Re: An Alternate Pain Agreement

On Nov 7, 2:36 am, Sean C <redh...@xxxxxxxxxxxxxxxxxxxxx> wrote:
An Alternate Pain Agreement

<http://paynehertz.blogspot.com/2007/11/alternate-pain-agreement.html>
orhttp://tinyurl.com/3cjman

I recently posted an article about pain contracts here, where I argued
that pain contracts are coercive, one-sided and unfair. These contracts
are definitely oriented towards protecting the rights of the doctor and
allow little in the way of rights or autonomy for the patient. This got
me wondering what a patient-oriented pain "contract" would look like,
and I came up with a few provisions which I think you'll find
interesting. Most of these are eminently reasonable, some are a little
tongue-in-cheek, and others could be considered blatantly unfair to
doctors, but I have included them anyway as an illustration that
despite their obvious unfairness, none is quite so unfair as the
provisions we must agree to that may result in our being denied medical
care for our pain if we fail to live up to all aspects of the
"contract." I am not suggesting that anyone actually attempt to use
this contract, as it will most likely result in your being denied
medical care, as patients have little power in negotiations with their
doctors over pain medication issues. I present this only to generate
discussion and to highlight the one-sidedness of the "contracts" we are
forced to sign and their inherent unfairness. I welcome any additions
you feel should be added to the pain management employment agreement
and I will add others as I think of them.

Pain Management Employment Agreement

I _______________________________ (enter doctor's name here), as an
employee subcontracted to provide medical services to my employer
________________________________ (enter patient's name here) do hereby
agree to provide opiate medications for my employer (hereafter known as
"the patient") under the following terms and conditions. As a
physician, I recognize that I have a moral and ethical duty to relieve
suffering, and that opiate medications play a key role in the
management of chronic pain. I agree to prescribe these medications in
good faith, without malice or prejudice and in accordance with best
medical practices and the best interests of the patient.

1. I will be honest with the patient at all times and not lie,
manipulate or deceive the patient in an effort to shirk my
responsibilities, or to pressure the patient into agreeing to medical
procedures that may or may not be in his or her best interest. I
recognize that any attempt at undue influence of the patient may lead
to immediate termination of the doctor/patient relationship, and
forfeiture of all fees due for my services coupled with any fines or
penalties a court of law may impose.

2. I will not place arbitrary limits on the amount of pain medication
prescribed based on my fear of regulatory scrutiny or personal "comfort
level." I will practice the scientific principle of titration to
effect, where the dose of opiate medication is slowly raised until
adequate pain relief is achieved or a balance between adequate pain
relief and intolerable side effects occurs.

3. I will always endeavor to prescribe medications based on a balance
between current scientific knowledge and patient preference. I will, to
the extent possible, respect patient autonomy and right to decide what
drugs he or she will and will not take and I will not discriminate
against the patient solely on the basis of his or her medication
preferences.

4. I will respect the human rights and dignity of my patients, and will
respect and obey all human rights agreements entered into by my country
and all local, state and federal laws protecting the rights and dignity
of my patients. I will adhere to The International Covenant on Civil
and Political Rights, in particular the following articles:

Article 6: "1. Every human being has the inherent right to life.
This right shall be protected by law. No one shall be arbitrarily
deprived of his life."

Article 7: "No one shall be subjected to torture or to cruel,
inhuman or degrading treatment or punishment. In particular, no one
shall be subjected without his free consent to medical or scientific
experimentation."

Article 17: "1. No one shall be subjected to arbitrary or unlawful
interference with his privacy, family, home or correspondence, nor to
unlawful attacks on his honour and reputation."

5. I will submit to routine urinalysis tests to check for the presence
of illegal drugs at least once a month and randomly whenever the
patient requests it. These tests shall not exceed four per month, and
any urinalysis done within one week of the patient's request shall be
valid to satisfy the request of another patient for drug screening, and
vice versa. The presence of any illegal drug on any routine screening
may result in termination of the doctor/patient relationship at the
patient's discretion and forfeiture of all fees owed for services
rendered.

6. I will fully disclose in writing any legal or illegal drugs I may be
on and submit to blood test screening for alcohol or illegal drugs of
abuse using gas chromatography immediately prior to any surgery, nerve
blocks, trigger point injections or other invasive procedures. The
detection of any illegal drug or prescription drug that has not been
prescribed by a licensed physician shall be considered prima facie
evidence of malpractice, irregardless of whether the procedure is
successful or not, and may result in forfeiture of all fees due for
services rendered including hospital fees as well as any other fines or
penalties a court of law may impose. The detection of any drug not
previously disclosed in writing, including legal prescription and
non-prescription drugs, shall be considered prima facie evidence of
fraud.

7. I will respect the patient's confidentiality, privacy, person,
autonomy and human dignity at all times. I recognize that my patient
has a zero tolerance policy for physical or verbal abuse, slander,
libel or other forms of defamation, and the deliberate infliction of
emotional distress, as well as any violation of privacy or patient
confidentiality. I will not disclose or discuss any aspect of the
patient's medical care or medical condition to any party, including
office staff, without specific consent of the patient. This also
includes research facilities, data-mining firms, and government
agencies not specifically authorized by law to collect this data. My
staff will not openly question the patient about billing or other
matters in the presence of other patients.

The inclusion in the patient's chart of any derogatory terms such as
"drug-seeker," frequent-flyer," "malingerer," "hypersensitive,"
"hysterical," etc. shall be considered prima facie evidence of libel
and the tort of deliberate infliction of emotional distress, and may
result in the immediate termination of the doctor/patient relationship
at the patient's discretion and forfeiture of all fees due for services
rendered, as well as any fines or penalties a court of law may impose.
This provision will also apply to the use of "scare quotes" around
words such as "pain," "condition" "disability" or any other words or
phrases the patients uses to describe his medical condition or state of
being. Additionally, the inclusion of any scientific or
pseudo-scientific terminology to describe the patient's psychological
state or motivations such as "psychogenic pain syndrome," "conversion
disorder," "hysteria," "personality disorder," "compensation neurosis,"
et alia shall be consider prima facie evidence of libel and practicing
psychiatry without a license, and may lead to immediate termination of
the doctor/patient relationship, and forfeiture of all fees due for
services rendered coupled with any fines or penalties a court of law
may impose. If the physician feels that the patient might have a
psychiatric or substance abuse disorder, he will refer the patient to a
competent psychiatrist or addiction specialist of the patient's
choosing.

8. In the event of a violation of this agreement leading to termination
of the doctor/patient relationship, the doctor will continue to
prescribe any opiate medications for a minimum of three months
following the date of the termination, and will support the patient in
achieving a tapered withdrawal from the drug in question or in
attaining the service of a competent physician to continue the
patient's care. Failure to adhere to this aspect of the agreement shall
be considered prima facie evidence of patient abandonment.

--http://paynehertz.blogspot.com/
Payne Hertz is a chronic pain advocacy site whose mission is to educate the
public about the abuse and maltreatment of people with chronic pain, and to
advocate for civilized and humane treatment of chronic pain.



Very good, sean.

But,how many doctors do you think will agree to it? No, not many,

At least, you say it reasonably-a doc would have to think hard, before
getting around all of that.

.

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