The Story of “Doctor Pat”

pat and skeleton

In early 2000 I was toying with the idea of hosting a radio call-in show. Well, the show still hasn’t happened. But that didn’t deter my former college roomie, Phil Ward, from writing the theme song.

A few weeks after hearing of my intentions, he surprised me with “Doctor Pat.” The song was featured on his album “Easily Amused.”

easily amused

Now Phil has graciously given me permission to share “Doctor Pat” on YouTube.

you tube dr pat

(Disclaimer: It was very touching that my talented friend paid me such a tribute… However, the only part of the song I stand by is the FIRST LINE !!!)

“Doctor Pat” by Phil Ward

Chronic pain sufferers all is not lost,

Spinal stimulators at half my cost.

Nerve blocks, epidurals, everything must go,

I must be insane my prices are so low.

 

Take advantage of my craziness before they come and get me,

Doctor Pat, Doctor Pat.

I want to give it away but my wife won’t let me,

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

 

Morphine pumps, facet blocks, trigger point injections,

In flagrant violation of my bookkeeper’s directions.

May I just introduce one little concept at this juncture?

No payments ‘til 2002 on first time acupuncture.

 

And no money down on electronic implants with,

Doctor Pat, Doctor Pat.

Everybody get nuts and do a pain free dance with,

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

 

Take advantage of my craziness before they come and get me,

Doctor Pat, Doctor Pat

I want to give it away but my wife won’t let me,

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat, Doctor Pat.

Doctor Pat.

ap trail pat and phil Phil and Pat, circa 1982

“Doctor Pat” was written by Phil Ward with a little help from Doctor Pat (P. Ward, J. Murphy) Copyright 2001, ASCAP.

Thanks to Stephen Bassett for helping me with my first ever attempt at posting a YouTube video.

Discover the genius of Phil Ward – entertainment’s true Renaissance Man – by exploring Phil’s website and visiting his Facebook page.

James Patrick Murphy, MD, MMM

jamespmurphymd.com

Twitter @jamespmurphymd

Doctor Pat on YouTube http://www.youtube.com/watch?v=6vuUpSnPXz0

Phil Ward’s Facebook page https://www.facebook.com/pages/Phil-Ward-Live/180936201939986

Download “Doctor Pat” from iTunes https://itunes.apple.com/us/album/easily-amused/id69823459

Phil Ward, Trough Records philwardmusic.com

Easily Amused http://www.rhapsody.com/artist/phil-ward/album/easily-amused/track/doctor-pat

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ARE WE IN AGREEMENT?

…One Pain Specialist’s Take on the Controlled Substances Prescriber-Patient Agreement 

 me and c arm

With all of the information and misinformation about pain medicines, addiction, and prescription drug abuse, I thought it might be useful to publish a sample of what a “full-bodied” patient-prescriber agreement looks like. More and more states are requiring these for ongoing treatment with powerful medications that have a substantial potential for abuse (i.e. “controlled substances”). Although this version may not be best for everyone (some may be longer, some shorter), my pain management office uses a document similar to this.

So if you have a little time on your hands and want to know what goes into these agreements, here’s my take on what a thorough prescriber-patient agreement looks like.

 cs agree pic

 

INTRODUCTION:

I understand controlled substances medications (i.e. opioid pain medications, tranquilizers, etc.) have a potential for harm and are therefore closely controlled by the local, state and federal governments. I understand that any medical treatment is initially a trial, with the goal of treatment being to improve my quality of life and my ability to function and/or work. My progress will be assessed periodically to determine the benefits of continued treatment. Continued use is dependent on whether my prescribing provider and I believe that the medication usage benefits me. These drugs can be useful, but have high potential for misuse and are therefore closely regulated. This agreement will help my healthcare provider and me and comply with controlled substance regulations. I agree to use opioids (morphine-like drugs) as part of my treatment plan. The success of my treatment depends on trust, honesty and understanding of how opioids are used. I understand that violation of any part of this agreement may result in this medication being discontinued, as well as termination of my relationship with my provider. I agree to the following conditions:

safe

SECURITY OF THE MEDICATIONS:

I am responsible for keeping my pain medications in a safe and secure place, such as a locked cabinet or safe. I am expected to protect my medications. If my medication is stolen, I will report this to my local police department and obtain a stolen item report. I will also report the stolen medication to my physician. I agree that if my medications are lost, misplaced, stolen, or if I use them up sooner than prescribed, my physician may choose not to replace my medications.  I understand that this opioid medication is strictly for me. I will never give away my medications or sell them to others, because it may endanger that person’s health and is against the law.

FOLLOWING DIRECTIONS:

Unless directed to by my prescriber, I will not alter my medication in any way, and I will take my medication whole. My medication will not be broken, chewed, crushed, injected, or snorted. I am responsible for my opioid medications. I will not allow my medications to be damaged.  I will take my medication exactly as instructed and prescribed. I know that any change in dosage or directions must be approved by my licensed provider. I am responsible for taking the medication in the doses prescribed and for keeping track of the amount remaining. I will not take more than is prescribed.

TIME-LIMITED USE FOR ACUTE CONDITIONS:

I understand that a controlled substance used to treat an acute medical complaint is for time-limited use. I will discontinue the use of the controlled substance when the condition requiring the controlled substance use has resolved.

WHEN OTHER CONDITIONS OR SYMPTOMS ARISE:

I will notify my healthcare provider of side effects that continue or are severe or impair me in any way. I will notify Pain Center by the next business day if I need to visit another physician or need to visit an emergency room due to pain or if I become pregnant.

I agree to not request or accept a controlled substance medication from any other prescriber or individual while I am a patient at Pain Center. However, if another licensed provider, after being made aware of my Pain Center Agreement, still feels it is in my best interest to administer or prescribe a controlled substance for me, I will notify Pain Center by phone by the next business day. I will inform all of my healthcare providers of all medications I am taking, including herbal remedies. I understand that medications, including over-the-counter non-prescription medications can interact with opioid medications and be dangerous.

no_drugs-1331px

NO ILLICIT SUBSTANCES:

I will not use any illicit substances such as cocaine, marijuana, etc. I understand that the use of alcohol together with opioid medications is dangerous and can lead to death. I will promptly inform my Pain Center prescriber if I use or intend to use any of these substances, including alcohol.

KEEPING APPOINTMENTS:

It is my responsibility to schedule appointments for the next refill. I will communicate fully and honestly with my prescriber about my pain level and my activities. I understand that in order to more thoroughly evaluate my plan of care as it pertains to the use of controlled substances, I may have additional visit scheduled at my provider’s discretion. I will keep all my Pain Center appointments.  If I must reschedule, I will notify Pain Center prior to my scheduled time.  If an appointment for a prescription refill is missed, I will request another appointment as soon as possible. I know that immediate or emergency appointments to address medication issues may not be available. However, I understand that I am allowed to seek the services of another healthcare provider in the event of an emergency or acute situation.

REFILLS:

Refills will not be made as an “emergency.” They will be made at planned clinic visits, during regular business hours. I will not expect any medications will be prescribed during the evening or on weekends. I do not expect prescriptions to be written in advance due to vacations, meetings or other commitments. I do not expect my prescriptions to be mailed. I expect that a government issued picture ID will be required to pick up prescriptions.

friendly-pharmacist1

ONE DESIGNATED PHARMACY:

I will designate and use only one pharmacy for all of my controlled substance medications and give the Pain Center full permission to communicate with the pharmacist about my medical care and medications.  Unless I have been given authorization by Pain Center, controlled substance prescriptions can only be filled by a pharmacy in the same state as the Pain Center, even if I am a resident of another state. I will allow my prescriber and his or her associates to send a copy of this agreement to my other healthcare providers and/or to the pharmacy where I obtain my prescriptions.

Urine Sample

DRUG TESTING: 

My prescriber may perform drug testing on me. I agree that I may be called at any time to come in to the clinic for a count of all my remaining medications and/or a drug screen and I agree to come that day. I agree to be responsible for any costs this may incur. If requested to provide a urine sample or other type of sample if necessary. If I decide not to provide a urine sample, I understand that my prescriber may change my treatment plan. This might include discontinuation of my opioid medications or complete termination of our patient-prescriber relationship. The presence of a non-prescribed drug or illicit drug in my urine may be cause for termination of our relationship.

SHARING INFORMATION:

I agree to allow my healthcare provider to contact any healthcare professional, family member, pharmacy, legal authority, or regulatory agency to obtain or provide information about my care or actions if the he or she feels it is necessary. I will allow my prescriber and his or her associates to receive information from any health care provider or pharmacist about use or possible misuse of alcohol and other drugs. I will allow my prescriber and and his or her associates to contact my family and friends to monitor my conditions.  Furthermore, I consent to a criminal background check.

PRIMARY CARE PROVIDER RELATIONSHIP:

I have and will maintain at all times a relationship with a primary care provider and keep him or her informed of all medications I am taking. I agree to and understand the requirement that I have an annual preventive health screening and physical exam by my primary care provider. If recommended, I will see a specialist and/or complete a screening exam to help determine whether I am developing an addiction or psychological illness.  I agree to be responsible for any costs this may incur.

FUNCTIONAL GOALS:

I understand that the main treatment goal is to improve my ability to function. I understand that in general, it is unrealistic for patients to expect complete resolution of their chronic pain with any specific treatment or combination of therapies. I understand that it is important to have a conversation with my provider about my treatment plan and set realistic goals for improvement. I pledge to work together with my provider towards improving my pain control and achieving specific functional goals. I understand that functional goals might include increasing physical activity level, resuming a job/hobby or improving the quality of sleep.

exit-sign

AN “EXIT STRATEGY”:

I understand the concept of an “exit strategy” regarding these medications. I agree that if any of the following goals are not attained this may be evidence of a failure of opioid therapy and discontinuation of some or all of my medications could be the most appropriate plan: (1) meaningful pain control; or (2) acceptable level of function; or (3) tolerable side-effects; or (4) stable and acceptable mental health and behavior: or (5) compliance the plan of care, laws, and regulations.

PATIENT EDUCATION:

I acknowledge that I have been educated on the following matters through verbal or written counseling: (1) proper use; (2) impact on driving and work safety; (3) effect of use during pregnancy; (4) potential for overdose and appropriate response to overdose; (5) safe storage of controlled substances; and (6) proper disposal.

OFF-LABEL USE OF MEDICATION:

All prescription drugs in the US have a label approved by the FDA.  This label provides an indication and dosage for the drug, but neither physician nor patient is legally bound to follow them.  Studies cannot reliably evaluate all the combination treatments in complicated, difficult-to-treat conditions. I understand that my treatment may include “off label” use of medications. 

DISCONTINUATION OF CARE:

I understand that my violation of any of the above conditions may result in re-evaluation of my treatment plan and discontinuation of my medication. I could be gradually taken off these medications or even discharged from the clinic. If my violation involves obtaining controlled substances from another individual, as described above, I may also be reported to my physician, medical facilities and other authorities, including the police.

handshake_between_doctor_and_patient_with_the_sky_background_1341168865

I HEREBY AGREE:

I have read this agreement or it has been explained to me by the Pain Center practitioners and/or staff. If I am not currently receiving controlled substances from Pain Center, this agreement does not apply.  However, I understand that this agreement immediately becomes effective if in the future I do receive controlled substances.  I fully understand the consequences of violating this agreement.  I have been explained the risks and potential benefits of these therapies, including, but not limited to, psychological addiction, physical dependence, withdrawal and over dosage. All of my questions regarding the treatment of pain with opioids have been answered to my satisfaction. I hereby agree to participate in the opioid medication therapy and acknowledge that I have received this document.

Disclaimer: This is not legal advice.  This is not medical advice.  This is my personal opinion and has not been endorsed by any individual or entity.  All persons should consult his or her own legal counsel and/or health care providers for advice and guidance.

job-reference-check

First Do No Harm: The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain, Version1.0  http://www.in.gov/bitterpill/docs/First_Do_No_Harm_V_1_0.pdf

Sample Controlled Substance Agreement Developed by The Greater Louisville Medical Society http://kbml.ky.gov/substance-abuse/Pages/default.aspx

Kentucky Board of Medical Licensure, House Bill 1 Ordinary Regulations Effective March 4, 2013 http://kbml.ky.gov/hb1/Pages/House-Bill-1-Ordinary-Regulations.aspx

Medical Licensing Board of Indiana, Emergency Rule (Pain Medications) http://www.in.gov/pla/files/Emergency_Rules_Adopted_10.24.2013.pdf

Indiana Pain FINAL RULE (Effective November 1, 2014):
http://www.in.gov/legislative/iac/20141105-IR-844140289FRA.xml.html

 

me close up

James Patrick Murphy, MD, MMM attended medical school at the University of Louisville, interned in Psychiatry at the San Diego Naval Hospital, studied at the Naval Aerospace Medical Institute, and later served as a Naval Flight Surgeon onboard the aircraft carrier U.S.S. Enterprise.  He returned to Louisville for residency training in Anesthesiology after which he completed a Pain Medicine Fellowship at the Mayo Clinic in Rochester, MN. Dr. Murphy is board-certified in Anesthesiology, Pain Medicine, and Addiction Medicine. He is President of the Greater Louisville Medical Society, Medical Director of Murphy Pain Center, Assistant Clinical Professor at the University of Louisville School of Medicine, and serves on the board of the International Association for Pain and Chemical Dependency. In May 2013 Dr. Murphy earned a Master of Medical Management degree from the University of Southern California Marshall School of Business.

Dr. Murphy’s blog is The Painful Truth. He can be found on TWITTER by searching @jamespmurphymd. His President’s eVoice and other communications & videos can be accessed at the Greater Louisville Medical Society website.

This Cathedral Won’t Build Itself

washmonwinter

It’s Sunday morning February 16, 2014 at the American Medical Association Candidate Workshop. I’m sitting in this Washington, D.C. conference room, listening to one-hundred ways I can get more politically involved, but hearing one-thousand reasons why it would be crazy for me…

And this popped into my mind.

 

Stones_

Breaking rocks?

In the closing days of my Master of Medical Management program at USC, Professor Dave Logan introduced to our class the concept of a default future, the future that will happen if nothing is done to change it. He then asked the class – 22 seasoned physicians – to describe what health care would look like in 10 years:

“Everything will be automated and impersonal.”

“You’ll have to wait two years to get a hip replacement.”

“It will be a two, no three tier system.”

“The doctor-patient relationship will be history.”

“Managers will run everything.”

“Doctors will be worker bees.”

“Patient care will suffer.”

“I will finally get to go home at 4:30, because everything will shut down.”

What struck me is that no one mentioned that doctors would be paid less money. This was the Marshall School of BUSINESS, yet none of these professionals put lower income at the top of their list of worries. Which is precisely why these physicians, all physicians, need to be leaders – not just managers, not just worker bees.

I have been a GLMS officer for the past three years, and at every board meeting it stared at me from the backside of my name placard – our mission statement. Only in the past few months have I really taken notice. It is so elegant:

Promote the science, art and profession of medicine.

Protect the integrity of the patient-physician relationship.

Advocate for the health and well-being of the community.

Unite physicians regardless of practice setting to achieve these ends.

Doesn’t this sum up why you and I became physicians? Isn’t this a stark contrast to the default futures predicted by my USC cohorts?

I remember very little about the blur that was my first week of medical school, but I will never forget the question that one of the PhD types posed to our class. He asked us to raise our hand if we went into medicine to save the world. Without hesitation almost every hand enthusiastically went up.

“Then you are in the wrong place,” he smugly blurted into his lavalier mike. “Go learn how to grow corn in the desert. Then you will save the world.”

crops on the desert

This made me think. Why did I want to be a doctor? Was it for the prestige? The respect? The money? The power? Or was it because I wanted to have a profession where I could touch the lives of others? Relieve the suffering of a single individual? Of a multitude?

It has been my privilege to be a physician now for more than twenty-eight years. And while I still can’t fully answer the question of why I wanted to become a doctor, I can definitely say why I want to wake up tomorrow and be a doctor. It is in that mission statement.

Some of you are in the whirlwind that is medical school, others are developing confidence to match the bravado that carries you during the early years in practice, some are grinding away against the current of the faceless third-party, and some are looking back and wondering if they should have tried to grow corn on sand.

There is a default future out there. Somehow, you know what it is. If you pause and think, you can even say it out loud so it seems more real. And it will come to pass, unless you make a decision to act – unless we make a decision to act.

I am asking you to unite with your partner, your mentor, your colleagues, your spouse, your patients and me. Together we can take the first steps to change the default future. It has to start somewhere. It can start here. Right now.

We have core values that we share, and when our strategy is in line with achieving the greater good, our choice of profession becomes a higher calling.

Communication is paramount. And we must communicate passionately and effectively. Connect with your colleagues via tweets and email (find me on Twitter @jamespmurphymd; my email is president@glms.org). Join a committee, attend the meetings, call legislators, write letters to the editor, join the GLMS Alliance with your spouse and look to GLMS for leadership development opportunities. As soon as possible, download the new GLMS mobile app and read the alerts, publications and notices.

Lead. Manage if you must, but you must lead.

Breaking rocks?

Dave Logan told us of a band of laborers sweating in the hot sun in some poverty-stricken Third World country. They were pinging away at rocks with small hammers, relentless, sweat pouring, dust choking. But amazingly they seemed happy despite the mind-numbing conditions. When one was asked how he could not be miserable in the mundane task of breaking rocks, he replied, “I’m not breaking rocks, sir. I am building a cathedral.”

oaxaca cathedral

Let’s make a new future.

Let’s build a cathedral.

Sincerely,
James Patrick Murphy, MD, MMM
President, Greater Louisville Medical Society

president@glms.org

Twitter  @jamespmurphymd

 

P.S. Have you heard about what happened during my installation speech at the GLMS Presidents’ Celebration? Watch the video here.

Note: This article was first published as the

Greater Louisville Medical Society President’s eVoice,

Louisville Medicine, June 2013

The way we were…

pat and adele at washington

Pat and Adele, Spring 1985

OPIOID EMAIL RECAP

Screen Shot 2014-02-10 at 10.14.19 PM

The premier offering of “Optimal Prescribing Is Our Inherent Duty” concluded on Sunday, February 9th.  I plan on having more to say… soon.

For now, I thought it worthwhile to share the three emails I sent to our staff, participants, and faculty each evening.

It was a sincere privilege to serve with the OPIOID team.

OPIOID picture

FEBRUARY 7, 2014 – DAY ONE

Dear all OPIOID’ers,

Well, day ONE was a great success. All ten participants were energetic and focused. Our GLMS staff was superb. After an overview by yours truly, Dr. Paul Sloan gave a thorough review of pharmacology and guidelines. Then Detective Beth Ruoff did a fantastic job explaining the diversion issues facing prescribers.  Dr. Boz Tabler educated us on the science behind addiction. Lastly, Dr. Heather Tluczek joined the team and facilitated two earnest and brutally honest Healing Place peer mentors offering a gut wrenching account of the toll addiction exacts.

hp

The staff of The Healing Place was great. The room was perfectly outfitted. And the food was delicious.  And we ran on time all day! Thanks to Dr. Mary Helen Davis and Dr. Mark Boswell for stopping by for support…  the day before they present.

Tomorrow (Saturday) we are at the Greater Louisville Medical Society headquarters for DAY TWO. More great lectures, discussions, and experiential learning!  It’s happening! More later…

– Pat

old school now

FEBRUARY 8 – DAY TWO

Dear Friends of OPIOID,

Day TWO has come and gone… and what a day it was!

mhd

We convened bright and early at the Old Medical School Building (GLMS headquarters). After some camaraderie and a hot breakfast, Dr. Mary Helen Davis took us through the inner workings of KASPER, the governmental process involved in making policies, and finished with a discussion on physician motivation in the age of regulatory expansion.

boz

We then had what, to the casual observer, must have looked like group therapy – led by Dr. Boswell Tabler.  I believe this was another major breakthrough moment in the course, as the participants began to open up with personal accounts. At the end, all seemed to be fully motivated to make the changes necessary to be successful.

boz and ken

Then Dr. Ken Kirsh gave an extremely thorough review of the interface between pain and psychological issues. This was followed by Dr. Tabler’s interactive discussion on psychiatric treatment strategies.

After breaking for lunch, Dr. Mark Boswell had us enthralled by his categorical run down of the different types of challenging pain patients. He followed this with a lecture on how to screen for psychological pathology in our patient population.

Then it was on to “Pain Management Meets Speed Dating.” Dr. Heather Tluczek, along with Dr. Patrick Myers and seven other gifted actors posed as various types of challenging pain patient – allowing the course participants private one-on-one mock interviews.  This was a fast-paced, exhausting, and enlightening experiential learning exercise. Everyone had a good time and learned something about themselves.

Tomorrow Dave Hopkins will get us up to speed on KASPER. Then I will be bringing it home with a thorough run down of Kentucky’s laws and regulations. We will conclude by getting familiar with some “tools” and memory aids in order to help the participants apply their new skills efficiently in their own practice setting.

This is going great! Our GLMS staff is fabulous. Our OPIOID faculty is superb. I almost don’t want it to end.

– Pat

really dave and boz

FEBRUARY 9 – DAY THREE

Dear OPIOID friends,

In May of 2012, just after Kentucky passed House Bill One on the last day of a Special Legislative Session, the thought of having a comprehensive educational course for prescribers took root. Well, today that sapling idea bore fruit.

The inaugural OPIOID course concluded today around 1:00 pm. It was three days packed with lectures, group dynamic work, testimonials, didactics, theatre, poetry, and focused engaged effort by ten pioneering participants.

dave K

Today we had breakfast together then nourished our minds with 90 minutes of Dave Kasper, err, I mean Dave Hopkins – the KASPER director. He loaded our heads with vital information about our state’s electronic prescription monitoring program. I then led a discussion on drug screens and compliance monitoring.  During our final two hours we poured over the Kentucky pain regulations in detail and learned strategies on how to incorporate the rules effectively into our daily practice routines.

What was most gratifying to me was seeing how our participants (now to be rightly known as our “partners”) remained focused and underwent a metamorphosis of sorts. But in reality, I don’t believe they were changed in any way by the course. Instead, I believe OPIOID may have rekindled a spark in each of them that was already there – only perhaps a bit beaten down by the regulatory grind. I know I was inspired by what happen over these past three days.

I am grateful to so many people and in the coming weeks I plan on communicating that message in other formats. For now, let me just say that everyone who participated – staff, volunteers, faculty, students, and even our impromptu professor GLMS security guard “Cory” felt something special had happened over the past three days.

…and something special has begun.

Yours in earnest gratitude,

– Pat

juggle dr m

*still juggling…

patient

practice

community

*P.S. You had to be there.

3 balls

 

James Patrick Murphy, MD, MMM  is President of the Greater Louisville Medical Society.

 

OPIOID Possibilities are Limitless

65_doctor_saying_sto

“What am I supposed to do? I’m over the limit.”

Recently I was visited by a patient “warrior”. I hadn’t known her before, but she had read one of my articles online and wanted to meet me.  I was touched. There in the foyer of our surgical center, she motored up in her electric scooter and smiled the genuine smile of a person seeing a long lost friend.

Are there limits to friendship? No.
Are there limits to prescribing opioids for pain? Maybe.

At the vortex of misinformation swirling around pain regulations is the fact that no state has limited what physicians are allowed to prescribe, although some states make it unwieldy to treat legitimate pain patients compared to other states; some set unsubstantiated quantity limits while others require consultation to a pain specialist if a predetermined (yet not scientifically proven) “morphine equivalent dose is prescribed”.  Nevertheless, no states unilaterally prohibit a prescription at any dose if the regulations are followed.  However, requiring a pain specialist in some cases may become a logistical nightmare because in most instances there are not enough pain specialists to go around.

photo-stepping-over-the-line1

To be sure they have created thresholds above which physicians are required to do certain obligatory actions like: drug screens, re-evaluations, treatment agreements, and database queries. But these requirements do not represent ceilings to what can be prescribed – as long as it is medically necessary.

Are these regulatory obligations rational, reasonable, fair, or effective? That is a subject for another article. What is true now, however, is that prescribers are drowning.

“OPIOID” is the acronym used in an upcoming seminar that aims to rescue prescribers from the regulatory maelstrom.

OPIOID picture

“OPIOID” means Optimal Prescribing Is Our Inherent Duty. It is a seminar conceived by physicians, approved by Kentucky’s Medical Board, and produced by the Greater Louisville Medical Society in association with the University of Louisville – February 7 – 9, 2014.   The goal of “OPIOID” is to empower prescribers to optimally care for suffering patients and adhere to the governing regulations.  Clinicians and support staff can register by email: physician.education@glms.org or call: 502-736-6354 or visit online at https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).

My new friend, whose pain had confined her to her motorized chair, wasn’t quite convinced when I assured her that her state’s (Indiana) regulations did not limit what her doctor could prescribe. But in her friendly eyes I saw hope. And her hope gave me strength.

Am I strong enough to climb over the barriers created by these regulations? Are you?

As long as there are patients willing to fight the good fight, then so will I.  And courses like “OPIOID” provide us the tools we need to win. Together, the possibilities are limitless.

nolimits

James Patrick Murphy, MD, MMM

January 26, 2014

Note: This article was originally posted January 27, 2014 on Dr. Jeffrey Fudin’s blog http://paindr.com/opioid-possibilities-are-limitless-2

Weather the Storm with OPIOID

OPIOID Helps Caregivers Weather the Regulatory Storm

perfect-storm

Healthcare is engulfed in a torrent of regulations raining down upon caregivers. Nowhere is this more evident than in the delivery of pain care. Perhaps OPIOID is the way to weather this storm.

Allow me to explain…

Recently, I was talking with a sales rep from a drug screen lab, and our conversation naturally veered into a discussion about how states were beginning to require urine drug screens for patients receiving pain medication.

To a drug screen lab these regulations are like liquid gold.

But as easily as regulations are passed, they can be erased. And if the success of a lab is based on the existence of a regulation, then the business model is built on thin ice and for the wrong reasons.  If the regulations dry up, so does lab.

I’m a physician, and – like the lab – I expect compensation for what I do.

What I do is care for people by applying factual knowledge, energized by creativity, in accordance with evidence-based protocols, while remaining cognizant of the mysteries still misunderstood and the mysteries awaiting discovery. It’s a marriage of science and art.

I know that following regulations goes along with the territory. But following regulations does not make me jump out of bed every morning with passion and determination. A regulation never delivered a baby, bypassed a clogged artery, or discovered a cure. People do these things.  People need these things. I’d rather work for people than a regulation.

The delivery of pain care is perhaps the most regulated activity in medicine. And depending on the state, the regulations can seem foreboding to the caregiver.  The message is clear. Either get on board or the Board will get on you.

The thought of abandoning our suffering patients out of fear is bitter. The thought of losing our licenses is chilling. And the thought renouncing our calling as patient advocates to blindly follow regulations we don’t even understand…  is demoralizing.

It doesn’t have to be this way.

Remember my lab rep? My advice to her was to go back to her supervisors and suggest that they promote their product primarily as a means to help patients by helping prescribers. Then they would be serving the best interest of millions of people, as opposed to serving at the pleasure of a few hundred lawmakers. In other words, make improved quality of life the real goal – not adherence to regulations.

OPIOID picture

That’s what OPIOID is all about.   OPIOID means Optimal Prescribing Is Our Inherent Duty – a seminar conceived by physicians, approved by Kentucky’s Medical Board, and produced by the Greater Louisville Medical Society in association with the University of Louisville – February 7 – 9, 2014.   The goal of OPIOID is to empower prescribers to optimally care for suffering patients and adhere to the governing regulations.  People can register by email: physician.education@glms.org or call: 502-736-6354 or visit online at: https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).

OPIOID is a prime example of caregivers holding steadfast to their calling in the regulatory storm.  Please spread the word. Together we can weather this.

rainbow-500x375

James Patrick Murphy, MD, MMM

January 26, 2014

Note: This article was first published January 27,2014  on http://www.drjohnmdthe blog by John Mandrola, M.D.

 

How Will You Define Yourself?

I am a doctor, but a doctor is not what I am.

– penned in my spiral notebook, circa May 1985

Despite a medical career’s insatiable hunger for attention, my chosen path does not define me, but it has provided glimpses of who I am.

San_Diego,_CA_Old_Naval_Hospital_Administration_Building_1955

For example, during my internship at Balboa Naval Hospital I was occasionally assigned to draw blood for labs. One such afternoon, my blood-rounding brought me to a diminutive, bent, hairless, elderly man sitting quietly in his bed on the open bay ward. After a brief exchange of pleasantries, he offered an atrophied left upper extremity for blood acquisition. Upon completion he warmly thanked me and even complimented me on being a “good needle-sticker.”

Later, I learned that the diminutive octogenarian was a retired two-star admiral who was admitted to this ward because he had refused any special treatment in deference to his lofty rank. If a no-privacy open bay ward was good enough for his sickly comrades, it was good enough for him too.

Besides an amazing lesson in leadership, my encounter with the admiral taught me that, regardless of how powerful, wealthy, famous, weak, poor, or humble one might be, we each travel a path to the same destination.  In days past, simply rumor that he was onboard ship would have created an air of anxious hyper-attention. But in his life’s final chapter he was humbly grateful that the apprentice doctor sent to draw his blood didn’t botch the needle stick.

What defined this person. His accomplishments? His failures? His youthful conquests? His final chapter?

Are we defined by life’s moments? Perhaps the sum of life’s moments?  Is one’s present moment – or even one’s final moment – life’s truest summation?

I have my doubts.

Despite our yearnings to the contrary, our present evaporates and becomes our past – no different than a dream. And we are not defined by our dreams – nor our past.

So, if not the past, are we defined by the present?

I have more doubts.

brain speed

The brain does not work at the speed of light – not even close. In fact, every conscious thought results from a chain of chemical reactions initiated by sensory stimuli. Therefore, awareness of a moment in time can only occur after the stimulating event.  Awareness of the present is really just a memory.

So does the present even exist? Yes it does; in theory (i.e. the theoretical present). But I can’t prove it.

giving-records

During a deposition I gave years ago, with the lawyer’s argument hinging upon proving the medical record to be comprehensive, she asked, “Isn’t it true that if it wasn’t documented, it didn’t happen?”

My response was, “If it wasn’t documented it simply means it wasn’t documented.”

I still stand by that.

Like the medical record, your perception of the present moment is legitimate documentation that your present moment exists.  But that’s all it is – documentation. Not proof.  Again, awareness of the present is really just a memory.

I have lots of memories – especially of my patients. And being a physician to a significant number of elderly patients, I deal with loss on a regular basis. While it is never easy to say good-bye, I usually find solace in knowing that I tried to provide comfort in a patient’s latter steps along life’s journey.

Obituaries, written to summarize these journeys, usually pique my curiosity.  Some are just a few lines. Some are novellas. Some offer comparison photos of the youthful and the elderly visage.  Regardless of length, obituaries cannot define a life.

N.Mandela in his cell on Robben Island (revisit} 1994

For example, by the time you read my article, the iconic Nelson Mandela will have been laid to rest – after perhaps the most extensive obituary in the history of the media – and still the world will have only gotten an infinitesimal account of his life.  At the end of it all, will we have defined the man?

Not a chance.

Hess obit

About a year ago, I read the obituary of a local doctor, P. Patrick Hess, M.D. He was eloquently described as: “A dedicated pediatrician, gifted artist, collector of oddities, beloved husband, father, grandfather, voracious reader, with a quick wit – Patrick Hess had an obsessive curiosity and a driving desire to unravel the mysteries of the world.”  It went on to mention his family, accomplishments, education, and professional endeavors – all lovely. But I felt there was more to this man’s life. Then I read his poem and felt something had indeed been defined.

All physicians are artists,

not always in disguise.

Our way of looking at a patient,

allowing our minds to roam all over those perceptions of our previous life,

often forgotten,

to scan these memories and pull something from our unconscious mind – all with the purpose of creating something. 

Something to help the patient.

This creation is,

itself,

a work of art.

Every imperceivable moment that passes is not only a new reality; it is rebirth, renewal, and redefinition.  Therefore, like the theoretical present, we can only be theoretically defined.

How will I define myself? I guess this will have to do:

I am a doctor, but a doctor is not what I am.          

circa January 2014

old-doctor-in-the-mirror

How will you define yourself?

Note: This article was first published as the President’s eVoiceLouisville Medicine, January 2014.