From today’s New York Times:
Some of the most common and most powerful prescription painkillers on the market will be restricted sharply in the emergency rooms at New York City’s 11 public hospitals, Mayor Michael R. Bloomberg said Thursday in an effort to crack down on what he called a citywide and national epidemic of prescription drug abuse.
Since when is Michael Bloomberg licensed to practice medicine?
Same as I’ve always thought about him… his heart in in the right place, almost… but politics run his brain… and people want “something to be done” so he does “something”. Old story with most politicos… and with everyone.
Yep, this isn’t right. And I thought his “sugary drinks” law was ridiculous.
Not right. Absolutely not. First of all, you are right. He’s not a doctor. And ER is a different beast. If someone is injured, they have the right and the need for the relief of pain. Addiction does not start from opiates in a visit to the ER. It starts with over-generous doctors.
I too was nonplussed by this, until I read the whole NYT article. Then it finally sank in: this applies only to Emergency Room medicine and does not preclude follow-up treatment and prescriptions through a regular doctor visit. This was pertinent:
In other words, the ER is for, well, emergency treatment. That gives the patient three days to get non-emergency care. This seems reasonable to me, considering the fact that abuse of the system is rampant. This is the least reliable and most abusive segment of the population we’re talking about and the system we have isn’t working. I applaud Bloomberg for dealing with it – he is one of the very few politicians who are willing to engage the toughest problems – my kind of guy. IMO.
I disagree. While I like Bloomberg, I do not agree that he should be substituting his judgment for the professional judgment of the ER physician on the scene. ER doctors in particular see a lot of critically injured individuals in immediate need of the strongest available painkillers. You can’t make those patients wait three days for an office appointment. And whether it’s a walk-in with no money and a toothache or a critically injured accident victim, what and how much to prescribe should be the doctor’s call.
Another quote from the article:
Sorry, PT, I can’t see it. Dr. Rosenau seems to think that an ER doc in this most urban of all urban areas can make some kind of judgement about the trustworthiness of random patients claiming an emergency. On what does he base this judgement? Appearance? Dress? Doctor ESP? I think Dr. Rosenau is wearing his doctor pride on his sleeve.
Seems to me there are two kinds of judgement at issue here. One is purely medical, in an emergency context only. The second kind of judgement is one of longer-term healthcare, and for that I would think proper documentation is needed. Wouldn’t the new electronic medical records fit that bill? That way the non-emergency medical staff and doc know the documented facts, address, medical history and most important, any record of past misbehavior, crimes or abuse. Seems to me that’s the way the system ought to work, and from the news I see, a chaotic ER is not a good environs for making such judgements.
And, I believe you have misinterpreted the three days thing. Patients, per the quote I cited, will be able to get three days’ worth of meds or whatever other treatment they need. It’s not like they are going without treatment for three days, which is what you seem to think. The NYT article is clear on this.
I’ve got to side with Dr. Ronenau. However he assesses and judges the patient he’s treating, including using his “doctor ESP,” he’s the one on the scene making the judgment, not Mayor Bloomberg over at City Hall. When it comes to medical treatment, the doctor trumps the mayor every time. Dr. Ronenau has a right to wear his doctor pride on his sleeve; he’s the one with the medical degree.
Yes, I see now that patients will not go without treatment/medication for three days; nevertheless, what they receive for those three days should be the doctor’s decision, not the mayor’s. If the doctor judges that the patient needs three days’ worth of oxycodone, for example, s/he should be able to prescribe it. In fact, there may be legitimate reasons why the patient needs more than a three-day supply. It’s a judgment that only the doctor on scene can and should make.
Yes, electronic medical records would certainly help in the assessment of any patient, assuming the patient has a regular doctor who has established such a record and that said record is available to the ER doctor. But as we know, many patients are in the ER because they don’t have regular doctors.
ERs are, without doubt, often chaotic; that’s the nature of the beast. ER doctors are trained to work in such an environment, to make medical judgments under pressure. They choose that environment; emergency medicine is their specialty. I contend that on their worst day, they are still better qualified than the mayor to make medical decisions for their patients.
Bottom line, the effort to keep drugs away from drug abusers, however well intentioned, should not limit what doctors are allowed to prescribe for legitimate patients.
Of course much of this would not be a problem if emergency rooms weren’t now required by law to render aid (for free, if necessary) to everyone who walks in the door. ERs should be reserved for emergencies.