Still Pain

This was prompted by an article about the fatal overdose of a nurse who had ‘doctor shopped’ to feed her pain-killer addiction in Australia, before stealing liquid fentanyl from her workplace.

“Doctor shopping” is touted as becoming a problem worldwide, particularly with the over-prescription of medications,  fuelling prescription medication addiction and drug-seeking behaviour (although this study finds no correlation between doctor shopping and short-acting abuse-able opioid use).

The addicted then ‘shop around’ multiple doctors simultaneously to receive multiples of the same prescription, more than would normally be prescribed by a single doctor.

They also visit multiple pharmacies, to minimise the risk that they could be caught filling multiple prescriptions.

Without a centralised, real-time prescription-patient database in place to track filled prescriptions, both doctors and pharmacists are forced to make an educated guess - is the patient for real, or are they drug-seeking?

It's not easy to guess

Unfortunately, this has resulted in many doctors refusing to prescribe strong pain killers or relaxants, especially in the US.

Even emergency departments at hospitals are starting to refuse to provide pain relief.

That leaves those with chronic pain no way to get pain relief.

My peeve - 'prescription shopping' not 'doctor shopping'

‘Doctor shopping’ is badly named.

If you want to buy clothes, you go ‘clothes shopping’, not ‘clothing shop shopping’.

Want to buy food? Go ‘grocery shopping’, not ‘grocer shopping’.

If you want to get prescription medications, you go ‘prescription shopping’.

You don’t want to buy a doctor!

Unfortunately we are stuck with the inaccurate term of ‘doctor shopping’.

Tolerance is not the same as addiction

Many chronic pain sufferers are not addicted. The amounts of medication they take are only just enough to cover their pain and symptoms.

Unfortunately, the human body can build up a tolerance to medication, and chronic pain sufferers then require more or different medication to cover their symptoms. But that doesn’t mean they are addicted. It just means their medication schedule and types need tweaking.

Dependence can also cause a problem, making it hard to stop using a medication when the symptoms have recently disappeared. But most medications can be tapered down over time, after the initial reason is resolved.

Addiction is taking too much, too often, more than the symptoms require. And it means doing this over an extended period.

Can you tell when someone is lying or not?

Most chronically ill people don’t lie about their needs.

Most if not all addicts do lie, often very convincingly, just to feed their addiction.

It’s not fair to punish the doctors and pharmacists for being human and not being able to differentiate something that is often not differentiable.

Doctors move and retire, patients move too

When a patient has seen many doctors in a relatively short period of time, they are often accused of ‘doctor shopping’.

In my experience, doctors don’t stay for decades in the one clinic. The move regularly. They change fields. They retire, and a replacement comes in.

I saw at least 6 different doctors in the years I was at university, just in the university clinic. I’ve had to find new doctors almost every time I’ve moved house (and countries) - about once a year.

I’d be flagged for changing doctors too often, for sure!

You can change doctors to seek a second (and third opinion). Or to see different specialists.

It can be because the doctor just isn’t taking your illness seriously.

The number of times I head “You’re imagining it” when trying to get my endometriosis diagnosed was insane!

Not all ‘doctor shopping’ is driven by suspect motivations, such as prescription drug seeking.

The solution: a central patient-prescription system

A simple (if expensive) solution - an electronic, real-time prescription system connecting all doctors, all clinics, all pharmacists, all hospitals and the government if rebates are allowed.

These systems are already half-implemented in many countries.

This would all but stop prescription shopping, prevent doctors losing their licenses for over-prescribing, provide multiple doctors access to the complete medical records of a patient.

This leaves the medication available for those who need it - the chronically ill patients.

Don't punish the chronically ill or the doctors who try to help them, just because of the tiny few who prescription-shop and the current broken system that allows them to do it.

What are your thoughts?

Have you been personally impacted by  ’doctor shopping’?