Nobody, least of all doctors, seems to know whether doctors themselves have an addiction problem. Smart-arse wise-cracking punters may define an alcoholic as someone who drinks more than their doctor, but, as with most smart-arsed wise-cracks, real evidence is hard to come by. What is more certain is that most doctors have problems with crack heads and cotton shooters. Substance misuse – to give the subject its sanitised, politically correct name – remains very much a Cinderella specialty, while many GPs – despite touting themselves as generalists happy to take on all-comers – refuse to admit drug addicts to their lists.
It is, therefore, very much to JD’s credit that he should not only treats addicts, but openly admits to doing so. Indeed, were it not that we know otherwise, the post hints that that JD’s practice is a right old Fagin’s Den of harboured criminals and space cadets in regular receipt of stratospheric prescriptions for all manner of controlled drugs.
While the post is ostensibly about one doctor criticising the clinical practice of another – a prison doctor opined that JD ‘should be shot’ for prescribing at such high levels (and Dr No is with JD on this – such opining is both out of order and unhelpful) – and takes in the ‘harm reduction’ approach to managing drug addiction – the approach JD clearly prefers and adopts – and even manages a jab at ritualistic, possibly even sadistic, prison medical services, it only, understandably, covers what to do when the addiction is present.
All this talk about managing addictions in various ways is all very well, but it misses the point that these addictions had to start somewhere. Many, of course, start on the street, in the club and at home, but a number, a significant number, are started, with not a little irony, by the very profession that in other guises and around other corners will agonise, argue and opine about how best to end addiction.
Those very same GPs who decline to soil their surgeries with the flotsam and jetsam of the drug underworld are far more inclined than they should be to start patients on teensy-weensy doses of benzos to tide their patients over the slings and arrows of normal misfortune. How much easier it is for an over-pressed GP, a long list of waiting patients rattling at the surgery door, to reach for the pad and write a prescription, than give the extra minutes of firm but drug free guidance?
Just as many take alcohol without becoming alcoholics, so many will take benzos without becoming addicted. But the risk is there, and many a patient has come to regret that first casual and unnecessary prescription that has started them on the road to addiction. The trouble is that, as long as GPs continue to behave like shopkeepers, they will forever be doling out unwise and unneeded prescriptions: the gatekeeper caught in the ‘gotcha’ of an apothecarial ancestry.
” doling out unwise and unneeded prescriptions”
You mean like Statins?
It includes statins, but the list is as long as your arm (and longer if we go back in time): antibiotics, antidepressants, benzos, barbiturates etc etc.
Dr No suspects many of these prescriptions happen because of the historical roots of the social contract between the GP and the patient. GPs, whether they like it or not, are the lineal descendants of the apothecaries, and the apothecaries were shop keepers; and customers (shoppers) expect to come away from the shop with something in their hands. (In reality, over-prescribing is a collusion between the shopkeeper(GP) and the shopper (patient), but the GP carries the can because they are the professional adviser and should know better than to dole out unwise and unneeded prescriptions.)
Statins appear to be part of a new sinister trend which Dr No calls mass prescribing. The general idea is that everybody should be on ‘X’, whether they need it or not, because it might do some good in some people. Fluoride is the classic example. Similar cases can be made for drugs like statins. Before we know it, we will be like livestock on the farm, doped and drugged to the eyeballs; all, of course, in the common good!
Edit: spoke too soon: following a tip off from HyperCryptical it seems there are already moves afoot to dole out statins with the burgers…and no, I’m not lovin’ it!
I think that you will find this a stronger feature of private medicine, my experience of 3 continents is that the expectation of a prescription at the end of a consultation is the norm in other societies also. Indeed it appears to be much stronger in other systems where practitioners are paid directly by their customers. If you look at prescription rates in Continental Europe these are much higher than in the UK. Antibiotic sales in the Subcontinent are rampant, hence the rise of the new superbugs. Some years ago I was working in Australia, where there is a big secondary Market in prescription drugs amongst addicts. Some practitioners would quite happily write big prescriptions for benzos for 50 bucks per consultation on fairly flimsy grounds.
Doctors tend to be on a spectrum between those who prescribe a pill for every ill and those theraputic nihilists who don’t believe anything works. There will always be a tension between the two. You pays your money and takes your choice.
These photos are absolutely beautiful. The same results just can’t be duplicated using Photoshop on a digital photo.