Editor's Memo: Keeping the Trust in Difficult Times
Today, as I write this memo, The Wall Street Journal reports that a full 49% of Americans no longer feel that the Affordable Care Act (Obama Care) is a good idea.1 The results of a WSJ/NBC poll found a growing dislike of the Affordable Care Act “just months before enrollment begins for the government-sponsored insurance exchanges. The exchanges are designed to allow people who don’t have access to low-cost insurance through an employer to shop for regulated insurance plans and apply for subsidies toward the cost of premiums.”
No wonder. We are in the first phase of implementation and many insured patients are seeing their health insurance premiums and prescription drug costs go up, while access to their favorite physicians are being restricted. The average person can’t help but feel a little frightened as to what the future of health care may bring.
Pain patients, particularly those with severe conditions who require opioids and other potent medications, have additional reasons to be concerned. Recently, some states and medical groups seemingly have become more concerned about the misuse and abuse of opioids than about the suffering and care of legitimate pain patients.
Where do we pain practitioners fit in and what should be our response? Reader’s Digest gives us a clue.2 They recently conducted their annual “Trust Poll: The 100 Most Trusted People in America.” The Digest then ranked those people by profession to come up with “The Most Trusted Professions in America.” Physicians ranked number one, followed by teachers (Table). The high trust ranking doesn’t surprise me as I believe American physicians, in the main, are truly dedicated to patients despite the trials and tribulations of today’s medical practice.
How do we pain practitioners keep the trust we now have? Here are some of my thoughts. First, remember that these are uncertain, confusing, and frightening times for many patients. It’s critical for our patients to know that we are here and we are going to stay regardless of whatever changes the health system may throw at us. As you know, the chronic pain patient desperately wants to know that they will be able to get ongoing care. With health maintenance organizations and preferred provider organizations, some patients have already been forced to leave their chosen doctors and choose physicians selected by their health plan. As a back up to any unfortunate hiatus in patient care and/or the inability to pay out-of-pocket drug and laboratory costs, we must immediately teach patients how to better care for themselves. Patients need to learn low-cost strategies to get some modicum of pain relief with over-the-counter medications, electromagnetic devices, exercise regimens, hormone replacement, and dietary supplements—and not rely so heavily on prescription medications. (Below is a survey of popular supplements.)
It is also important for patients to know that the majority of pain doctors are not supportive of the emerging schemes to limit quantity or quality of medications, including opioids. Perhaps the best way we can maintain our high level of trust is to educate and inform pain patients that they can and must advocate for themselves. They need to know that they have every right, and responsibility, to complain to their health insurance provider if they can’t get the care and medications they need. Although patients know they have elected representatives, they rarely think to complain to those representatives when their care is threatened or sacrificed by a regulatory body or insurance plan. Above all, patients have to know that we physicians can’t advocate on their behalf unless they have personally complained to their insurance plan or governmental body that is threatening their care.
—Forest Tennant, MD, DrPH
Editor in Chief