clinicRx created in Wix 2016

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Does your prescriber give you what you need?

I was once resoundly criticised by a colleague who grandly told me that all I did was "give the patients what they wanted". It's not often I'm lost for words but I was then. After a minute or so I replied that what I did do was ask each patient what it was they needed.... and then I genuinely and sincerely listened to and heard what it was they told me. Then if it was clinically indicated and I could do it .... I would give it to them.  That approach has led to some incredible stories of recovery, and established high retention-in-treatment rates that have allowed people to thrive.

He did get me thinking though about just what were the things that my patients fed back to me that they appreciated so much. All of them relate to a clinical practice built around the golden rule... treat others as you would like to have them treat you. Its a timeless principle and that critical doctor was right..... its exactly what my patients want.... .

Many of these qualities are self evident and one would think not worth noting, but sadly for many opioid dependent people finding a prescriber or doctor who genuinely cares can be difficult. They don't want hand holding or shoulders to cry on, but they are humans who have the full range of medical conditions as "regular people" and THEN some. They want good doctors who treat what they see not what they believe.  Opioid dependent people are stigmatised and treated punitively within the health system, even by the doctors, nurses or case managers who are employed to care for them. If you get a chance to talk to an opioid dependent person about their experiences in emergency departments or with with new GP's, or even opioid dependency clinics, it can be heartbreaking.

 

One of the best predictors of good outcomes and survival rates for a client is how well they get on with their prescriber.  Isn't that an amazing statement?  It is based on clinical evidence and I have found it to be true in my personal clinical practice.

Working with opioid dependent people can be challenging, but there is never any excuse for shaming, disrespectful, humiliating or punitive treatment.

Does your prescriber/case manager.....

  • Make good eye contact with you

  • Are they are welcoming and friendly

  • Do they listen to you and try to understand what is happening for you right now

  • By and large do they remember what you talked about last visit.

  • Do you get adequate time to discuss your treatment and related issues

  • Do you feel belittled when you express your opinions

  • Are you allowed to ask questions, including about your prescriber's treatment decisions without being dismissed

  • Does your prescriber listens to your thoughts about your dose.

  • Do they encourage your input in the decision making when it comes to methadone vs buperenorphine.

  • Do they know how to assess buprenorphine treatment failure and when it is not working you are offered methadone?

  • Have you ever been forced to swap from one treatment to another/ Did you ever get a clear understanding of why

  • Do you feel you are working with your prescriber or does it feel like an us vs them situation

  • As this is often long term treatment it is vital that it is sustainable - does your prescriber attempt to make your program something you can live with? They should!

  • Your prescriber should take into account regional travel, poor public transport, child care, other carer responsibilities, work and personal disabilities when discussing takeaways with you.

  • Your prescriber, or prescribing service should give you access to Work Development Orders (NSW only) to assist in paying off state fines. It is an easy uncomplicated process.

  • Do they allow you to make requests for travel within what is a reasonable time. I can arrange an interstate transfer in 20 minutes.... but I prefer a couple of days. Two weeks for a routine transfer to a state capital is frankly ridiculous. Find a chemist near where you're going... after that it's some paperwork, a phone call and a fax.

  • Do they ever put your dose up or down against your will

  • Do they encourage you to get off the program when you know it is not a good time for you, if ever.

  • Barring bad news, you should always leave a good doctors consultation feeling better than when you walked in.. do you?

  • Are you scared and worried before each appointment.

  • Can you tell your prescriber the truth about your situation and not be punished for that

  • Do you find yourself getting labelled "unstable" when you know things are going ok?

  • People should get and lose takeaways based on how stable they are - they are never to be removed as a punishment or given as rewards... does this happen to you?

  • Do you find your prescriber telling you that things are being done for your safety when it feels like punishment?

  • Is your dose ever reduced for missed appointments? (yes! it does happen)

  • Are they defensive when you make suggestions about treatment?

  • Do they give you several treatment options and it is up to you to select which one you think best? Or are these decisions always taken out of your hands?

  • Do they use urine drug screens as a tool to help you show how well you are doing, or as a trap to catch you out?

  • Do they have a clear understanding of harm reduction..... and do they support it.

  • Do they praise and encourage for the harm minimised or do they judge and punish for the harm remaining?

  • Is he or she is fully aware of the risks and statistics around relapse when coming off the program?  Have you ever been provoked to jump off a program because of unfair treatment?. Your life shouldn't be at risk because they are having a bad day.

  • Do they ever speak to you in a manner that would offend them if you spoke that way to them - disrespectfully, aggressively, swearing , patronising. demeaning etc.

  • Do they actually show an understanding of real world drug use or at least show a willingness to listen to you when you talk about your reality?

  • Do they make appointments based on your need, or on some predetermined fixed regime eg every two weeks forever and ever regardless of when you last had drug instability.

If you make an inventory and feel that your prescriber is not up to scratch, you have several options - Usually the best one is to find an alternative prescriber who meets some or most of the criteria  above. Talk to other people on the program.

If their treatment is exceptionally bad then you have the right to complain to the Health Care Complaints Commission in NSW or the Ombudsman in QLD.  Your prescriber is not allowed to treat you punitively when you make a complaint. Public clinics are usually very defensive and can make life difficult for anyone who makes a complaint.

You may not get much action about your complaint, but cumulatively your voice can identify problematic services or clinicians.

Voting with your feet is the best way, find a new prescriber who will request an exit from your doctor. Doctors cannot refuse to relinquish an authority when asked.