Chronic pain – GP is away again and my opioids may be denied

Quick post. Or I’ll try to make it quick. Must. Stop. Rambling! Once again, my GP is on holiday.

She’s a human being; she needs a holiday. Especially in a high stress career, as she is. I am in NO way saying that GPs should not take breaks. I am saying GPs DO need to take breaks. But, when they do, they have a responsibility to provide cover for their patients. It’s a part of being a doctor, you must ensure that your patients are cared for, covered, at all times. That’s how it works in hospital. That’s how it should work in the community.

I went to make my 4-weekly appointment with my GP last week, and saw she had no appointments during the week I require my prescription refilled, and the next two weeks after that. Heart sink moment. I had no choice but to go in and see her the following day, the only appointment she had available. I had to postpone my rheumatology appointment to do so.

My rheumatology appointment is very important, because I am waiting on Rituxan approval. I need to see my rheumatologist about this. Ah well, never mind. Can’t be helped. Rheumatologist postponed.

I saw my GP. She said I should make an appointment with the other GP at the practice.

There is only one other GP at the practice now. And the last time I saw this other GP she told me unequivocally, and in no uncertain terms “DO NOT COME BACK TO ME. I WILL NOT FILL THIS PRESCRIPTION AGAIN.”

She was very unpleasant. But very clear.

I told my GP this.

My GP sighed and said “Well, she’s going to HAVE To fill your script.”

I must have looked doubtful, because she added “I will talk to her. Don’t worry, I will make sure you get your medications”

I believe my GP believes this.

I also believe that the other GP will refuse to prescribe. She has told me as much, very clearly.

I wrote about her here:

and here

She told me clearly. DO NOT COME BACK.

My GP cannot compel the other GP to prescribe. Even though the other GP is ethically bound to supply my medication, for continuity of care.

Refusal to do so will put me in agonising pain for two weeks, and likely opioid withdrawal as well.

I have never experienced opioid withdrawal in the past. Perhaps I am a freak of nature. I suspect what is actually happening is that the pain is far worse that the withdrawal symptoms, so I am only aware of the increased pain. That’s how pain works – you only feel the most severe pain.

My appointment is on Wednesday.

Obviously, I am anxious about this appointment. I do not want to consult a GP who has expressly told me she does not wish to see me again. That puts me, and her, in a very awkward, very unpleasant, situation.

Why can’t my GP write a post-dated script?

Why can she not ring the Medicare authority line, explain she is going on leave, and have scripts approved? They could be waiting for me, to be picked up on the usual day, the day they are due. I could attend the practice, pay my fee, and pick up my script. Not a minute before.

Would that be so hard?

Why is this impossible?

Given that opioid pain medications have become some kind of moral issue for some GPs, this is the obvious solution.

Why can’t this be done?

Because the ACT government does not care about people who live with constant, severe pain. People who live with painful, progressive, incurable disease. Disabled people. Sick people.

If this can’t be done, why are other GPs not compelled, ethically, to write scripts? I’m sure this is what is supposed to happen. However, GPs can refuse, of course. No one can make a GP see a patient they do not wish to see, or prescribe a medication they do not wish to prescribe.

Even though dumping a person into a pain crisis is not ethical.

Even though dumping a person into opioid withdrawal is not ethical.

So how is it that GPs feel ethically OK about doing this?

Because they have been taught that opioids are unnecessary. That people on long term opioid therapy for chronic pain are addicts. That opioids do not work for chronic pain. That addiction is common and overdose is common. NONE of this is true.

But even if this were true, it does not change the fact that a person will suffer due to a GPs inaction. A GP’s conscious decision to deny that person their regular medication will cause suffering, of one type or another.

It’s pretty abhorrent.

It is beneath a doctor, a GP. I still expect doctors to somehow be a better class of person. To be more ethical, to be more upstanding…however you want to phrase it.

To devote your life to the study of medicine, and the relieving of human suffering, is a higher calling. I still somehow expect doctors to be better people than average – morally, ethically, personally.

But…its not true. Doctors are just people. Some are great. Some are not.

But my problem remains.

Once again, I am completely powerless. I am the pariah patient, that no one wants to see. NO one wants to help. Drug seeker. Malingerer. Exaggerating pain to get high. I know this is what this other GP thinks of me, she was very clear last time.

I am anxious about even being in the same room as her. Let alone begging her for help. Depending on her for help.

I am powerless, have no agency, no choice, no voice, no control.

And accessing my pain medications, is once again, consuming my time.

It should not be this difficult.

Last time someone told me to just go to the ED. It is far, far worse at the ED. They will leave me in Siberia (a cold cubicle at the end of the hall where angels fear to tread) and ignore me for 10-11 hours. Before telling me they do not provide opioid pain mediation sand give me a Panadol and discharge.

My local ED does NOT provide opioid pain medications unless you have lost a limb or some other major trauma.

Again, abhorrent.

My regular GP is uncontactable. The other GP will do whatever she wishes. And she will wish to deny me opioids, I know this.

What will be, will be.

Once again, accessing my usual pain medications, which I have been taking for a decade, is dominating my life.

I am so SICK of the government making this so difficult. I

am sick of the misinformation.

I am sick of the cherry-picked research and the smug addiction medicine researchers lying through their teeth on camera, in person and in writing. They KNOW they are lying, to build their career. To line their nest. To receive those sweet, sweet, research dollars.

I am sick. I am disabled. I am in constant, severe, pain. I do NOT need this hassle! My life is hard enough. This should be simple. It should not consume me for days on end.

I am bringing my support worker to the appointment. She will accompany me into the consult room. I will tell the GP I required help getting there, which is true. My wheelchair will be necessary. The practice is not very accessible for wheelchairs. I have a power assist, but I will require someone to help me get up the hill to the door, and through the narrow hallways.

They clearly do not have many wheelchair dependent patients. And clearly do not think about accessibility much. I am fast learning how inaccessible the world is, and how little people care.

I will show up with my support worker, and I will be calm, polite and firm. I would like my pain medications please.

When she declines to fill the script, who will I complain to? What recourse do I have?

Not much.

I believe the doctors at this practice are independent contractors. They rent their rooms and the facilities, reception staff, etc. And run their practices independently.

This is partly why no one can compel this GP to write this script. She is an independent contractor. She can choose to deny opioid pain medications. The practice manager is not her boss; there is no one above her to override her decision in the interests of ethical patient care.

I can complain to the ACT Human Rights Commission. I did that before, when a surgeon allowed me to bleed (almost) to death in the hospital for five days, post op. I waited over a year for my case to get to the top of the list, and in the end they did nothing. They made things worse, to be honest.

The only authority I can complain to is AHPRA – the Australian Health Professionals Regulatory Agency. Generally, they deal with malpractice, serious negligence. I don’t think a doctor refusing to prescribe opioids would bother them much. A doctor OVER prescribing would rate a mention…but under prescribing? No. I don’t think so.

So again, no one cares. Not about people who live with painful, progressive diseases. People who have physical trauma that can’t be healed, or surgically ‘fixed’. People who’s bodies are broken and generate constant, severe pain.

We all know that’s not true, right? No one has pain like that. Not really. They just THINK they do. A bit of education, some psychological strategies, and some exercise will fix them right up.

That’s what people believe. From doctors to friends and family to the person next door. Everybody knows it CAN’T be THAT bad.

And hence, nobody really cares whether I get my opioid pain medication…or not.

I’ll let you know what happens on Wednesday.