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Yes We Can
What can I write this evening?. . .
The world became a different place a week ago. It was inevitable yet unbelievable as America rose up and opened the possibility to live out the true meaning of its creed. It is still too incredible for many to comprehend at times. The genie is out of the bottle and no matter what the future holds it cannot be put back in that bottle. Though I have done little to express it, I have never been more proud of my country nor more proud to be identified as an African-American. I was at the same time saddened to see many cling to the bitterness and ignorance that has divided us since pre Civil War days. But the good part is that it doesn't matter in the same way as it did before the 2008 election. John McCain's greatest moment, to me, came during his concession speech. He sincerely buried the hatchet and set the stage for healing and unity when he didn't have to. I will forever respect him for being gracious and showing class at a difficult time.
Scholars of Dr. King understand that the issue has never really been about black versus white but the true issue has been about an America that is fair for all people. Where a man such as Barack would not be judged by the color of his skin but instead the content of his character. Some, including myself, doubted it would ever occur in our life times. But the right man came on the scene at the right time and rose to the challenge. History was made. His most important promise was hope and he has already delivered. The rest is up to us as citizens to re-examine our personal selves in the way that JFK so eloquently challenged us to ask not what our country can do for us but ask what we can do for our country. To me, that is what true leadership is about. If each citizen threw into the pot the best they have to offer the possibilities would be endless. These words may come off as rhetorical but I find a rhetoric consisting of hope preferable to one based on fear. This is where I believe Obama will really make history. He holds the power to destroy forever all of the myths and stereotypical beliefs perpetuated to the world about the Black man. If you've never been a man of color you may not understand why I would even write such a thing. I'm so glad that America has grown and majority rejected the knee jerk reaction to lies of Obama being a terrorist, that he would change the national anthem, paint the white house, and to the extremely bizarre of him being the anti-Christ signalling the rapture in forty days. All of these ideas are totally nuts but there are actually people among us who believe such.
I am quite aware that it is a waste of time and rarely productive to discuss politics or religion. It can be enlightening, however, to do such with one who is learned. Even more so with one who is learned and passionate. Politics, I have found to often be a dirty, cut throat kind of game. The game is roughly 80% based on psychological principles which makes it interesting for me. Sometimes I don't feel fear when I should and I also have a burning desire for truth. I don't like being lied to or tricked. Give me the facts and let me make up my own mind. Religion is different from politics in that it is mostly faith based. You have to believe in order for it to have any real meaning or power. The facts often have to be interpreted in religion. The ability to incite the emotions of fear or anger within people is what makes politics and religion such volatile and controversial topics. Friendships have been severed and countries have gone to war over disagreements with religion or politics. Is it really worth it?
For the first time in quite a while, I feel no animosity and no anger within. I feel a sense of hope that I have never experienced before. I feel validated. My life is far from perfect. There is much work to be done. I understand that President Elect Obama is powerless without the support and efforts of the people. I sense forward motion and reject all negativity headed my way for the years to come.
Time for Change
I do take comments seriously. . .
thus the new look of the sight. The white letters on black background really had played out in addition to being harder to read than traditional white background with dark print. I have known that for a while but continued to procrastinate mainly because I didn't think anyone really cared. From the beginning of this journal I never really expected many people would find it worthwhile to read and I sometimes forget that there have been a substantial number of readers over time. Knowing that has provided me enough motivation to continue posting.
I understand that I have one of the most interesting jobs on earth and feel it important to share sometimes that which is appropriate to those who may be interested. I can say that no day is ever quite the same and that tends to make the feelings of stress and frustration bearable. Of most importance, my job has taught me limits over time. It is no secret to regular readers that the greatest challenge has been dealing with non compliant uncommitted substance abusers. The bottom line has become resoundingly clear that there is no help for those who choose not to help themselves. Our country has a dysfunctional system for handling the growing problem of addictions which greatly affect the the lower class and appears to be rapidly affecting the middle class. I still identify with that population because that is where I came from. I feel enraged at the fact that more isn't done at the entry level into the country for cocaine and heroin. Instead the focus is directed toward people like myself who are trying to help fix the problem. That is why I feel cynical about politics. No candidate has said a single word about the drug problem. It is as if it doesn't exist. It makes me wonder who really controls the country. Is what we see what is really reality? Follow the money. Who is really receiving the benefit at the expense of others? How do the drugs really get to the consumer? Maybe the jails and the court system and law enforcement need the users to continue using.
Some days I can't believe what has happened to me with this issue with the Medical Board. I did take the risk of seeing many patients that other doctors would not see or were not appropriate for the public centers that are supposed to treat addictions. Many of the addicts were actually created by our dysfunctional system which punishes doctors for associating with such patients. My case has been continued until February now. I think they realize they have a hot potato. All of the useful evidence that could be used against me is from over a year ago and most of it I told them willingly (which I now realize was a stupid thing to do). This is obviously a witch hunt, which serves the purpose of diverting attention from the real problem. I believe within my heart that there are indeed corrupt individuals within our legal and political systems. That is the true source of what is destroying the fabric of our communities. People need jobs, access to proper health care, and education.
Sometimes it may appear that I overinflate my self worth by associating my situation with the national agenda. I view it a bit differently and feel that the true enemy needs for people such as myself to be marginalized, discredited, suppressed, or neutralized for we are a threat to the status quo. I feel validated when people that I know, mainly patients, reject the smear tactics used against me. People who truly know me are aware of what type of person I truly am and that, most of the time, I actually am pretty good at what I do. I have worked hard to correct what the Medical Board deemed deficient. My reputation was attacked but it is not sticking. There are a few pharmacists who have gone out of their way to propagate the negativity but they are only hurting their own business. People have assured to me that my plight has been a part of their daily prayers. I feel confident that the enemy will not prevail here. If God is for us then who can be against us. For me, this is becoming a test of faith.
On the lighter side... Someone told me that cats are suppose to calm down when they are sterilized. That apparently is not true. My cat actually seemed to resort to the behavior she displayed when in heat. She's bolting out the door every opportunity and sniffing for the tom cat's scent. At least she loses interest after a few minutes and comes back in. I wonder how long this will last. I was afraid to admit that I had relocated Squeaky to my property in the country because I was afraid she might not adapt. She has some ferral cat tendencies and suprisingly has done quite well so far. There is a neighborhood scavenger dog that I was most concerned about. She has learned to evade him when necessary. She loves climbing the trees and exploring the proximal territory. The first time she climbed a tree she was stuck about 15 feet off the ground and afraid to come down. She started whining out of fear and confusion. Sounds like a job for the fire department. Yeah, right. They would have loved to come back a third time. Eventually she came down to a lower level and jumped. There was a considerable thump but fortunately she wasn't hurt. Live and learn.
It's All In the Mind
Nihilistic thinking means anticipating the absolute worst for the immediate future...
Those suffering from depression are most vulnerable to this form of thought content. As a therapist my strong suit turned out to be a gift for interpreting. At the commencement of numerous sessions, patients have voiced feelings of despair and hopelessness and somehow end up leaving with a better outlook for their future. The process for this to happen usual starts by allowing the patient to express the laundry list of everything not going well in their life then pose the simple question: Well, what good is happening? The automatic response to that question is "nothing." I challenge them to rethink that answer and almost without fail, at least one positive thing can be identified. This single positive is used as a foundation to help make associations with the considerable number of worthwhile aspects of that person's life. There have to be reasons they even chose to keep their appointment. If their situation were truly that hopeless, they would likely have offed themselves or drowned their sorrows with alcohol or other mind altering substances. I point out that the fact they have kept the appointment and chosen to not entertain the thoughts or temptations of self harm is an important asset and that hope remains alive.
Prioritizing is crucial. Freud wrote that true happiness is based on the quality of personal relationships and the status and degree of satisfaction with ones career or occupation. Any person who has lost their job and has a marriage on the rocks simply must feel grief emotions and depression at least for a period of time. If they do not, that person is truly out of their mind. The question is whether or not the person has sufficient coping mechanisms and an adequate support system to endure the storm. There are only two scores to be made on this crucial test; 100 or 0. One who choses to take their life and succesfully do so receive the zero. Even the person botching the suicide attempt receives a score of 100. Those who choose substance abuse as their primary means of coping are rapidly headed toward the zero mark. One who has children or grand children will be less likely to engage in the selfish act of suicide for they more than anything don't wish to transfer their pain to others that they love. Given enough time every storm eventually passes. Suicide can become a legacy since the number one risk factor for a succesful suicide is to have had a close relative commit suicide. It must be taken into consideration as well that severe substance abuse is no less than a masked wish to die and suicide in slow motion. The trigger has been pulled but the bullet just hasn't struck yet.
Nature provides a simple guide that it doesn't take a rocket scientist to figure out for how to stay focused and make the best decisions. The answer is children. Almost every mammalian species has it encoded in their DNA to rear their young to at least some degree. Parents who consciously do their best to meet the needs of their young tend to have better mental health. This does not mean giving the child every material object they themselves never had or sparing the rod. Kids actually want to be disciplined and failing to meet this need will result in more acting out of undesirable behaviors. Kids with special behavioral needs associated with conditions such as ADHD or ODD need to be treated professionally as part of their parents involvement with being responsible and effective in the parenting role. Yes, you the mother or father of the child experiencing problems likely may carry an adult version of what your child has. It's nothing to hide or be ashamed of but be thankful we understand these conditions better today and can offer safe and effective treatments. Stop reading the internet and package inserts so much. It still amazes me how some people can learn more in an hour of Googling than I learned in 8 years of training and 12 years of practice. When this happens, as it often does, it gives me a pretty good clue of the origins of the problem at hand.
My months of labor at my Chatham County retreat are starting to pay off. Out of what appeared to be random forest with major over growth, i have been able to restore a piece of history. Observers don't see me as a nut so much now. It is therapeutic for me, though at times it feels like PTSD without the trauma. Over forty years ago comes back to me as if it still lives. Practically all the adults I knew at that time are dead and long gone from a physical perspective but the memories are priceless. I see the pedal car, the tricycle, and remains of the little red wagon I once pulled lying in a pile of junk. I know its just rusted metal that should be hauled away to the random observer. The freight train passing by twice a day is undesirable noise to the random observer. It brings back memories to me of leaping from bed to run and wave to the engineers and count the cars. The dogs howling and owls hooting in the distance are not frightening to me but reminders of a simpler time in my life. I've spent 90% of my time working around the spring and the branch because they were my favorite places as a child. I know how to appreciate those simple structures. I think of how my ancestors relied on this source of water for their very lives. I think of the time and effort they must have put in so many years ago. Now it's up to me to not let that be forgotten. I am honored.
I'm Back
I had started to grow tired of writing about the same old old depressing topics. . .
therefore, I haven't made an entry in several weeks. It seems that recent references to partisan politics made my Blog unattractive to the national market just as I thought things were about to take off. The AOL Journals site has announced it will shut down for good this month. That is where Thoughts From The HEADoc began over four years ago. I'll need to find a way to save the archives on this site or another.
Traditionally, October seems to be a bad month when everything that can go wrong usually tends to do so for me. I learned of the death of a resident at the 1/2 way house where I work this morning who apparently died in his sleep possibly from an accidental overdose from opioids bought off the street. I had helped him through his detox period and seen him several times where I resisted his drug seeking and refused him what his body craved from years of dependence from family doctors, emergency rooms, and off the street purchases. He had a couple months abstinence from his drug of choice. His addiction, it seems, still ended up taking his life. Had I been able to start him on Buprenorphine at the commencement of treatment he may have resisted those cravings and not have resorted to desperate measures. The next witch hunt may look at me as the primary villian in this tragedy though I may in all actuality be the one who could have prevented it. Despite completing the training to use Buprenorphine, there is a strong possibility the Medical Board will restrict me from prescribing it for its intended use because of their need to discipline me for prescribing opioids to treat chronic pain patients in the past and not having the documentation to suit their satisfaction. There is an abundance of opioid pain medications on the streets today that addicts have access to. Where it all comes from I do not know. It does make me quite angry to think of what I have been put through for what I find to be politically motivated. Not only do I find my past involvement to not be a significant part of the problem, I have been one of the few foolish enough to try and help those in need with prescription drug addictions. For that my reputation was attacked and my name dragged through the mud. At my last meeting with their people and my lawyer, I was told that if I had hired a lawyer from the very begining, none of what has happened would have happened. Thanks for the belated advice. I found that it is dangerous to assume that because you think you have done nothing wrong that you will necessarily be treated that way. It's not that difficult for the system to make a decent person look like a criminal if that becomes the intent. It's not personal they say. Live and learn I guess.
I have never been more sick of anything than I have of this whole Medical Board thing. I want so much for it to be over. The Consent Order is expected to be finalized this month. At the very least, I expect to be restricted from writing Schedule 2 Narcotics. As long as I can continue to write ADHD medications such as Ritalin and Adderall I have no problems with this. I think it is fair for them to order me not to treat chronic pain patients if that is what they feel they must do. I don't believe it will have any impact on the problem that exists with opioid dependence/abuse in North Carolina. I know it is no more than a gesture that may make them feel they are doing a good job. I will find it unfair and difficult to accept not being able to prescribe Buprenorphine, which is a Schedule 3 medication approved last year for the purpose of helping people get off of pain medications and heroin. It is the first medication ever that will allow doctors to treat patients safely in the office setting. It is more effective than methadone but more importantly much safer to use. Physicians must complete 8 hours of training to be certified to prescribe this medication. Each certified physician can manage up to 30 patients the first year, monitored by the DEA. I'm hoping The Board will not see it necessary to deprive me of such a useful tool. If they really want to hurt me they could also not allow me to prescribe Schedule 4 medications such as Ativan, Klonopin and Xanax. I see no reason for them to take such a stance, but they hold all the cards. They could take my license to practice if they wanted to.
Enough of that. I cannot even find a way to joke about such thoughts as that. My cat was spayed. It's finally over. I don't have to worry about any more kittens. Squeaky had to go due to some major sanitary issues. I truly believe her to have some major emotional developmental issues as well. It's amazing how easy it becomes to detach from them emotionally once they are no longer a cute cuddly kitten.
The Truth Is The Light
Very little is as it seems in our reality. . .
I have found that to be one of the greatest truths, yet sometimes The Headoc forgets that. There may be times when a myth or parable actually contain much greater truths than perceived reality. All great orators and teachers are gifted in using metaphorical illustration as a means of enhancing their transfer of information. Most of the greatest humans to live were actually misunderstood during their time. Jesus was brutally nailed to a tree. Joan of Arc was burned at the stake. Galileo was imprisoned for years as a heretic just for suggesting the world was round instead of flat. I won't even mention the 1960's in America. I believe in seeking out the truth in any situation and confronting that truth. By nature I have always been a risk taker which has sometimes paid off in various ways and at other times made my life more difficult. I am highly intuitive and spiritual at times. I don't care much for religious dogma, however. Most people in the world rely on what their eyes see and ears hear but are unaware of the realm of intuition and balancing emotion and reason as part of the equation. But in America alone there are over 250,000,000 individuals who biologically are 99% alike yet vary greatly in individual experiences that have contributed to their psychological develpment.
On the Internet, I sometimes enjoy a game of Poker at The Full Tilt Site. My play is more unorthodox and undisciplined than most which often infuriates players of the opposite playing style. I believe myself to be unusually lucky for brief windows of time, yet extremely unlucky most of the time. Players such as myself are often referred to as donkeys, donks, retards, tards, or idiots when we win a hand against the so called good players. Sometimes it's hard to not take it personal and I must remind myself to put things in perspective and consider the source of the insults. Usually I find it amusing to observe how some players believe that by following their system of probabilities and statistical laws that they should win the hands they think they should. In reality, if I could ever just learn when to quit I would win just as much as they do through my intuitive and luck based approach.
A flood was produced by the hurricane via the dried creek bed on my property last week. Most of the washout damage was due to blockage from debris left by the dozer during the land clearing process. While attempting to clear out some of the debris I came across my friend the terrapin I had rescued from the highway a few weeks ago. I picked him up to have a look to find his body limp and lifeless. He had drowned from being trapped by the water pressure of the stream. I felt hurt, angry, and defeated and asked myself why? Maybe he would have been better off with his chances of crossing the road that Saturday morning. I thought I had done a noble deed yet in the long run ended up contributing to the creature's demise.
The turtle story is symbolic of how the practice of psychiatry in the public sector sometimes seems. Those who work with this population can usually, at best, just try and do what they feel to be the right thing. This must be performed within the confines of greatly limited resources for the desired objectives to be met. As with the poker, sometimes I feel I continue to do what I do knowing that in the end it might not make any difference. Still I find creating hope and comforting people to be a worthwhile venture. The Medical Board represents that angry player who refers to me as a retard. I am not a retard and far from an idiot. I do sometimes make choices motivated by feeling and conviction. Irrational fear is my enemy.
A colleague suggested I write something to clarify my status with the Medical Board since there are rumors abroad about the situation with me and treating chronc pain. Sometimes when there lacks clear information people tend to think the worst. First of all, I have no criminal charges against me and I have committed no crime. I have never been placed in handcuffs and taken off to jail as some pharmacists have been telling my patients. Nothing has changed with my medical license or my DEA license. Nothing has happened with my practice except that I am phasing out any treatment for management of medications prescribed for the treatment of chronic pain. Thats it! There is no juicy story. This involves a fraction of the patients I treat. I want to focus on just psychiatry and as few substance abuse patients as possible. The Board is a govermental agency which by nature incorporates some degree of political agenda. As with the IRS, DEA, SBI, or even the SHP (State Highway Patrol) you do not want them in your life, and most do all they can to prevent encounters. In my case there is so much irony. I have worked with detox patients at Residential Treatment Services of Burlington for about 12 years now. Yesterday, 100% of the patients I saw were opioid dependent, taking large doses, yet none of them had ever received a prescription from me. The Board investigator assured me that my case is not a witch hunt and I should not take things personally. I still beg to differ when they have facilitated such a hostile public attack on my reputation and I am the one who treats the problem. My special DEA # to use Buprenorphine is on hold until my case is settled even though I have completed the training. I have completed the CME training requested by them to prescribe controlled medications. I have done everything asked of me but because my documentation records of a few charts were not to their satisfaction they have continued to drag this situation on. They are doing their part to fight the war on drugs during an election year by dealing with me. The true function of the Medical Board is to identify doctors who may pose danger to the public and remediate such a problem. I am no more a bad doctor than I am a tard or a donk. I think that time will prove this point. If it becomes too difficult for me to practice how I want to practice I may just have to find another way to make a living. Some things just aren't worth tolerating because life is to short.
and it doesn't cost a dime to benefit. I have made a couple of entries previously about the process of transference and counter-transference. Freud made these two concepts popular in his practice of psychoanalysis. The subject may transfer emotions on to the therapist that are associated with past encounters with significant people. An example may entail the subject subconciously feeling contempt, resentment, or fear for their controlling and emotionally unavailable father since childhood. For the sake of interest, lets say the father recently died with those issues left unresolved which caused enough internal conflict within to motivate the patient to seek therapy. Since the primary issue with such a patient centers around problems with male authority figures this will almost certainly surface repeatedly in sessions with a male therapist. The therapist has three tools to work with: confront ideas and comments made by the patient, clarify ideas and comments, and make interpretations of how the past may be associated with the present. How and when to make such interpretations is crucial in how effective the therapist is in helping the patient to gain useful insights into their behaviors that will motivate positive change. Counter-transference essentially involves what emotions the patient drums up in their therapist. The therapist is able to interpret that if the patient arouses certain emotions within them then chances are they arouse the very same emotions in others they encounter. Since the therapy session is like a laboratory where ideas can be therapeutically dissected, the therapist over time can help the patient see more clearly why others treat them certain ways and the role they themselves play in that process. Most importantly is finding solutions to their unhappiness or other symptoms they may experience.
I wanted to write about animals today but I thought the above preface necessary to help put my ideas into context. Three kittens have found loving homes. One I just couldn't let go. I spent less than two months with them but it was delightful observing them nurse and interact with their mother. As babies they just want to be loved and cared for. Some people deprived of such nurturing during their developmental years can become arrested in a psychological limbo and have ongoing issues and inner conflict. Squeaky is the name I chose for my Alpha kitten because of her high pitched meowing in comparison to the other three kittens. Squeaky was always the first of the litter to explore the environment. She was the most aggressive nurser and the first to discover the food and water bowls. She would follow mother around alone at times. Without her siblings as a reference point now Sqeaky seems traumatized. She is withdrawn and doesn't like being touched much. I think she senses the change in environment without the others and fears she may be taken away next. I kept Squeaky because I like her spirit. She was different.
Yesterday I encountered a terrapin in the road on my way to my weekend landscaping project. This isn't the first time this has happened to me and as usual I felt the urge to turn the car around and to go back and rescue the poor terrified creature. I knew it was moments away from being crushed to death by a passing vehicle. He thought he was out of danger by retreating to the safety of the shell. Sometimes I have done the same thing metaphorically, thinking that by avoiding a problem that I had ridded myself of the problem, yet rendering myself oblivious to the potential dangers existing in reality. So I rescued another terrapin and moved him to a safe environment. I feel good about that.
On the other hand... I have never resolved my irrational fear of snakes. During my raking and burning I came across a freshly shedded skin of a substantial sized serpent. I now knew that it wasn't all just in my head. He was really in the vicinity, probably watching me at that very moment, and I had no idea where he was. I was extremely cautious in my raking expecting at any moment for an aggressive four footer to hiss and strike at me just like on TV. Aha! Under a pile of moist leaves there he lay almost ten inches in length. He appeared disoriented and confused as if he had been minding his own business and enjoying a peacful Saturday afternoon. Instinctively, I decapitated and violently beat the head with my rake. Feeling victorious, I picked up the evil serpent to examine the deadly hypodermic fangs I so feared. To my surprise there were no fangs. This meant I had killed an innocent and harmless water snake. Intellectually, I understand terms such as harmless and innocent but somehow haven't learned to view the snake the same as I view the kitty and the terrapin. I do feel bad sometimes about being a snake killer so maybe I can reform and allow some of those poor creatures to live in peace.
I did meet paths with a wasp nest in a small cedar tree that I wished to cut down. As a kid, I never got along with wasps very much and was known to pick a fight and end up being stung. So I have had an irrational fear of wasps, hornets, and bees in addition to snakes. This time, the wasp and I fought to a draw. I stopped chopping on the tree and he went back to finish his nesting business. Another day and another time the tree will be mine. I feel like I conquered yet another phobia in that brief encounter with my foe the wasp.
My encounters with nature tapped into my emotions in a unique manner. The only true and rational emotions I believe to be the love for the kittens the compassion for the terrapin, the remorse for killing the snake, and the respect for wasp's residence. I'm glad to have this opportunity to work through my issues and misunderstandings with nature.
It could be the daylight of peace and tranquility or it could be the proverbial freight train of more and worse to come, or maybe just another mirage to extend hope a little while longer. I arose this morning to learn that a favorite comedian Bernie Mac was dead at age 50 and Senator John Edwards had confessed to the rumors in The National Enquirer putting his political career in ruins, for the time being at least. These shocking realities saddened me but also caused me to realize how blessed I am. In the past couple of years I have faced the threats and realities of divorce, foreclosure, bankruptcy, death of family, business failure... Every doctor fears the humiliation of being published in the quarterly newsletter of the Medical Board for facing disciplinary intervention. We all understand that is the way the profession polices itself since most physicians are quite conscientious and feel bad when they commit a regrettable act on occasion. For most it would be preferable to secretly spend thirty days in the County Jail than to endure unfair or unwarranted public scrutiny. I had prepared myself for the inevitability of making the Newsletter. I definitely was not prepared for newspaper and television news involvement. I never read the article nor saw what was reported on the evening news. Some who support me described it as B.S. It makes me feel good to know that not everyone is programmed to automatically accept everything they are fed at face value.
In order to move on with my career and my life it is important for me to speak for myself and make sure the record is set straight. Those who really know me are aware of my competence as a practitioner and my caring nature. There is really no power given to any human or group of humans capable of changing those two facts. The Medical Board became involved with my practice of medicine because of complaints from outsiders who drew their own conclusions to how I found it most appropriate to treat opioid dependence and chronic pain patients. Many would comment that you shouldn't have been treating them in the first place. My answer to that would be that if our health care system functioned as it is suppose to I never would have been treating such patients. Maybe so many other doctors would not avoid such patients if the inappropriate patients received appropriate intervention medically and legally. The real problem is not legitimate chronic pain patients. The real problem is the addict who has chosen to willfully engage in unlawful behavior. A person of such character has no regard for anyone but self and they deep down don't really even care for self or they would not choose such a self destructive pathway to live. I have little compassion for a person who is willfully dishonest and deceitful. Many have been discharged from my care once the truth became known. Such people are the other source of complaints and false information supplied to the Medical Board. Aside from that, the Board reviewed five of my charts dating back 1 to 2 years. During previous meetings with them I was told what was deficient in my documentation and what needed to change in the future to continue treating chronic pain patients. The Board left me believing that completing the Continuing Medical Education I took at Portland State would be sufficient to prevent them from going forward with any legal proceedings. They made a compilation of all I had told them in good faith and used charts they already knew were representative of the pre remedial situation to justify a public smear of my practice of medicine.
So what could be the worst possible outcome? That of course is easy to answer. I could lose my privilege to practice medicine permanently. Is that likely to happen? Absolutely not. Most of the Board's leverage comes from embarrassing a doctor publicly when they want that doctor to comply. After that, they tend to show a display of overwhelming force to show that doctor that he or she cannot possibly win against them. They have nothing to do with the actual practice of medicine but everything to do with who is allowed to practice medicine and what their scope of practice can entail. They mask everything behind protecting the public. In my case the main people protected by them are ones who regularly break the law. Others such as legitimate sufferers of pain from chronic conditions will be again told they can't be treated in the most appropriate manner because of intervention by their government agencies.
How much wrong have I really done? First of all, I don't really want to treat a lot of chronic pain patients. For the vast majority of patients I have prescribed an opioid to I think it is for the best for them to be treated elsewhere. Where that elsewhere is, I'm not sure. This catch 22 cannot be resolved by me. The pain clinics can go only so far with them, the orthopods and neurosurgeons would rather not be bothered, family docs don't have the time to address the addictive component associated with many of these patients' condition. A subset of patients found the perfect home with me and have done exceptionally well. They have found adequate relief to have their life back, to a degree. Without such relief some patients would consider suicide. To the Medical Board this would be preferable to me continuing their treatment. I'm sorry but that really bothers me. That's why I encouraged such patients to write the Medical Board themselves to express their feelings about their right to treatment being tampered with for bureaucratic purposes. Some patients simply do need a medication such as methadone to control their chronic pain. I think it is probably unethical to deprive them of the treatment they need in the name of protecting them. As Dr. Deluca with the Pain Relief Network has stated in his video interview, few people in America receive the true standard of care for chronic pain for the simple reason that the average doctor fears the repercussions for attempting to provide such treatment to the degree that may be necessary. I feel if I had never prescribed methadone for chronic pain treatment the Board would never have taken things this far. The DEA is a federal institution and could only charge me for a criminal act or for using narcotics for non medical use or for treating substance abuse disorders without the proper licensing. Physicians usually use certain narcotics for the treatment of a diagnosis of a chronic medical pain condition. This is perfectly legal in the United States. But... the State Medical Boards make the criteria for what is deemed a legitimate medical condition. Most doctors are not aware of the detailed criteria in the policies until it's too late. By that time the Boards can have enough against a particular doctor to use against them in any way they see fit to suit their purposes. In my case, the remediation done as requested was irrelevant but it would give them justification to allow me to continue treating pain patients if that was their desire. They hold all of the cards.
I have been advised against going through with the hearing for it would more than likely be pointless and could make things worse in the long run. However, if I had the legal backing and finances I think the cause is worthwhile to fight for. Without such support no individual citizen can expect to beat the State. That much has become clear to me. The norm in such a case as mine is have a consent order issued that allows the Board to feel it has acted sufficiently on behalf of The People of The State of North Carolina. Basically, the doctor is ordered to do as they say and the doctor consents. This consent frees the doctor to not have them on his or her back any longer. The doctor's license is usually restricted for a year as a technicality but things go on as usual as long as the doctor stays out of trouble in the future.
All but a few of the patients I have treated for chronic pain seem to be handling the news ok that I will be ordered to no longer treat their condition. At times I wish I had forced myself to cap my chronic patients at the 10 or 12 that I find it most rewarding to treat. Had I done that, I believe that none of this would have happened. I can only hope and pray that they will find one willing and able to provide the treatment they need. Those patients are most dear to me because they constantly remind me that I did do some good in this context and that in principle I have been right. Despite that, there still often comes a time when one must let go because ones limits have been reached for a situation.
August 8, 2008 will mark the 4th anniversary of Thoughts From The HEADoc-Quest 4 Sanity. . .
How cool is that? The HEADoc has thought of this journal often as a cry from the wilderness. Such a metaphor tends to speak for itself in that it was known from the start that not every potential reader would hear the messages while still others would hear what they chose to hear. Some would interpret courage and insight yet others would see foolishness or insignificance. Still The HEADoc tried to keep it real and write about subjects rarely mentioned from such a perspective as his own. The Quest was never about the personal sanity of any individual person but mostly about situations in life that can sometimes challenge that personal sanity of essentially anyone. The THOUGHTS have not been specific for Psychiatry but have been generated by one who practices Psychiatry. An effort has been made to document original thoughts, freely associated, and of interest most of the time. On a rare occasion an entry has been synonymous with pornography as far as what has been shared with readers. In a pornographic film the actors tend to relish in exhibiting a behavior that should be private. The actors know that those seeking what they have to offer will identify. The idea here is not to suggest perverted writing but to suggest that The HEADoc did not alter the writing for the sake of political correctness or attempting to please readers or to make himself look good. Non fiction to The HEADoc is more valuable than fiction.
Readers who are of an ultra conservative right wing world view will never see eye to eye with The HEADoc on much and usually wouldn't read more than one post anyway unless wishing to pursue an argument, which has actually happened before. The HEADoc, believe it or not, is not a bleeding heart liberal as one might be inclined to believe but would identify himself with The Rationalist's party, if such a party existed. The Rationalist's party would take the good ideas from the existng political parties and discard the rest of the B.S. The Rationalist would be seen as a communist by the Right and as too hard to pin down by the Left. A Rationalist would be small on talk and big on action. A Rationalist would not need to lie to the public or mislead the public because he or she would identify with the public. When a policy failed, The Rationalist would be required by conscience to admit that and immediately investigate and begin a rational reform of that policy based on fact and logic. The Rationalist Candidate would win every election because of full undisclosed accountability to the public. The Rationalist Candidate would conform only to common sense and show limited loyalty to political correctness. He or she would not fear stating such beliefs as: Oswald didn't act alone nor did James Earl Ray or Sirhan, that more could be done to stop the flow of illegal drugs across the U.S. borders, that Bush didn't really win in 2000, investigate 9/11 to find out what really happened, the Iraq War was unecessary, there is no gas shortage (yet), Obama really is the better candidate.
Enough of the nonsense. The HEADoc has worked through his grief fairly well and does not wish to be perceived as a victim. He has thought long and hard about the situation with the Medical Board and has tried to see the situation from their pespective. He has accepted the possibility that perhaps they could be right (according to the statutes) and on a technical basis at least, The HEADoc should probably just accept that. In the arena of treating chronic pain patients, the time to throw in the towel is nigh. The HEADoc has begun to see that most of the true pain patients greatly fear having to find another doctor to effectively treat their pain and fear losing the security they have found with knowing someone cares enough to make sure they have what they need. Some of The HEADoc's patients have done exceptionally well with treatment after years of seeking relief. The HEADoc believes this mostly due to the fact their emotional needs were validated and addressed in addition to the physical state of disease initiating their pain. The most important lesson learned from treating chronic pain conditions has been how the road to true and lasting analgesia is centered in changing how the brain perceives the pain signal. Ridding the body completely of pain is an unrealistic goal for any treatment. Teaching the brain to experience pleasure again is key in the chronic pain patient with depression and anxiety based on the premise that the brain is not constructed to perceive pain and pleasure simultaneously and must choose which to experience at any given time. When chronic and persistent pain becomes the sole focus of ones life the regions of the nervous system that conduct primarily good thoughts and feelings, in a sense, can cease to function adequately. The pain conducting areas of the nervous system then operate unchallenged, thus a vicious cycle of pain, depression, and anxiety persists.
At this time, The HEADoc recognizes that the well being of the patient is what is most important. The Board states the safety and well being of the public as its primary responsibility. The Board's basic stance, in this particular case, is that it is better for many people to live in more pain than they have to than to risk one more addict getting their hands on a drug they shouldn't have. The HEADoc intends to continue providing quality psychiatric care to the chronic pain patients within the practice while facilitating referrals to a provider willing to treat their pain conditions. This will be an extremely difficult process for some patients and will produce emotional distress. Many patients have made it clear that the value of the mental health care received has been equal to or greater than the value of treatment of their pain condition and they have no intention of terminating their psychiatric care because of being required to find chronic pain treatment elsewhere. The HEADoc will do his best to help such patients deal with the fear associated with the change. Their treatment has been considered sucessful and if successful in finding effective continuation of treatment for their chronic pain condition the best may be yet to come for them.
In this life we all experience times of challenge. . .
Some of us carry in our DNA a propensity to develop episodesof major depression that is most often triggered by prolonged stressful events. Such individuals cannot always control how things happen to them but they must realize that they are in full control of the response to a situation. There are always things one can do to battle the stress response. It is possible to teach oneself a form of maintenance cognitive behavioral intervention once the concept is learned through a competent therapist and enhanced through ones own self education and practiced through repeated life experiences.
Our very reality as humans is driven by constant battle between our limbic system of the brain, where strong emotions are generated, and our cerebral cortex (gray matter) which we use for reasoning and logical thinking. From an evolutionary survival standpoint the drive from the limbic system has a propensity to override the logic and reasoning in times of stress, or perceived threats, which can result in periodic lapses in judgment and emotional over reaction or emotional shutdown. Our fight or flight response is a gift from our ancestors that when correctly working increases our probability of survival. Adrenalin can be quite helpful in an emergency but over utilization tends to result in mental problems, especially if a change in environment or detrimental behaviors is not achieved.
Yesterday I felt myself consumed by an almost overwhelming feeling of frustration and sadness. Over time I have learned that the key to getting through such an emotional state is basically not allowing myself to shut down or to over react because the result of such behaviors is usually self defeating. A friend once offered me a phrase to use that I find quite helpful, "This too shall pass." Lately, my life has entered a place that seems like a bad episode of "The Twilight Zone." I'm hoping it will all start to get better once I have this situation settled with the Medical Board. I really don't quite understand what they really want or what they are really trying to prove. If surrendering my DEA license would make this nightmare end I would be willing to even do that. If I can prescribe ADHD medications and benzodiazepines, I can practice fine without the use of other controlled drugs. There is no point in attempting to punish me because, short of not letting me practice at all, I can be hurt no worse than by what has been done to me by the news media. It is not easy listening to rumors and lies daily that are based on absolutely nothing. Some of my patients have been told that I was led off to jail in handcuffs, others that I have been shut down or that the state is going to use patients discharged from my practice for violating their contracts to turn states evidence against me. This is totally ridiculous and much more than I ever bargained for.
The irony of this whole thing is that I have never tried to do anything short of help others. I finally have my practice at a place where that can happen and is happening. I will have to start turning patients away soon because I won't be able to see them all and 90% of them are not pain patients or seeking drugs that can be abused. I like to think that it is because I am a competent and caring provider of mental health care. Neither me nor my patients deserve the bad publicity that has occurred. I think of all the good I have tried to do in my career and rarely has it been given the slightest notice. As I have said repeatedly, I will continue to let my conscience be my guide and do the best I know how.
On the lighter side, I'm going to enjoy watching my four new kittens develop. I've found future homes for two already. Though she will definitely be spayed in the future I have no regrets for allowing my cat to experience reproducing. There is nothing more natural. Sometimes mistakes can turn into blessings if we just look for those blessings. I love my new Al Green CD. It takes me back to a more carefree time in my life. I always wondered what his singing would sound like with the benefit of modern recording technology. To me he is the greatest ever, and I love every single cut. He has some help from John Legend, Anthony Hamilton, and others who help transition the '70s style to contemporary. The horns, percussion, and strings really make the music live. It talks to my soul. Thanks Al.
It has been really hard getting back into the swing of things. Lots of bad news lately, but I try to find silver linings where they exist. It's a bit more difficult to make fun of myself lately in my posts I suppose out of fear of how it could be perceived by some. There is another side of me that really doesn't care that much what negative people think of me. My involvement with most of the patients I see continues to be as strong and positive as ever. That keeps me going from day to day as I seek additional ways to enrich my life and find the fulfillment of self sought by all humans. I find that adversity often challenges one to reconnect with or strengthen ones spiritual being and can provide enough humility to help one find perspective in ones life. So true yet so boring to write about.
I'd much rather write about my new fun activity of pulling stumps out of the ground with my 4 Runner. I never knew something so primitive could provide such exhilaration. Yee-haww! Or I could write about my newest restoration project of the spring and the little stream where I used to retreat to when I was a kid and in trouble for misbehaving. It was always such fun to capture the tadpoles, crawfish, minnows, or salamanders. Once I got into even more trouble for capturing a baby snake in a coffee jar. My aunt gave me a scolding and made me throw the poor thing away with the lid still on. I worried about that snake for a long while. Snakes just seem to have always gotten a bad rap. Even today, they are the only creature that I instinctively kill, even though they probably represent no harm to me. It's somewhat interesting that I found myself retreating to that same little stream now over 40 years later when I'm involved in a much different form of adult trouble.
I could probably write a pretty good story about my cat giving birth to kittens last week, as well. I think that's an experience everyone should have at least once, but probably not in the way I chose to allow it to happen. In 2 months I have become experienced in feline sexuality, labor and delivery, and the behaviors of early nursing. Nature did all the work with minimal assistance from me. I had barely finished reading my online article about cats in labor before I actually accepted the fact that my cat Oreo was showing exactly the signs I was reading about. Before I knew it there was a piercing scream coming from the bathroom followed by a higher pitched squeal. As I rushed in and peered into the tub we both looked at each other dumbfounded as the 1st born lay helplessly at her side. It had been almost 18 years since my OB-Gyn rotation. (not that it would have made any difference) Too late for hot water, the cat had already beat me to thinking of that commonly suggested first maneuver. So I ran to get towels and a box. I was too slow. She had already taken the baby kitten to her secret hiding place. All I was really needed for was to help clean up. So I'm just staying out of the way until she brings the kittens out of hiding. Her behavior is totally back to normal other than her having less time for me. She actually talks to me when she needs something, so I don't fret. So far, I've found a future home for one kitten. And yes, my cat will be spayed before having the chance to go into heat again. I have definitely learned my lesson there.
As many people already know, nature provides endless opportunities for escape from the stressors of ordinary life. The Serenity Prayer teaches me to ask for the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. These are two of my current coping tools that I look forward to putting to additional use in the future.
psychology
I'd much rather write about my new fun activity of pulling stumps out of the ground with my 4 Runner. I never knew something so primitive could provide such exhilaration. Yee-haww! Or I could write about my newest restoration project of the spring and the little stream where I used to retreat to when I was a kid and in trouble for misbehaving. It was always such fun to capture the tadpoles, crawfish, minnows, or salamanders. Once I got into even more trouble for capturing a baby snake in a coffee jar. My aunt gave me a scolding and made me throw the poor thing away with the lid still on. I worried about that snake for a long while. Snakes just seem to have always gotten a bad rap. Even today, they are the only creature that I instinctively kill, even though they probably represent no harm to me. It's somewhat interesting that I found myself retreating to that same little stream now over 40 years later when I'm involved in a much different form of adult trouble. 
I could probably write a pretty good story about my cat giving birth to kittens last week, as well. I think that's an experience everyone should have at least once, but probably not in the way I chose to allow it to happen. In 2 months I have become experienced in feline sexuality, labor and delivery, and the behaviors of early nursing. Nature did all the work with minimal assistance from me. I had barely finished reading my online article about cats in labor before I actually accepted the fact that my cat Oreo was showing exactly the signs I was reading about. Before I knew it there was a piercing scream coming from the bathroom followed by a higher pitched squeal. As I rushed in and peered into the tub we both looked at each other dumbfounded as the 1st born lay helplessly at her side. It had been almost 18 years since my OB-Gyn rotation. (not that it would have made any difference) Too late for hot water, the cat had already beat me to thinking of that commonly suggested first maneuver. So I ran to get towels and a box. I was too slow. She had already taken the baby kitten to her secret hiding place. All I was really needed for was to help clean up. So I'm just staying out of the way until she brings the kittens out of hiding. Her behavior is totally back to normal other than her having less time for me. She actually talks to me when she needs something, so I don't fret. So far, I've found a future home for one kitten. And yes, my cat will be spayed before having the chance to go into heat again. I have definitely learned my lesson there.
As many people already know, nature provides endless opportunities for escape from the stressors of ordinary life. The Serenity Prayer teaches me to ask for the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. These are two of my current coping tools that I look forward to putting to additional use in the future.