Why I stopped prescribing narcotics, and never looked back

I was never a big prescriber of narcotics.  I grew up “country,” in a tougher world where your parents taught you to accept pain as a part of life.  Pain is how you know you’re still alive. They’d tell me, “if you’re hurtin’ you ain’t dead yet.” You fell down; it was going to hurt.  You learned not to fall.  Twisted your ankle doing something stupid (and it was always while doing something stupid, like jumping off the roof), well we’ll wait a day or two and see how it goes.  Put ice on it, and next time think harder before you jump off the roof.  Just because everyone else was doing it, yada yada yada. So most of the time it never occurred to me to prescribe narcotics, except for severe crippling incapacitating pain.  Cancer, broken bones, post-surgical pain, or severe arthritis.  And after thirty years in practice, I knew I was an expert at figuring out who really needed the medication, and who was just scamming me. And on those days when things were slow, I would sometimes play “the game” when a new patient wanted narcotics.  You know how it goes.  You get the history of some terrible trauma/ongoing problem/lost medications/etc.  Then you ask, what were you taking? The patient can’t remember.  It was “a round white pill” for pain. I’d respond, “Ibuprofen!” “No doc, that wasn’t it.  It was kypo or depo or hypo something.” “Ahh,” I’d reply knowingly, “It was Depo-Medrol.” “No doc, that’s not it.  Oh, I ...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Physician Pain management Source Type: blogs