I thought I’d put up an actual EMS related post since this is an EMS related blog.
came across one of my news feeds while I was on vacation. I sort of laughed and moved on to other items. Then I saw another article about the opiod crisis and how some doctors are dealing with their chronic pain patients. That is, patients that have chronic pain, not patients that are chronic pains. I’ll post a link to that in a bit.
From the first article,
Dr. Chris Eberlein, medical director for Tri-State, said he noticed paramedics were often giving small doses of narcotics like fentanyl to patients who ended up not needing a prescription for pain medication.
“We started reviewing ‘Why are they giving narcotics?’ and really it came down to the fact that they didn’t have many other things they could do in the ambulance ride,” Eberlein said.
Huh? I have to think that the good Doctor was referring to things that they can do to treat pain, as opposed to just things they could do to while away the time until they arrived at the hospital.
So, they decided that aromatherapy using essential oils would be be a viable alternative. I’m a bit skeptical, buy I’m old enough to remember when aromatherapy consisted of “smelling salts.” Not just old school, but ancient school, that.
I’m also skeptical that the relatively low doses of opioids that most systems allow their medics to administer are going to instantly cause addiction. We’re talking about medicine here, not Lays potato chips.
Pain control alternatives include positioning, splinting, ice (or cold packs), and elevation. All of which are well established.
If the medics from La Crosse Ambulance are giving low doses to patients with minor pain, then they need re education on the indications for opioid use. Many systems have adopted the non opioid pain medication Toradol, which is given via the Intramuscular route. It reduces pain by reducing swelling. Pretty much like Motrin, but much more potent.
Other systems have decided to add oral medications such as Motrin or Tylenol (both of those are brand names) to their medication boxes. The problem with those is that they are orally administered. If you want to see an anesthesiologist go crazy, then give a patient who might need surgery anything by mouth six hours before they go to the Operating Room. It’s bad enough that they have to operate on trauma patients with bellies full of beer and Chinese Food, so giving patients oral medications that probably won’t work anyway just drives them berserk.
More wisdom from Dr. Eberlein,
“Before you get in, you get a nice whiff of diesel fume or exhaust in the back. And then you’re in this very sterile-like environment, bleachy smell, plastic smells,” Eberlein said.
I guess the good doctor hasn’t been in an ambulance lately. That diesel smell not only shouldn’t be inside the ambulance, it should be all diesely at all. Ironically, the process of reducing diesel exhaust creates a very bleachy smell as a by product. I’ve never heard of bleachy or or plasticy smells causing pain. Nausea maybe, but the way most EMS providers drive and ambulances ride is enough to cause nausea. And not just in patients.
It all seems kind of New Agey and silly to me.
Then there is this,
Many doctors around the country are now asking patients with chronic pain to sign a document agreeing to certain conditions before they’ll prescribe an opioid pain medication.
As part of these “opioid contracts” or “pain contracts,” patients agree to random urine drug screens, opioid pill counts, and other conditions. Violation of the terms can result in patients no longer being prescribed opioids by that medical professional.
The contracts, also known as “opioid treatment agreements,” are one tool among many aimed at reducing the misuse of prescription opioids such as oxycodone, hydrocodone, and codeine.
They’re also intended as a way to inform patients of the risks of prescription opioids.
“It is really meant to be used as a clear way to establish an understanding of [opioid] treatment guidelines and expectations of the patient and physician,” said Dr. Kavita Sharma, a board-certified pain physician with New York-based Manhattan Pain & Sports Associates.
I’ll cut through all this BS here and state that this is not for the patient’s benefit. It’s to keep the doctors out of trouble with law enforcement and limit their liability risk. I’d be willing to bet that these “contracts”, which are actually non enforceable agreements, were written by lawyers. Or maybe doctors who are also lawyers.
Drug tests are usually limited to some employees and convicted criminals. I rather doubt that my ninety-nine year old Mother in Law is out on the street scoring more opiods because she’s become addicted to Tramadol.
If a doctor really wants to explain the risk, benefits, and alternative treatments, then they should sit with the patient and take the time to explain the risks, benefits, and alternatives. Not have them sign a dumb “contract” which many of the patients may not take the time to read or even understand if they do read them.
“There are a variety of responses, but generally patients either say yes, of course, or they are clearly offended, refuse, and decline to continue their care with me,” said Dr. Britt Ehlert, a general internist practicing with Allina Health in Minnesota.
My doctor is one of the “sit and explain the risks, benefits, and alternatives” doctors, so I don’t foresee him (or a nurse practitioner in his office) shoving a form in my face and telling me that if I don’t sign it, I don’t get pain medication. Which I generally don’t use except immediately post surgery. Other doctors have different approaches, I guess.
Critics have raised several concerns about opioid treatment agreements.
One is a lack of evidence showing that they’re effective.
A 2010 review of previous studies, published in the Annals of Internal Medicine, found “weak evidence” that opioid treatment agreements reduce opioid misuse by patients with chronic pain.
It’s passing strange how doctors are all about “evidence based medicine” until a study shows that something they favor doesn’t work. Then it’s a different story.
Of course medicine (or somebody) brought this all about because somewhere along the line patient satisfaction became more important than patient treatment. Hospitals and doctors live in constant fair that their “patient satisfaction” scores will fall and since those are often tied to reimbursement, doctors are under pressure to aggressively treat pain in their patients.
Since pain is subjective it becomes difficult to treat properly. The 0-10 pain score is useless in the real world. Yet, it’s used to judge what type and how much medication a patient should be given.
A good rule of thumb here is that that generally acute pain (such as in EMS patients) is under treated and chronic pain is over treated. The real problem is figuring out how much and what type of medications should be used. Maybe someday we’ll have a non addicting pain medication that is really effective.
Essential oils are not that medication. In fact they aren’t medications at all.
Just keep in mind that the real “Essential Oils” are Gun, Motor, and Cooking.