IDENTIFYING AND EDUCATING
FAMILY MEMBERS
Treatment with opioids
sets the stage for adversarial actions, rendering doctors who prescribe opioids
vulnerable to administrative, civil, regulatory, and criminal assaults. Opioids
are believed, as a matter of faith, to be evil, dangerous, and even lethal. A
strategy is needed to identify the potential litigants and adverse witnesses
who will appear in these situations, so that they can be educated about pain
treatment, and commit themselves in writing to the perceived benefits of such
treatment. Without such a strategy, one often doesn't even know of the
existence of these potential adversaries, until they appear on the witness
stand to testify against the doctor who allegedly addicted or killed their
relative.
This strategy targets the
population that has the most pressing need to learn about opioids; the families
of chronic pain sufferers. They are also the most likely candidates to become
adversarial witnesses, if they are not educated. This approach identifies all
members of the patient's extended family and educates them, prior to initiating
opioid treatment. This amounts to a broadening of the concept of informed
consent. Ultimately, this approach has the power to modify the belief system
within our culture that makes prescribing opioids the most dangerous things a
doctor can do.
Many who read this will
object, because of the amount of work this approach seems to entail, and they
will have concerns about how patient privacy will be impacted. The first concern
is easy. This strategy can be implemented mostly by the clerical office staff,
as it consists mainly of having forms filled out on a regular basis. The
privacy concern is more troubling, but must be weighed against the threat that
opioid prescribing presents to a doctor's livelihood, reputation, freedom, and
in at least one case, even his life.
1) At the
initial visit:
a. Have the
patient fill out the "Family Tree" form.
b. After
that form has been filled out and placed into the medical chart, present the
patient with an informed consent form for each family member named in the
family tree. This sequence of events is important, so that the purpose of the
family tree form does not become apparent to patients who might choose to
conceal the existence of family members who are opposed to their treatment.
These are exactly the individuals who must be identified.
c. Each
consent form must be returned before the start of opioid treatment, along with
a copy of that relative's photo ID.
d. If any
family member has questions or reservations about opioid treatment, these must
be resolved before treatment is begun.
2) Testimonial
letters should be obtained from all of the identified players at monthly
intervals. This interval can sometimes be lengthened after treatment is
stabilized. Testimonial letters serve several purposes:
a. Every
family member stays on board with the treatment.
b. Each
member recommits himself to report any concerns to the practitioner, allowing
any problems to be addressed without delay, and preventing the manufacturing of
such items at a later date for the purpose of adverse testimony.
3) Care must
be taken so that this approach doesn't backfire in the courtroom. Plaintiffs
attorneys and prosecutors will seize upon any perceived inconsistency.
a. The
response to concerns expressed by any family member must be fully documented,
along with whatever was done to resolve them. Otherwise, later it will appear
that the practitioner was aware of a problem, and "blew it off". A written
letter from the concerned family member explaining that the concerns have been
resolved to his satisfaction should be obtained and place in the chart.
b. The
interval on all testimonial letters should revert to one month, until such time
as the situation has been stabilized for at least 3 months.
c. There
should be a low threshold for referral for additional testing, or consultation
with an appropriate specialist, whenever any concerns arise.
Comments/Opinions
Frank B. Fisher, MD
frankbfisher@earthlink.net
510-233-3490
Or
webmaster@cpmission.com