Saturday, October 12, 2019


    In our life and in many a times we see the pendulum of opinion swinging . At one time coffee is bad then someone does research  and then tells us that coffee is good. High fat diet was bad for many years then came low carb is good  and high fat diet is good. I have seen this medicine too . We were told that steroids  are needed to treat COPD   and now it is OK not to use steroid inhaler. We are told that we have epidemic of narcotic use  and addiction .But when we look at it we realize that WE ALL are responsible for it .But then we got to have someone else to be blamed for it - may be then we can collect some money. So blame big pharma . As much as they are  responsible,we all are. I just want to mention that I do not  and did not prescribe these medicines. But with hospitals pushing doctors to get better patient satisfaction, the narcotics were prescribed  and they were more than what was  medically needed. The hospital reimbursement was dependent upon the patent's satisfaction. So we created the dependence  and the addicts . So now the pendulum has gone to another direction and that brings me to the story.
    One my my patient age 90 years plus called me on week end stating that she has chest pain on right side . She was doing weed whacker  and she fell down  and hurt the arm  and the skin -which was thin to begin with tore,She was also badly hurting on right side of the chest after the fall. . She went to ER  and they did chest x- ray  and not sure if they did CT scan. They gave her some medicine and discharged her . She wanted pain medication and the ER MD did not give her any . She was disappointed so she called me .I told her that with weekend , I could not do much ,but she can try some over the counter medications  and if not better then go back to ER again . And she did not feel better and so she went to different ER . The events were repeated . The ER physician gave her muscle relaxer - no pain medications  and discharged .She was having pain 'worse than labor pain' as she described it to me . I told her to come to ER where I can see her and let the ER doctor know that I will come and see her. I did ask her to call her PCP  and she had done it , but now a days no PCP goes to hospital, so that was not an option. She came to ER . I went to see her. The ER physician told me that she would not do any tests  as she told them that the 2 previous Er did all the work up. So I talked to her  and told her that we need to do X- ray of the ribs  and she agreed . We did the X- ray  and she has SIX RIB FRACTURES ! She needed to be admitted.
      The question is why did the ER physicians did not do rib X- ray , why did they not admit her  and lastly WHY DID THEY NOT GIVE HER PAIN MEDICATIONS?This old lady was not addict, she was not going to become addict and she had obviously pain starting after a fall. The answer is in the narcotics fear that we have created  and the hoops that physicians have to jump through to JUSTIFY narcotics prescriptions. So that is what I am calling as pendulum has gone to other side. 

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