This is very different from a baby because they have little motivation to lie and you can see them reacting to simple painful situations like bumping their head.
So? The first response should always be to take folks seriously. Always. Even if they are really searching for opioids. No doctor should assume folks are lying upfront.
Even if that means that a couple people are getting off work when they don't need it. And I'd much rather have a disability system that occasionally gives the wrong people benefits than to withhold benefits from someone and make their life torturous. Much like theft an loss are costs of retail, this should be the cost of a disability system: A few folks take advantage.
People who look at the statistics after that, finding our doctor prescribing a significant amount of all opioids in the community, are liable to think that he's some sort of unscrupulous stooge of a pharmaceutical company.
That'd cause a race to the bottom of pain medication skepticism. To fix that you'd need some sort of liability reform (as just changing guidelines will never work if it's opposed to a self-sustaining incentive gradient), though I'm not sure what that would actually entail.
Nope. In a well-designed system, this just be minimal. Design a better system with better access to medical records throughout the system, lesser liability (the US, mostly), and paid medical leave so that people can actually heal. The alternative is simply that we leave folks in different levels of pain. Heck, even just being able to see prescriptions nationally would be a bonus (Right now, in Norway, when I get an electronic prescription, I can go to any pharmacy to fill it and they can see my prescription history) Innocent people shouldn't have to go to the black market for pain relief because they can't get things figured out legally.
Again, I firmly believe that the first response should always be to believe the patient.
I was constantly pushing doctors to try alternate treatments so I can deal with actual issue rather then take pain meds. They had no interest. Took me 3 years to finally get a prescription to LDN, which finally worked for me.
As my go to story on these sorts of issues, my partner had an ER doctor tell them that they hadn't been stabbed. The fact that there was an open wound oozing blood and multiple witnesses was not sufficient evidence. That wound was obviously a diabetic sore. That my partner is not diabetic was also a lie and the fact that their medical records showed no history of diabetes was merely proof of the incompetence of the previous doctors. Stitching the wound had to wait for two blood sugar tests to be performed, because the first test was could only have been a machine glitch. After a second negative test for diabetes, the doctor finally conceded that he couldn't rule out a stabbing.
I remember a Google employee changed a popular font for headings. It broke the layout on a very large number of websites.
Several people discussed this with the employee, suggesting the font should be forked rather than force-updated. The employee engaged, but refused. Eventually they said that if enough users contacted them with complaints, that would be evidence they would consider. When it was pointed out that it was very difficult to know how to contact them (they were not required to engage on the forum, or anywhere else, no contact information for them was otherwise findable, etc) they barely shrugged. It was as if part of the logic function in this human was managed by a 4 year old child internally.
I do not know the gender of the person under discussion, nor do I know if that person has pronoun preferences. I simply followed the "generic person whose gender is unknown" standard.
I've been using "they" in this manner for 50+ years. Never had anyone comment on it before. Are you attempting some kind of meta virtue signalling, considering "pronoun preferences" is a very recently added option?
We should probably focus more on finding ways to reduce cynicism and lack of empathy in this profession than fighting false positives in the system.
> It’s because people lie for many reasons.
You should err on the side of caution and default to "they're probably not lying".
Most of us can agree that applying the logic you're describing to the law would be wrong. Imagine that instead of having the presumption of innocence, we'd assume that certain types of people are probably guilty, so we'll punish them pre-emptively.
This already happens, of course, because of racism, xenophobia etc... but we do agree that it's morally wrong and at least we're trying to fix it.
And in this climate of all opiates are the devil, I get it.
We are in a weird state in pain managment.
We essentially don't have anything to cure chronic pain, except cutting nerves.
Opiates make people feel better physically, and emotionally.
They are addictive because they work. Unlike all those tricyclic/heterocyclic drugs.
Young people should never be on opiates, except during surgery.
Old people in pain should not be denied the drug. It should be a right.
(There are numerous studies of older people being given opiates for pain/misery, and most studies they did not want to increase their dosages.)
It is amazing how much of the medical community states they believe in science, yet they seem entirely disconnected from it at times.
Unfortunately, neuroscience is not at a level where we can actually perform these tests. There is no objective measure to see if someone is in pain, or depressed, or suffering many other psychological symptoms.
Similarly, brain imaging for pain is at the research level, and may come with several other risks. I doubt there are such tests that could be used to conclusively prove that someone is or is not in pain.
There are blood and urine tests for seratonin, but studies are mixed on how reliable they are. Since depression can also be accompanied by other factors though, there is a wide range of tests that can help provide objective evidence.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.practicalpainmanagement.com/pain/cortisol-screen...