We wake up every morning to some combination of CBC’s Metro Morning and The Current (depending on how ambitious we are about getting up). Which just about every other day means I wake up angry. Because between Andy Barrie’s brash old-fashioned ego and the often-surprisingly-uninsightful The Current, someone’s going to say something that makes my eye twitch.
This morning it was The Current. Which is disappointing, because on Monday I actually learned something from them (Turkish hazelnuts, check it out) . But this morning… sweet Oprah.
The story was about a 28-year old woman, who became addicted to and then overdosed on painkillers. Rooted in conversations with her mother and father, they discuss “and why no one she encountered in Canada’s health care system managed to prevent it from happening.”
The point The Current-->
Like many episodes of The Current, there could have been a story there. There is a system in place to track prescriptions of certain drugs, to detect if someone is manipulating the system to get an unsafe amount — as this woman was (she had prescriptions from 5 physicians). The reason it didn’t register here was because that system involves manually logging the prescriptions, and with a full-time staff of 6 people, they are currently backlogged months worth of work.*
But that wasn’t really what this story was about, and why it made me angry. The story was mostly about the parents being upset that no one had told them. Their daughter was addicted to painkillers, why hadn’t a doctor contacted them? How were they not told she was taking these medications? She was so beautiful, look at this picture, they were going to play Ave Maria at her wedding and instead played it at her funeral. Maybe we should revisit patient confidentiality, and here’s a doctor who has often thought when the patient had a problem that he would like to be able to tell their family.
Teeth grinding.
She was twenty-eight years old. Well past being a minor, and well into being responsible for herself. We aren’t even given extenuating circumstances (other than that she was diabetic). I have exactly no time for this. If a capable grown woman gets hooked on painkillers and works out a way to get enough meds to overdose, that’s something a grown woman might do. I’m certainly not going to be more upset about it because she was pretty and her parents say if only they’d known (“how did she get this past me”), and in this case I’m certainly not going to get worked up about it being someone else’s fault.
What this story almost completely lacked was any discussion of personal responsibility. Any hint that just maybe, this 28-year old fully independent and capable adult woman was culpable for her actions. The parents describe a 28-year old as a “young girl”, who should have been stopped in her gaming of the system by the doctors, the doctors are blamed for not being sufficiently well-trained in spotting a potential addict, the Triplicate Prescription Program (TPP) is blamed for not being efficient enough, the province is blamed for making doctors go too fast.
Absolutely, the health care system shouldn’t support these situations, and there should be checks in place (like the TPP) to try and prevent them from happening. A social welfare state should provide resources for mental health and addictions recovery. Doctors should be well-trained in watching for and recognizing the symptoms of addiction (and manipulation). I believe absolutely in a culture where we help each other out. We are all responsible for putting social supports in place, and doing the best job we can to make them available to the people who need them. As adults however, we are also all responsible for not abusing social services like public health care, so sometimes, if we make stupid decisions, bad things are going to happen to us. A social welfare state is different than a nanny state, or a babysitter state, or an “I don’t agree with your decisions so I’m calling your mother” state.
Patient confidentiality is in place because it recognizes that individuals over the age of majority should be treated as autonomous adults responsible for the consequences of their actions. I won’t see that jeopardized because these people want the system to support them infantalizing their grown children.
Listen to the segment here (it starts around min 4:30).
* And briefly on the sort of issues they could have discussed
The question The Current should have asked is not whether they needed to have 12 people working full-time at the TPP to get rid of the backlog (they did ask this), or even whether this process should be automated (asked that too), but possibly, just possibly, they could have looked at how it is that these ‘flagged’ medications are prescribed so frequently that 6 full-time staff are insufficient to stay on top of registering all the prescriptions for these drugs (just in Alberta). Maybe we could talk about how so many of us are trying to solve physical and mental ailments with a magic combination of pharmaceuticals?
One interviewed doctor briefly touched on something related to this, saying that as physicians are under pressure to see so many patients so quickly, it leads them to not be able to pay as much attention or give the situation the consideration it needs. I absolutely have a problem with a public health care system pressuring doctors to respond to overload by giving revolving-door patient care. But that is not a carte blanche excuse for physicians to go along with it. There are opportunities to take responsibility at many different points along the line, and one of them is the quality of job that you are doing. Pressure from above is not a get-out-of-professional-integrity-free card.