Structural Iatrogenesis — A 43-Year-Old Man with “Opioid Misuse” - Stonington and Coffa, 2019

Interestingly the patient’s perspective on these events is not reported in the article. The doctors were worried that the patient was using “unprescribed opioids” and that they were at risk of being arrested. I bet that the patient was just pissed that their new doctor was too inept to properly fill their prescription on time, and that they had to spend their already-limited money buying black market oxys.

Anyway, I appreciate that articles like this are written, just have my doubts that their recommendations (that doctors take action to fix beareaucracies / remedy structural iatrogenesis) will ever happen in practice. Who has more power: one frustrated PCP, or the insurance companies that rule over them?
 
So do I, I am torn between knowing that PCPs are in a huge position of power over our daily existence, and feeling resentful in many ways, but also that shifting responsibility onto one group is not going to be effective and probably diverts attention from the other angles that need addressing.
 
5vforest said:
Interestingly the patient’s perspective on these events is not reported in the article. The doctors were worried that the patient was using “unprescribed opioids” and that they were at risk of being arrested. I bet that the patient was just pissed that their new doctor was too inept to properly fill their prescription on time, and that they had to spend their already-limited money buying black market oxys.

Anyway, I appreciate that articles like this are written, just have my doubts that their recommendations (that doctors take action to fix beareaucracies / remedy structural iatrogenesis) will ever happen in practice. Who has more power: one frustrated PCP, or the insurance companies that rule over them?
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Maybe not in this case but there are many health care systems in the US that require physicians to only prescribe exactly as many pills as needed and get regular appointments to get them filled again. With zero to spare, so whenever something comes up to delay an appointment where do people turn to instead? Obviously black market pills. And of course the DEA loves to run stings on those so many people seeking medical care end up getting the big stick of punishing law enforcement, where suffering is used as entrapment.

It's a system built on punishment that then punishes following all the rules. Probably not relevant here but it plays a huge role in how the opioid crisis played out in the US.
 
rvallee said:
Maybe not in this case but there are many health care systems in the US that require physicians to only prescribe exactly as many pills as needed and get regular appointments to get them filled again. With zero to spare, so whenever something comes up to delay an appointment where do people turn to instead? Obviously black market pills. And of course the DEA loves to run stings on those so many people seeking medical care end up getting the big stick of punishing law enforcement, where suffering is used as entrapment.

It's a system built on punishment that then punishes following all the rules. Probably not relevant here but it plays a huge role in how the opioid crisis played out in the US.
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That's exactly what happens to people with ADHD in the US, and people with ADHD find it really hard to time it just right - funny that. From what I hear it's a huge stressor and leaves people without their medication for a few days each month at minimum and often causes them to miss work too. I can imagine the feeling of injustice and lack of control makes it even more stressful.
 
if i don't have a certain non-opioid medicinhen i don't sleep at all. sleep is one of the biggest factors in overall health. lessofthat medicinemeans bad health.

but being stuck with a zero-to-spare system and relying on others who are unreliable to get the medicine and spilling practially every time i try to transfer to a bottle that works better for me and taking it at night meaning occasional spilling from evfen teh better bottle and feeling as if under suspicion for no reason makes health worse and for health reasons never being able to resolve bureaucratic issues and insurance being hostile and not being able to talk or deal with stress of dealing with insurance to fix the problems and dr office taking time to get messages [vua othrs who are unreliable] and act on them and pharmacy literally making 2x-4x math errors.

the medicine works for me but i would want off it merely so that i don't have to deal with all that. but i know no alternatives that work. so i am treated like a subhuman to the detriment of my health.
 
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