March 31, 2005

Conscience Clause

It's been brought up many times in the debate over the movement to allow pharmacists not to dispense birth control that no such sentiment exists for allowing them to refuse to prescribe drugs like Viagra. But a very valid reason for doing so may exist.

It turns out that, unlike masturbation, Viagra can permanently damage your eyesight. But I guess that's a risk a consumer group composed of your typical grown man can make its own informed decisions on.

I was at the dentist a bit ago, and I was in quite a bit of pain. The dentist prescribed Vicodin because it works for me and I don't have to take very much of it very often. On the way out, the receptionist felt prompted to warn me of the addiction risk, and to tell me that ibuprofen was far better for dealing with this type of thing. I felt embarassed, wondering what this perfect stranger thought of me, and I felt prompted to explain myself (though admittedly, in less detail than follows.)

Having had a major surgery that took over a month to fully recover from, and having been hospitalized for migraines, including one that literally knocked me down, I've had some experience with narcotic pain medications because the storebought kind have their limits. But let me make this clear: I f***ing hate being on Vicodin. There's the whole cessation of pain benefit, which is nice, but they make me feel muzzy, stretched, weak, and like a blanket has been drawn over my head and is being held there by some kind of tight band. It feels like not having slept for two days and having it all catch up to me at once.

They aren't as bad when I'm going straight to bed, because then I don't have to be awake for the effects. But if I'm tired and they pull me down to sleep, I always have that moment of fear. It prolongs the moment of falling asleep while at the same time it feels like it's shutting down the part of me that could decide to wake up, the choice to fall asleep. It's scary because it feels like I'm dying, and I can't say it's especially fun.

What the hell do people see in this stuff? The rebound headaches and sleeplessness the next day are bad enough all by themselves, and while you're on them there's always some part of you that's just a little shut off. It's a little nerve-wracking to walk around feeling less than optimally functional.

Finally, I've developed an allergy to ibuprofen. It took me a while to figure out that it was the ibuprofen, and not jet lag, that made me dizzy, unfocused and nauseated after a grueling trip that gave me a stress headache. I didn't have anything else, thought I'd try it and see. I tried it again a few days later, because the headache had been helped and I don't like the narcotic treatments, it was definitely the ibuprofen causing the dizziness. Not until I talked with a classmate did I find out that this allergy is becoming more common, which she was told by her doctor when reporting similar but not identical symptoms to mine after taking it.

All this feeds into one conclusion: When I'm in an ungodly amount of pain, Vicodin is the lesser evil. It's an informed decision based on my medical history, and which various medical professionals I've seen have agreed was the right course. Every time I have to take pain medication for anything, it makes me grateful all over again that I figured out how to prevent my migraines instead of having to treat them.

It's a decision that I'm glad doesn't have to be explained to every busybody who sees my prescription and worries that I'm going to turn into Rush Limbaugh. It's between me and my doctor and not their business unless they're in a position to know that it conflicted with something else I was being prescribed by a doctor. It's something I'd rather not explain here, but there's almost as much dishonesty about health subjects in our society as there is about sex, and until people are willing to talk about it that won't change.

All this over a short term, non-refillable prescription for a pain medication to treat a condition suitable to be discussed (though for politeness sake, not at length) in almost any type of company. I can't imagine putting up with that kind of suspicion and resistance in someone I had to go to for a recurring, long term prescription for a reproductive health issue which I wouldn't want to discuss in most circumstances.

A lot of women take birth control to control painful ovarian cysts and various other problems with the reproductive system, most of which are also painful. Why should this have to be explained to anyone who's properly ignorant of the medical history of the person before them?

It's frankly a humiliating prospect, and something that no one should be forced to go through, particularly for a benign prescription like birth control.

Posted by natasha at March 31, 2005 03:57 AM | Health/Medicine/Health Care | Technorati links |

I would have handled that a little differently. First, I would have asked the receptionist what her special medical qualifications were. Having established that she has none, I would have suggested that if she could do her real job properly, it would be quite an improvement on her performance in the past. Finally, on getting home, I would write the doctor a letter expressing my displeasure that his office staff felt free to comment on medical matters (in public, no less) that I had just concluded discussing with a real doctor.

The situation with MDs hiring unqualified buttinsky staff members has become absurd.

For example, by the time they are 50 almost every American has used opiate painkillers for serious pain problem. Given the choice, the public consistently uses less painkiller, for a shorter time, than their doctor or nurse would direct. About one percent of us have a tendency to "abuse" the opiates.

You can be pretty sure the buttinsky desk clerk knows nothing of this.

Posted by: serial catowner at March 31, 2005 05:27 AM

I would have told to mind her own fucking business. I really would have--what gall and arrogance.

What, in the end, does this all really matter for? I have no clue. I'm sure as hell not taking snap judgments from anyone about how I should live my life.

Good luck with the pain. I'm sorry about that John Kerry rant on Monday, but only because I didn't keep my cool. I'll never forgive that idiot for his war vote, or the cretins in Iowa who didn't and still don't have a clue. Dumbasses.

Posted by: paradox at March 31, 2005 08:21 AM

Yeah, I probably should have told her off, but I have a really hard time doing that to people in person. Even when it's well deserved.

Also, I'm fine right now, with a consistently improving ratio of fine:not-fine, but thanks :)

paradox - You don't have to apologize about the Kerry rant. It was just saying out loud what I bet most of us have thought from time to time. You should hear the SO, there's so much vehemence in his voice you'd think that Kerry personally cheated him in business or something, he's mad enough for both of us.

Posted by: natasha at March 31, 2005 12:18 PM

I might have amiably responded "I am a sensible, self-controlled person, and I will take responsibility for following the doctors orders, thanks." But that's just to an intrusive busybody with no real control over me. I am far more concerned about those people who will be denied the filling of any type of prescription on the arbitrary basis of the pharmacist's values. That's patently unethical and seems to me to be prima facie evidence of non-competence (not necessarily the same as incompetence).


Posted by: tres_arboles at March 31, 2005 12:43 PM

You folks need to give her a break. I think you read too much into this, there are many not-so-busybody reasons for this suggestion:

1. People do get addicted to vicodin really easily. It's cheap, ez to get, & legal. a lot of my x-addict friends have lived off it for years. These are not Rush clones, these are people just like you and me, and most of them go unnoticed. Trust me here, I know, I have lived in and around this and a lot worse for a decade. She's probably dealt with dozens of them pleading for refills, never a pleasant experience.

2.She could be a recovering addict, or have a family member who is still off in active addiction. Or just dealt with a big scene with an addicted patient. I have rescued people passed out in the gutter due to long benders, perhaps she has too.

3.It could be a practice policy for all you know, for the same reason as #1. Narcotics are messy, that's all there is to it. My endodontist hands out monster ibuprofens, only giving vicodin if you ask for it. I agree ibuprofen is better, but not for everyone, everyone's different. This really should have been handled by your dentist, but many practices the dentist only does the drilling and injections, others do everything else. Unless you know this person isn't a healthcare professional, don't assume she is a fool or has other moralistic motives. Know this: it is highly likely she has more experience with more people on more drugs with more reactions than you do. Consider the possibility that she did this to help, not to judge or hurt.

Honestly, life would be a lot more harmonious if people would assume the best rather than the worst. So what if you are wrong doing this sometimes, does it really pay to believe the negative and hold a grudge, rather than believe the positive and feel good about it, not knowing which it really is?

Just a thought. Peace.

Posted by: ben in redmond at March 31, 2005 11:51 PM

ben - I don't despise this woman or anything personal like that, but she's new and it's the first time I saw her at the office, and she isn't a health professional. My point was that she was talking about this in the waiting room, and she was rather loud, and I felt both awkward and embarassed.

Now, she seems very nice, and I'm sure she didn't mean to make me feel like that. But in a position like that, she should act with a little more restraint. She shouldn't be projecting her history with other friends or patients onto everyone that comes into the office.

The larger point is that it was awkward getting loudly grilled by a receptionist in a dentist's office about a pain prescription. How much worse to be someone in a more vulnerable position getting hassled by the pharmacist about birth control, and having their whim determine whether your doctor's instructions for your care are executed? I understand that people have valid concerns about certain treatments, but the the doctor-patient relationship is private for a very good reason.

Anyway, I'm sorry if people you've cared about have been negatively affected by addiction. It's tragic, and I wish we had a better way of helping people with it as a society.

Posted by: natasha at April 1, 2005 12:47 AM

It was none of her business. I would complain to your dentist. The receptionist needs to learn about the patient's right to privacy. She should not have read the presciption in the first place.

Posted by: uptown at April 2, 2005 04:59 PM