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Comment by joemag | Hacker News Reader

Aren’t the doctors to blame for this as well? It always surprised me how quickly and easily they prescribe serious painkillers. A few years ago I had a tooth pulled, and the doctor gave me prescription painkiller. In the end, I ended up using regular ibuprofen, and that was more than enough.

I wonder how much of this comes pharmaceutical sales reps pressuring the doctors to use their medicine. That whole system seems broken and unethical to me.

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I've had a couple of surgeries. Honestly, ibuprofen worked better because it dealt more directly with the inflammation. The oxy was more fun in the sense that I didn't care about the pain as much, but after the prescription ran out, I won't lie - I wanted more. The story ends there, fortunately. Seeing what's going on now, I won't even fill another prescription for it if I'm ever given one.

I really wish they'd take a harder look at referring patients to cannabis. I'm not one of those people that thinks its entirely without side effects or that it's a cure for everything, but it seems like it'd be a lower risk alternative for at least some kinds of pain.

A decade ago there was a giant push in the media government, and hospital administrations calling doctors heartless for not prescribing more painkillers. Hours of mandatory classes on using opioids in all sorts of situations. Exposes on chronic pain patients made to suffer.

This isn't really something that happened behind closed doors with drug reps. There was a concerted public effort to change the culture in medicine.

about 5-6 years ago, my wife had a small eye problem and we went to a local urgent care clinic. resolved the problem, but it was still inflamed and had some discomfort. the physician offered to write a prescription for either oxy or hydrocodone. (I can't remember which). "No, I'll be OK" my wife said. "Well, here, take this anyway", and she gave us a prescription for... 7 days of the stuff (IIRC).

2 years ago, both urgent care clinics in our town had signs out front saying "no prescriptions for oxycontin or similar painkillers will be given here". So... more legitimate use cases are now shut out from measured uses because there was such a rash of unneeded prescriptions years before.

The signs out front are to discourage drug seekers from coming in the door. They’ll prescribe it if you need it.

So basically a doctor prescribed a hugely addictive opioid for something described as "discomfort". That shouldn't just mean you lose your license it should mean you go to jail.

Worse than literal drug dealers, because they took the Hippocratic oath and have a much more informed understanding of addiction and its repercussions.

There's rampant corruption in healthcare, even after the Sunshine act passed into law in 2010.

Common methods include: - Paid "speeches" - Paid surveys - "Training/Education" retreats at swanky resorts

Also look into Outcome Health, a newly minted "unicorn" based out of Chicago. Their marketing spin is about how their mission is to help patients receive the most optimal treatments and "outcomes", but in reality the whole business model is based on installing "free" tv screens and tablets in physicians' offices and then pushing ads. Im sure there are kickbacks involved with the individual physicians. There was a WSJ expose about it a couple of weeks ago (http://archive.is/QZnTN).

"Improving patient outcomes" is quite possibly the most disgusting, 1984-esque buzzphrase right now.

It's worded so that like, "who could be against that?" is what anyone would think.

So some shady ads pushing startup is out there trying to handwave how they're making everyones life better and improving outcomes, despite not providing any innovation.

It would be like saying my meth dealer is improving my life outcome because I have more energy now.

It depends different people have different responses to pain I had a kidney transplant and needed very little pain killers they took out the pain buster after a 48 hours and I managed on the occasional paracetamol and I don't really need te full does just one before bed

Later on a guy in the next bed had an infected kidney out and he was in immense pain and needed much stronger pain relief

There was some research that downplayed the addictiveness of opioids, and a push from the VA to recognise and treat more pain. Then drug companies promoted their product with time release versions, claiming this reduced the risk of addiction.

That was a devastating combination.

Capitalist medicine is to blame, when you can vote with your money you can pick the doctor who does what you want, not what's best for you.

Ah not so its the same in France everyone demands a second opinion I recall a BBC program where a French doctor admired the NHS's strictness in that regard.

What? Even in single payer systems you can choose your doctor!

Not always. I recently moved, and was forced to change doctor (NHS in the UK). My new GP surgery is farther away from my new apartment than my old surgery was, I’m far less happy with the doctors there, and it’s far more oversubscribed than my previous GP was.

If people are idiots, why deny them the possibility to realize their potential?

Because we've already paid for their education, and will likely have to pay for their remaining life. If they want to be stupid on an island by themselves, fine.

Are you saying patients should not have any say in their own treatment?

They should not have total say, the doctor shouldn't be trying to please the patient to get more custom/better reviews. They should be trying to get the patient more healthy.

If your doctor is making actual medical decisions based on a pharma. rep's sales pitch, find yourself another doctor pronto.

But how would you necessarily know? And not everyone is equipped to make such a determination. Lots of people still treat doctors as infallible demigods.

There are plenty of bad doctors out there, just like there are plenty of bad software engineers and lawyers.

I'd agree doctors are partly to blame, and I've had a similar experience.

A couple years ago I went to the ER to get a dislocated shoulder fixed, and they sent me home with percocet, even though I told them repeatedly that the pain wasn't too bad any more and I didn't want it.

Please be aware how figured are paid and rated. They're micromanaged nowadays like they work at Arby's. If you come to the ER and later come back for the same reason, the doctor not only doesn't get paid for the second visit, they get dinged from insurance and from the hospital. They're highly incentivized to get you in and out.

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