently on behalf of The People of The State of North Carolina. Basically, the doctor is ordered to do as they say and the doctor consents. This consent frees the doctor to not have them on his or her back any longer. The doctor's license is usually restricted for a year as a technicality but things go on as usual as long as the doctor stays out of trouble in the future.
All but a few of the patients I have treated for chronic pain seem to be handling the news ok that I will be ordered to no longer treat their condition. At times I wish I had forced myself to cap my chronic patients at the 10 or 12 that I find it most rewarding to treat. Had I done that, I believe that none of this would have happened. I can only hope and pray that they will find one willing and able to provide the treatment they need. Those patients are most dear to me because they constantly remind me that I did do some good in this context and that in principle I have been right. Despite that, there still often comes a time when one must let go because ones limits have been reached for a situation.
Dr. Alex Deluca, Pain Relief Network
August 8, 2008 will mark the 4th anniversary of Thoughts From The HEADoc-Quest 4 Sanity. . .
How cool is that? The HEADoc has thought of this journal often as a cry from the wilderness. Such a metaphor tends to speak for itself in that it was known from the start that not every potential reader would hear the messages while still others would hear what they chose to hear. Some would interpret courage and insight yet others would see foolishness or insignificance. Still The HEADoc tried to keep it real and write about subjects rarely mentioned from such a perspective as his own. The Quest was never about the personal sanity of any individual person but mostly about situations in life that can sometimes challenge that personal sanity of essentially anyone. The THOUGHTS have not been specific for Psychiatry but have been generated by one who practices Psychiatry. An effort has been made to document original thoughts, freely associated, and of interest most of the time. On a rare occasion an entry has been synonymous with pornography as far as what has been shared with readers. In a pornographic film the actors tend to relish in exhibiting a behavior that should be private. The actors know that those seeking what they have to offer will identify. The idea here is not to suggest perverted writing but to suggest that The HEADoc did not alter the writing for the sake of political correctness or attempting to please readers or to make himself look good. Non fiction to The HEADoc is more valuable than fiction.
Readers who are of an ultra conservative right wing world view will never see eye to eye with The HEADoc on much and usually wouldn't read more than one post anyway unless wishing to pursue an argument, which has actually happened before. The HEADoc, believe it or not, is not a bleeding heart liberal as one might be inclined to believe but would identify himself with The Rationalist's party, if such a party existed. The Rationalist's party would take the good ideas from the existng political parties and discard the rest of the B.S. The Rationalist would be seen as a communist by the Right and as too hard to pin down by the Left. A Rationalist would be small on talk and big on action. A Rationalist would not need to lie to the public or mislead the public because he or she would identify with the public. When a policy failed, The Rationalist would be required by conscience to admit that and immediately investigate and begin a rational reform of that policy based on fact and logic. The Rationalist Candidate would win every election because of full undisclosed accountability to the public. The Rationalist Candidate would conform only to common sense and show limited loyalty to political correctness. He or she would not fear stating such beliefs as: Oswald didn't act alone nor did James Earl Ray or Sirhan, that more could be done to stop the flow of illegal drugs across the U.S. borders, that Bush didn't really win in 2000, investigate 9/11 to find out what really happened, the Iraq War was unecessary, there is no gas shortage (yet), Obama really is the better candidate.
Enough of the nonsense. The HEADoc has worked through his grief fairly well and does not wish to be perceived as a victim. He has thought long and hard about the situation with the Medical Board and has tried to see the situation from their pespective. He has accepted the possibility that perhaps they could be right (according to the statutes) and on a technical basis at least, The HEADoc should probably just accept that. In the arena of treating chronic pain patients, the time to throw in the towel is nigh. The HEADoc has begun to see that most of the true pain patients greatly fear having to find another doctor to effectively treat their pain and fear losing the security they have found with knowing someone cares enough to make sure they have what they need. Some of The HEADoc's patients have done exceptionally well with treatment after years of seeking relief. The HEADoc believes this mostly due to the fact their emotional needs were validated and addressed in addition to the physical state of disease initiating their pain. The most important lesson learned from treating chronic pain conditions has been how the road to true and lasting analgesia is centered in changing how the brain perceives the pain signal. Ridding the body completely of pain is an unrealistic goal for any treatment. Teaching the brain to experience pleasure again is key in the chronic pain patient with depression and anxiety based on the premise that the brain is not constructed to perceive pain and pleasure simultaneously and must choose which to experience at any given time. When chronic and persistent pain becomes the sole focus of ones life the regions of the nervous system that conduct primarily good thoughts and feelings, in a sense, can cease to function adequately. The pain conducting areas of the nervous system then operate unchallenged, thus a vicious cycle of pain, depression, and anxiety persists.
At this time, The HEADoc recognizes that the well being of the patient is what is most important. The Board states the safety and well being of the public as its primary responsibility. The Board's basic stance, in this particular case, is that it is better for many people to live in more pain than they have to than to risk one more addict getting their hands on a drug they shouldn't have. The HEADoc intends to continue providing quality psychiatric care to the chronic pain patients within the practice while facilitating referrals to a provider willing to treat their pain conditions. This will be an extremely difficult process for some patients and will produce emotional distress. Many patients have made it clear that the value of the mental health care received has been equal to or greater than the value of treatment of their pain condition and they have no intention of terminating their psychiatric care because of being required to find chronic pain treatment elsewhere. The HEADoc will do his best to help such patients deal with the fear associated with the change. Their treatment has been considered sucessful and if successful in finding effective continuation of treatment for their chronic pain condition the best may be yet to come for them.
In this life we all experience times of challenge. . .
Some of us carry in our DNA a propensity to develop episodes of major depression that is most often triggered by prolonged stressful events. Such individuals cannot always control how things happen to them but they must realize that they are in full control of the response to a situation. There are always things one can do to battle the stress response. It is possible to teach oneself a form of maintenance cognitive behavioral intervention once the concept is learned through a competent therapist and enhanced through ones own self education and practiced through repeated life experiences.
Our very reality as humans is driven by constant battle between our limbic system of the brain, where strong emotions are generated, and our cerebral cortex (gray matter) which we use for reasoning and logical thinking. From an evolutionary survival standpoint the drive from the limbic system has a propensity to override the logic and reasoning in times of stress, or perceived threats, which can result in periodic lapses in judgment and emotional over reaction or emotional shutdown. Our fight or flight response is a gift from our ancestors that when correctly working increases our probability of survival. Adrenalin can be quite helpful in an emergency but over utilization tends to result in mental problems, especially if a change in environment or detrimental behaviors is not achieved.
Yesterday I felt myself consumed by an almost overwhelming feeling of frustration and sadness. Over time I have learned that the key to getting through such an emotional state is basically not allowing myself to shut down or to over react because the result of such behaviors is usually self defeating. A friend once offered me a phrase to use that I find quite helpful, "This too shall pass." Lately, my life has entered a place that seems like a bad episode of "The Twilight Zone." I'm hoping it will all start to get better once I have this situation settled with the Medical Board. I really don't quite understand what they really want or what they are really trying to prove. If surrendering my DEA license would make this nightmare end I would be willing to even do that. If I can prescribe ADHD medications and benzodiazepines, I can practice fine without the use of other controlled drugs. There is no point in attempting to punish me because, short of not letting me practice at all, I can be hurt no worse than by what has been done to me by the news media. It is not easy listening to rumors and lies daily that are based on absolutely nothing. Some of my patients have been told that I was led off to jail in handcuffs, others that I have been shut down or that the state is going to use patients discharged from my practice for violating their contracts to turn states evidence against me. This is totally ridiculous and much more than I ever bargained for.
The irony of this whole thing is that I have never tried to do anything short of help others. I finally have my practice at a place where that can happen and is happening. I will have to start turning patients away soon because I won't be able to see them all and 90% of them are not pain patients or seeking drugs that can be abused. I like to think that it is because I am a competent and caring provider of mental health care. Neither me nor my patients deserve the bad publicity that has occurred. I think of all the good I have tried to do in my career and rarely has it been given the slightest notice. As I have said repeatedly, I will continue to let my conscience be my guide and do the best I know how.
On the lighter side, I'm going to enjoy watching my four new kittens develop. I've found future homes for two already. Though she will definitely be spayed in the future I have no regrets for allowing my cat to experience reproducing. There is nothing more natural. Sometimes mistakes can turn into blessings if we just look for those blessings. I love my new Al Green CD. It takes me back to a more carefree time in my life. I always wondered what his singing would sound like with the benefit of modern recording technology. To me he is the greatest ever, and I love every single cut. He has some help from John Legend, Anthony Hamilton, and others who help transition the '70s style to contemporary. The horns, percussion, and strings really make the music live. It talks to my soul. Thanks Al.
Had a few days off for the 4th. . .
It has been really hard getting back into the swing of things. Lots of bad news lately, but I try to find silver linings where they exist. It's a bit more difficult to make fun of myself lately in my posts I suppose out of fear of how it could be perceived by some. There is another side of me that really doesn't care that much what negative people think of me. My involvement with most of the patients I see continues to be as strong and positive as ever. That keeps me going from day to day as I seek additional ways to enrich my life and find the fulfillment of self sought by all humans. I find that adversity often challenges one to reconnect with or strengthen ones spiritual being and can provide enough humility to help one find perspective in ones life. So true yet so boring to write about.
I'd much rather write about my new fun activity of pulling stumps out of the ground with my 4 Runner. I never knew something so primitive could provide such exhilaration. Yee-haww! Or I could write about my newest restoration project of the spring and the little stream where I used to retreat to when I was a kid and in trouble for misbehaving. It was always such fun to capture the tadpoles, crawfish, minnows, or salamanders. Once I got into even more trouble for capturing a baby snake in a coffee jar. My aunt gave me a scolding and made me throw the poor thing away with the lid still on. I worried about that snake for a long while. Snakes just seem to have always gotten a bad rap. Even today, they are the only creature that I instinctively kill, even though they probably represent no harm to me. It's somewhat interesting that I found myself retreating to that same little stream now over 40 years later when I'm involved in a much different form of adult trouble.
I could probably write a pretty good story about my cat giving birth to kittens last week, as well. I think that's an experience everyone should have at least once, but probably not in the way I chose to allow it to happen. In 2 months I have become experienced in feline sexuality, labor and delivery, and the behaviors of early nursing. Nature did all the work with minimal assistance from me. I had barely finished reading my online article about cats in labor before I actually accepted the fact that my cat Oreo was showing exactly the signs I was reading about. Before I knew it there was a piercing scream coming from the bathroom followed by a higher pitched squeal. As I rushed in and peered into the tub we both looked at each other dumbfounded as the 1st born lay helplessly at her side. It had been almost 18 years since my OB-Gyn rotation. (not that it would have made any difference) Too late for hot water, the cat had already beat me to thinking of that commonly suggested first maneuver. So I ran to get towels and a box. I was too slow. She had already taken the baby kitten to her secret hiding place. All I was really needed for was to help clean up. So I'm just staying out of the way until she brings the kittens out of hiding. Her behavior is totally back to normal other than her having less time for me. She actually talks to me when she needs something, so I don't fret. So far, I've found a future home for one kitten. And yes, my cat will be spayed before having the chance to go into heat again. I have definitely learned my lesson there.
As many people already know, nature provides endless opportunities for escape from the stressors of ordinary life. The Serenity Prayer teaches me to ask for the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. These are two of my current coping tools that I look forward to putting to additional use in the future.
Burlington News
Three teens were arrested Monday night after they were allegedly caught spray painting graffiti on the county's transportation building on Graham-Hopedale Road in Burlington.
A two-car wreck at the intersection of North Church Street and Sellars Mill Road in Burlington Sunday afternoon left four people injured.
People who own a scooter or moped should make sure they lock it up, police warn.
Guns stolen from a Burlington pawn shop two years ago were found during the search of a home of a man charged with several drug charges in Randolph County.
The Super Kmart on Huffman Mill Road was one of seven stores in the state fined for excessive price-scanning errors.
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