https://goo.gl/hkbgDNWhile this story still shocks me years later, it would be too easy to vilify this young woman and others suffering from opioid addiction. Most people with opioid addiction got started on prescription painkillers, whether they were directly prescribed to them or obtained illegally. That means that I as a prescribing physician have a role to play in the opioid epidemic.
There are many external forces pushing physicians to prescribe more opioids despite everything we've learned about their deadly consequences.
Patient satisfaction surveys are one factor. Increasingly, physicians are paid and/or promoted based on their patient satisfaction ratings. In one survey of emergency room and primary care doctors, 60% reported their compensation was linked to patient satisfaction scores and 20% said their job had been threatened based on their patient satisfaction scores. Negative reviews on Yelp or Healthgrades can be damaging to a physician or practice. One doctor in Indiana was murdered because he refused to prescribe opioids.
Patients who don't get the opioids they want
will be less satisfied, even if opioids were not the right treatment for them. Saying no to an opioid request often leads to a time-consuming negotiation or argument. This can indirectly prevent a doctor from being able to see other patients and give them the attention they deserve too. These financial pressures encourage doctors to prescribe opioids to improve patient satisfaction scores and to get through their days faster. Studies so far have not proven a link between patient satisfaction surveys and opioid prescribing, but the evidence overall is weak.
Human nature can also drive physicians to prescribe opioids to avoid conflict. We are all capable of doing the right thing for someone else even when it means making them unhappy. Parents do this regularly when they discipline their children. Doctors do this regularly too when they say no to patients inappropriately seeking strong painkillers. While we can mentally reinforce ourselves that we are doing the right thing, it is depressing to leave a room with the patient yelling and cursing at you. The repeated conflicts and negotiations over opioids become mentally and emotionally draining over time. These negotiations are also extremely time-consuming and can completely wreck a busy work day.