Patients Who 'Must Have' Pain Medicine NOW

Michael J. Schiesser, MD


March 25, 2015

In This Article

Fast-Forward and Multiply

I have shared these solutions with thousands of primary care doctors over the past 7 years.

Process solutions and resource development require committed leadership where the details are informed by clinicians. When "care as usual" presents an unreasonable risk to the patient, how common is it that a primary care clinic has a detailed and coordinated response in place, drafted in advance of when a given patient actually shows signs of needing it? When primary care clinics fail to design support resources to effectively transition a patient away from chronic opioid analgesics, then the panic button and the easy button appear a lot alike. We wonder why so many patients are addicted to their meds, and so many physicians are burned out with resentment.

As I performed my one-to-one hour-long interviews with the small primary care clinic, I couldn't help but feel a great sense of compassion for these providers who are dealing with a major epidemic in prescription drug abuse, misuse, and addiction. Their accounts suggest their patients are experiencing distress from neuroplastic changes, regardless of whether they are following the rules. The physicians fear regulatory actions, civil suits, and unintended deaths. Layered on top of that is contempt toward one another, and burnout.

In many cases, simple conversations related to controlled medications that need to happen between doctors, and between doctors and staff—for example, regarding what to reasonably expect when a doctor is on call or what to reasonably expect when a physician goes on vacation—never get discussed or codified. Somebody may not like what is ultimately decided on a clinic-wide basis, but at least it's clear and on the table. The creation of organized clinic communications and policy structure is a critical first step to regaining physician quality of life in the face of an epidemic of painkiller addiction.

Michael Schiesser, MD, is and internist and addiction specialist in Washington state and director of "A Leader's Guide: Eliminating Problems from Prescribed Narcotics in your Primary Care Clinic," an online course for medical directors, practice administrators, and office managers.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.