Sunday, October 17, 2010

Unpublished and possibly career-ending letter to a fellow medical practitioner

Dear Dr Zu,

I saw Joanne X today. She was limping and she had many of the clinical signs of sciatica. Imagine my delight when I heard how you had successfully treated her back pain without recourse to drugs of dependence.

I'll have to imagine my delight, too, because that is not what I heard.

She said, and a call to the pharmacist confirmed, that you have prescribed her a bottle of alprazolam. I told her that alprazolam was not compatible with her other medications, because together they could cause dangerous side effects like memory loss.

She asked why I hadn't told her about this.

I told her I had.

This is the same woman you sent to me three years ago because she was addicted to alprazolam. She had nearly been intubated because of an overdose of alprazolam. Her husband and two daughters are addicted to alprazolam. The sojourn in the Barad-dur Women's Prison, the miraculously survived three motor vehicle accident, the three weeks in August sleeping in a station wagon, all are due to alprazolam. I have winched this woman's dose back to nothing over the last three years and three months ago she had what she swore was her last dose of alprazolam.

And then she strains her back and you give her alprazolam.

Sciatica occurs when an inflamed disk presses on a nerve root causing pain. The inflammation is treated with anti-inflammatories, the nerve root pain with analgesics. The only thing alprazolam is "treating" in this case is the very dependency issue that caused ninety nine percent of her problems in the first place.

She also mentioned some concerns about her weight gain. Perhaps you could prescribe her some pastry?


John Bronze,

BSc BM BS etc.


Blogger Benedict 16th said...

Dear Bronze,
The patient of course would never have said
Joanne: "But I need it Doc, it's the only thing that works for my pain"
Doc: "You could try Panadeine Forte?"
Joanne: "It makes me vomit and gives me constipation, it doesn't work".
Doc: "What about Pulltheotheroneam?"

So why isn't the patient partially responsible for her own behaviour? Or do I get a hint of counter-transferrence? That maybe all the energy and effort you put into Joanne, and made her "see the light" on the evils of Alprazolam* and she chooses to talk the non-dependence qualified 6 minute GP with 20 more patients in the waiting room, getting the same salary as you, but no sick leave, no holiday pay, if he doesn't work the bills don't get paid....
She also chooses to get the script, and she chooses to present it to the pharmacist, who should have known her history as well? And she chose to use her health card and cash to pay for it, and she chose to open the lid, but some how those tablets forced themselves into her mouth?


* Benzos are indeed evil, I don't think they really help with pain or anxiety or even insomnia, they just make you forget you had a shit night....

8:05 PM  
Anonymous Anonymous said...

Benedict: Would you serve beer to a recovering alcoholic? I'm not a doctor, but prescribing certain drugs to a person with a known addiction problem concerning those drugs seems to me to be not only irresponsible, but cruel. That the drugs weren't even appropriate for the ailment only compounds the astounding lack of care.


8:09 AM  
Blogger Bronze John said...

I can just see this conversation going well.
First off - Dr Zu made her sicker.
Second - The heart rending tale of this GP's third world living conditions does not correlate all that well with the fact he earns twice what I earn.
Twice my wage, nett. After expenses.
Third - it's not her, it's him. The man's a dickhead.
Fourth - addiction is a disorder of choice, of insight, of impulse control, of memory, of class and so on. I have strong reservations about the whole choice thing, like I have in the whole will-power thing. I do not believe in the little engine that could.

In the end, me asking "who is responsible for this woman taking alprazolam" is a theory question, in a way that "why has this woman been brought in dead with a possibly lethal blood level of alprazolam" is not.
Anyhow - what would I know? My opinion's worth about half of Dr Zu's.

11:29 AM  

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