Depending on the surgery that can still be drug seeking. I'm not saying he feigned his injury or anything, but if it's a low-grade surgery that only calls for anti-inflammatories afterward I've seen that enrage patients who expect narcotics. Their history with that condition means previous times where they've been prescribed and built the addiction back when the goal of pain management was the Sackler-sponsored absolution of pain rather than getting it to a tolerable level without risky interventions. If it was a serious spinal surgery warranting the good shit, I doubt he'd be mobile enough to do the shooting so soon after. When I worked in an SNF downgrading surgical patients we'd have a lot of spinal ones from procedures like vertebral fusions. They could barely ambulate to the toilet with help usually. Something more minor with the unrealistic expectation of the pain ceasing entirely on drugs he can't get and that's a motive.
Sure, I'd also want the same. Pain sucks. Do you go to a hospital to feel good or to receive the most scientifically valid care under the most strictly developed protocols? A chiropractor will make you feel good and is much cheaper, but there's a reason you hopefully go to a doctor instead of a spine warlock.
Medicine's goals necessitate the bigger picture both for your health and public health. If the protocol says you get opioids because you want them and they'll mask the pain with significant side effects/addiction risk, sure that Russian roulette might work well for you but every other patient is treated under the same protocol. That's dozens or hundreds per day. Each a personal and public health risk, every day until enough of you die to change the protocol in the obviously sensible direction.
edit: The counter-example to that is when I went in for a vasectomy. Typical recovery time is like three days with the dull sensation of being kicked in the testicles. The urologist gave me ten hydrocodones without me even asking for narcotics, which I strictly avoid as someone with an addictive personality. Taking that many under the vague assumption that it's the sound medical advice of a doctor is probably enough to get me hooked. I controlled that pain just fine with ice, ibuprofen, and a CBD vape. That's a bad protocol that could get me killed if I didn't come from stricter ones.
That's a more convoluted way of treating COVID with antiparasitics for horses. We don't put medicine in the hands of the public because no matter how competent and informed and ontologically sound you are the idiots driving next to you would have access to the same drugs under the same logic. The authority of the medical system isn't arbitrarily established in this case. That's a decade of schooling and teams of experts and treatment standards informed by external research that's continuously updated. Even if you manage to correctly identify all the elements of your easily visually identified condition and treat it totally appropriately to the standard you'd receive in a hospital, what's that crystal mom in the next car over going to do? She goes into Walgreens, walks to the OTC medications aisle, and everything that used to be behind a glass panel and a PhD is now on the shelf. What's she going to buy and is it going to be the right thing when she's treating abdominal pain?
Both really but I do mean ontology in this case. If your knowledge framework is up to that same standard of an informed scientific worldview, if there isn't some small gap for woo to enter through or some oversight in where your information came from and how it was processed, maybe it will work out just fine and you'll have the same experience you would from a doctor doing their job. Taking in those individual pieces of information is important but how you synthesise them into understanding something as wildly complex as the human body is where you can really fuck up.
I never used the words metaphysical nor supernatural, nor did I call ontology either. When I use ontology here it's the materialism/idealism split. The medical understanding is right in the way science in general or Marxism are. Non-medical understandings might be partially right but their social constructions don't result in the same kind of universalised knowledge base that I could cross-reference with other materialistic understandings like chemistry or biology. That's what you're paying for in a hospital. It's constructed out of that observational epistemological standard and then the resulting framework is the least-wrong set of conclusions we can make about the world. If there's a flaw in that framework the result is bad.
I had three after a dental procedure when I was a teen. That was enough to make me think "I like this feeling" and reach for the bottle to continue it in the same way that I'm never quite stoned enough. While I wouldn't jump to heroin after ten, if I still wanted that feeling or still felt the pain and had a cultural expectation/personal desire to not feel that pain I could probably score a different pill. If not physically addicted or mentally dependent, I'd have a positive association with the drug and its effects while knowing it's no big deal.
Alcohol can be just as addictive as opiates, in fact there are far more alcoholics than opiate addicts, but you probably don’t advocate for the prohibition of alcohol
Nor am I advocating for the prohibition of opioids, only their usage held to the same clinical standard any one of you criticising me would readily acknowledge with antibiotics. Alcohol was once prescribed widely and even now I've used medicinal vodka in the emergency room. Is that alcohol appropriate for infant sleeping tonics? Fuck no. Is it appropriate for a patient with a dislocated or broken arm? Nope. Patient seizing because they're a severe alcoholic and there are clinical indications their body needs it? That's a responsible and informed decision which takes their situation into account beyond their feelings on it. It's based on protocols based on current science. Serious painkillers have their uses and they also have a long list of times when they shouldn't be used. Could be used, patient would be thrilled if they were used, but it's not blood on the patient's hands when the next appointment also wants the same drug and has a negative outcome.
Stingy by what standard though? Indications/contraindications/statistics or the patient's personal goals independent of the reality of their medical situation? I've discharged a lot of patients with narcotic prescriptions and felt totally fine about it. Same risks of addiction, same potential contribution to the opioid epidemic, same self-reported level of pain as the next patient who is denied that drug. They just had the appropriate indications for using those drugs over other drugs. The risks were outweighed by what could be achieved by that drug but not a lesser drug. It's when that isn't met where I have an issue with their usage. Whatever is the most appropriate course of care holds that place for a good reason. Under-utilising them looks and feels bad certainly. Over-utilising them is worse. They're over-utilised where the patient's desires take priority over their clinical state. Necessarily the right level of usage falling below that will fail to meet their desires, even if it's protecting them in ways they don't prioritise or the patient after them who is demographically different but treated under the same protocols.
I'm sorry what kind of spinal surgery only requires anti inflammatory medication afterwards? Did I hear that right? Is the US medical system so afraid of opioid addiction that you can only get anti inflammatories after "minor" spine surgeries?
Also of course people with spinal problems were on opioids before surgery in certain cases, taking most anti inflammatories long term will destroy your kidneys. Or mess up your digestive system. It was also easier to get opioid prescriptions a few years ago. And they've probably been waiting to get operated on for years because of financial problems. Even if they were addicted before, is it right to let them suffer in pain because of a previous or ongoing addiction?
I am never, never, never, ever, going to get any medical care in the USA. Not like I would ever get the opportunity to anyways, but just reading that entire paragraph, it has me scared.
There's inappropriate pain management and there's pain management with realistic goals and protocols written in blood. If someome needs narcotics they're still widely used but the epidemic means the consequences of two decades of wanton prescription are forcing nuance. Patients don't see the clinical picture of their pain and living with it isn't a preferable option to drugging it at the risk of addiction.
Maybe this was a shitty surgeon oblivious to treatable pain out of stupidity or malice, but I'd expect he called the ward about the issue at least a time or two. If it were the appropiate decision to give him more pain management, there probably would have been at least one other opportunity for it even if he didn't have followups in that week.
Getting flashbacks to every doctors appointment I've had. At least my surgeon was good with pain management and post operative care. But other doctors, Christ.
Scientists play god with the laws and limits of the universe. Eventually they're even proven wrong as better scientists use the same process to form better conclusions. Do you reinvent physics to prove them wrong or do you see the basic value of expertise in their understanding of a field you don't work in? Feel free to be your own doctor but we've just seen that play out with the pandemic. None of those citizen-doctors seemed to outsmart the actual ones. They mistreated the disease they didn't understand and couldn't reliably digest information about. If they didn't die as a result, was their outcome better than what they would have received from those highfalutin doctors with their god complexes? Did they come to understand the virus more, treat it more effectively, or die less than they would have if they weren't libertarians about it?
I'm not stopping you. Please by all means be your own doctor or better yet reinvent the field they've spent a decade studying. That institution probably just arbitrarily exists and everyone in it is probably just some schmuck.
Do you understand that the way Doctor's treat pain is based on politics and vibes rather than patient outcomes? They spent decades handing out pain pills like candy because they were bribed by pharma companies, not because of science or really any justifiable reason.
What I'm saying is that we learned from that. It illustrates my point which is why it's my point. Recall how Oxycontin was originally marketed by the pharmaceutical company. As non-addictive. It was a magic pill that could cure pain without consequence. The patient's needs were fully met and they left happy. There's plenty of corruption with the marketing like kickbacks and sponsored events, but at the time pain management could transcend the word management and become an actual solution to pain. Pain mind you is your body screaming that you probably won't naturally survive what's happening to you, and it's only fixing that thing which makes pain go away.
We learned from opioids that they don't make pain go away, they only mask your perception of it. There are massive consequences to even prescribed versions like Oxycontin that go well beyond the individual patient with their individual goals. Using a pharmaceutical crutch meant discouraging things which might help restore the injury site or compensate for it, but slowly and with mild pain. There are health impacts beyond addiction and you not experiencing them doesn't mean the next person won't as well. If we open the faucet and then cut it back, they turn to street alternatives because a wholly different element of the healthcare system fails them.
So patient outcomes. I like that shit too. What's the actual outcome of prescribing those narcotic painkillers? Does it fix the pain, heal the injury or cure the illness, or restore function in some meaningful way? Those are all patient outcomes that any person in medicine seeks unless you're a full conspiracy uncle. It will dull or completely mask the pain sure, but it will do less for the injury than other classes of drugs while potentially aggravating what the pain is warning you away from using. That will mean the pain is still there when you use your full agency to choose to quit the painkiller. It has a role to play certainly. In plenty of contexts and patients. Where it's contraindicated though, patient outcomes are what develop those contraindications. If someone is turned away from those medications, there's reasoning behind that decision beyond that patient's immediate goal to stop hurting. That pain isn't a meaningless switch that can be turned off and on without consequence. Trying to do so demonstrably has consequences that are worse.
I'm sorry I'm hearing about opioid free spine surgery in your first comment and I've noped out. No amount of writing is going to convince me that it's appropriate.
Also this guy had a 5 day impatient stay at the hospital according to the video, to me that sounds very serious. My hospital stay for back surgery was only a few days longer.
If he's in there for five days they've got a really good clinical picture of his pain and how it should be addressed. That's 12 hour rounds with the attending physician, hourly nursing checks, probably followups with the surgeon and/or multiple specialists. I'm really curious to see what surgery he had, what he was discharged with, what he wanted, and what his medical history/comorbidities are. When there's an inpatient stay there are so many people involved in the care that it's not just the incompetence of a single provider. That decision has a lot of data behind it.
Depending on the surgery that can still be drug seeking. I'm not saying he feigned his injury or anything, but if it's a low-grade surgery that only calls for anti-inflammatories afterward I've seen that enrage patients who expect narcotics. Their history with that condition means previous times where they've been prescribed and built the addiction back when the goal of pain management was the Sackler-sponsored absolution of pain rather than getting it to a tolerable level without risky interventions. If it was a serious spinal surgery warranting the good shit, I doubt he'd be mobile enough to do the shooting so soon after. When I worked in an SNF downgrading surgical patients we'd have a lot of spinal ones from procedures like vertebral fusions. They could barely ambulate to the toilet with help usually. Something more minor with the unrealistic expectation of the pain ceasing entirely on drugs he can't get and that's a motive.
deleted by creator
Sure, I'd also want the same. Pain sucks. Do you go to a hospital to feel good or to receive the most scientifically valid care under the most strictly developed protocols? A chiropractor will make you feel good and is much cheaper, but there's a reason you hopefully go to a doctor instead of a spine warlock.
Medicine's goals necessitate the bigger picture both for your health and public health. If the protocol says you get opioids because you want them and they'll mask the pain with significant side effects/addiction risk, sure that Russian roulette might work well for you but every other patient is treated under the same protocol. That's dozens or hundreds per day. Each a personal and public health risk, every day until enough of you die to change the protocol in the obviously sensible direction.
edit: The counter-example to that is when I went in for a vasectomy. Typical recovery time is like three days with the dull sensation of being kicked in the testicles. The urologist gave me ten hydrocodones without me even asking for narcotics, which I strictly avoid as someone with an addictive personality. Taking that many under the vague assumption that it's the sound medical advice of a doctor is probably enough to get me hooked. I controlled that pain just fine with ice, ibuprofen, and a CBD vape. That's a bad protocol that could get me killed if I didn't come from stricter ones.
deleted by creator
That's a more convoluted way of treating COVID with antiparasitics for horses. We don't put medicine in the hands of the public because no matter how competent and informed and ontologically sound you are the idiots driving next to you would have access to the same drugs under the same logic. The authority of the medical system isn't arbitrarily established in this case. That's a decade of schooling and teams of experts and treatment standards informed by external research that's continuously updated. Even if you manage to correctly identify all the elements of your easily visually identified condition and treat it totally appropriately to the standard you'd receive in a hospital, what's that crystal mom in the next car over going to do? She goes into Walgreens, walks to the OTC medications aisle, and everything that used to be behind a glass panel and a PhD is now on the shelf. What's she going to buy and is it going to be the right thing when she's treating abdominal pain?
deleted by creator
deleted by creator
Both really but I do mean ontology in this case. If your knowledge framework is up to that same standard of an informed scientific worldview, if there isn't some small gap for woo to enter through or some oversight in where your information came from and how it was processed, maybe it will work out just fine and you'll have the same experience you would from a doctor doing their job. Taking in those individual pieces of information is important but how you synthesise them into understanding something as wildly complex as the human body is where you can really fuck up.
deleted by creator
That's actually just because of the order it comes in Aristotle. It's the chapters that followed the chapters on physics.
I never used the words metaphysical nor supernatural, nor did I call ontology either. When I use ontology here it's the materialism/idealism split. The medical understanding is right in the way science in general or Marxism are. Non-medical understandings might be partially right but their social constructions don't result in the same kind of universalised knowledge base that I could cross-reference with other materialistic understandings like chemistry or biology. That's what you're paying for in a hospital. It's constructed out of that observational epistemological standard and then the resulting framework is the least-wrong set of conclusions we can make about the world. If there's a flaw in that framework the result is bad.
deleted by creator
deleted by creator
I had three after a dental procedure when I was a teen. That was enough to make me think "I like this feeling" and reach for the bottle to continue it in the same way that I'm never quite stoned enough. While I wouldn't jump to heroin after ten, if I still wanted that feeling or still felt the pain and had a cultural expectation/personal desire to not feel that pain I could probably score a different pill. If not physically addicted or mentally dependent, I'd have a positive association with the drug and its effects while knowing it's no big deal.
deleted by creator
Nor am I advocating for the prohibition of opioids, only their usage held to the same clinical standard any one of you criticising me would readily acknowledge with antibiotics. Alcohol was once prescribed widely and even now I've used medicinal vodka in the emergency room. Is that alcohol appropriate for infant sleeping tonics? Fuck no. Is it appropriate for a patient with a dislocated or broken arm? Nope. Patient seizing because they're a severe alcoholic and there are clinical indications their body needs it? That's a responsible and informed decision which takes their situation into account beyond their feelings on it. It's based on protocols based on current science. Serious painkillers have their uses and they also have a long list of times when they shouldn't be used. Could be used, patient would be thrilled if they were used, but it's not blood on the patient's hands when the next appointment also wants the same drug and has a negative outcome.
deleted by creator
Stingy by what standard though? Indications/contraindications/statistics or the patient's personal goals independent of the reality of their medical situation? I've discharged a lot of patients with narcotic prescriptions and felt totally fine about it. Same risks of addiction, same potential contribution to the opioid epidemic, same self-reported level of pain as the next patient who is denied that drug. They just had the appropriate indications for using those drugs over other drugs. The risks were outweighed by what could be achieved by that drug but not a lesser drug. It's when that isn't met where I have an issue with their usage. Whatever is the most appropriate course of care holds that place for a good reason. Under-utilising them looks and feels bad certainly. Over-utilising them is worse. They're over-utilised where the patient's desires take priority over their clinical state. Necessarily the right level of usage falling below that will fail to meet their desires, even if it's protecting them in ways they don't prioritise or the patient after them who is demographically different but treated under the same protocols.
deleted by creator
I'm sorry what kind of spinal surgery only requires anti inflammatory medication afterwards? Did I hear that right? Is the US medical system so afraid of opioid addiction that you can only get anti inflammatories after "minor" spine surgeries?
Also of course people with spinal problems were on opioids before surgery in certain cases, taking most anti inflammatories long term will destroy your kidneys. Or mess up your digestive system. It was also easier to get opioid prescriptions a few years ago. And they've probably been waiting to get operated on for years because of financial problems. Even if they were addicted before, is it right to let them suffer in pain because of a previous or ongoing addiction?
I am never, never, never, ever, going to get any medical care in the USA. Not like I would ever get the opportunity to anyways, but just reading that entire paragraph, it has me scared.
There's inappropriate pain management and there's pain management with realistic goals and protocols written in blood. If someome needs narcotics they're still widely used but the epidemic means the consequences of two decades of wanton prescription are forcing nuance. Patients don't see the clinical picture of their pain and living with it isn't a preferable option to drugging it at the risk of addiction.
Maybe this was a shitty surgeon oblivious to treatable pain out of stupidity or malice, but I'd expect he called the ward about the issue at least a time or two. If it were the appropiate decision to give him more pain management, there probably would have been at least one other opportunity for it even if he didn't have followups in that week.
I love when doctors play god with other people's lives. It makes me feel really good about the standard of care I'm receiving.
Welcome to chronic illness 101.
Getting flashbacks to every doctors appointment I've had. At least my surgeon was good with pain management and post operative care. But other doctors, Christ.
Scientists play god with the laws and limits of the universe. Eventually they're even proven wrong as better scientists use the same process to form better conclusions. Do you reinvent physics to prove them wrong or do you see the basic value of expertise in their understanding of a field you don't work in? Feel free to be your own doctor but we've just seen that play out with the pandemic. None of those citizen-doctors seemed to outsmart the actual ones. They mistreated the disease they didn't understand and couldn't reliably digest information about. If they didn't die as a result, was their outcome better than what they would have received from those highfalutin doctors with their god complexes? Did they come to understand the virus more, treat it more effectively, or die less than they would have if they weren't libertarians about it?
:PIGPOOPBALLS:
I'm not stopping you. Please by all means be your own doctor or better yet reinvent the field they've spent a decade studying. That institution probably just arbitrarily exists and everyone in it is probably just some schmuck.
Do you understand that the way Doctor's treat pain is based on politics and vibes rather than patient outcomes? They spent decades handing out pain pills like candy because they were bribed by pharma companies, not because of science or really any justifiable reason.
What I'm saying is that we learned from that. It illustrates my point which is why it's my point. Recall how Oxycontin was originally marketed by the pharmaceutical company. As non-addictive. It was a magic pill that could cure pain without consequence. The patient's needs were fully met and they left happy. There's plenty of corruption with the marketing like kickbacks and sponsored events, but at the time pain management could transcend the word management and become an actual solution to pain. Pain mind you is your body screaming that you probably won't naturally survive what's happening to you, and it's only fixing that thing which makes pain go away.
We learned from opioids that they don't make pain go away, they only mask your perception of it. There are massive consequences to even prescribed versions like Oxycontin that go well beyond the individual patient with their individual goals. Using a pharmaceutical crutch meant discouraging things which might help restore the injury site or compensate for it, but slowly and with mild pain. There are health impacts beyond addiction and you not experiencing them doesn't mean the next person won't as well. If we open the faucet and then cut it back, they turn to street alternatives because a wholly different element of the healthcare system fails them.
So patient outcomes. I like that shit too. What's the actual outcome of prescribing those narcotic painkillers? Does it fix the pain, heal the injury or cure the illness, or restore function in some meaningful way? Those are all patient outcomes that any person in medicine seeks unless you're a full conspiracy uncle. It will dull or completely mask the pain sure, but it will do less for the injury than other classes of drugs while potentially aggravating what the pain is warning you away from using. That will mean the pain is still there when you use your full agency to choose to quit the painkiller. It has a role to play certainly. In plenty of contexts and patients. Where it's contraindicated though, patient outcomes are what develop those contraindications. If someone is turned away from those medications, there's reasoning behind that decision beyond that patient's immediate goal to stop hurting. That pain isn't a meaningless switch that can be turned off and on without consequence. Trying to do so demonstrably has consequences that are worse.
Quit being a power tripping :reddit-logo: nerd
What the fuck does that even mean? What's wrong with you and why is it my problem?
deleted by creator
I'm sorry I'm hearing about opioid free spine surgery in your first comment and I've noped out. No amount of writing is going to convince me that it's appropriate.
Also this guy had a 5 day impatient stay at the hospital according to the video, to me that sounds very serious. My hospital stay for back surgery was only a few days longer.
If he's in there for five days they've got a really good clinical picture of his pain and how it should be addressed. That's 12 hour rounds with the attending physician, hourly nursing checks, probably followups with the surgeon and/or multiple specialists. I'm really curious to see what surgery he had, what he was discharged with, what he wanted, and what his medical history/comorbidities are. When there's an inpatient stay there are so many people involved in the care that it's not just the incompetence of a single provider. That decision has a lot of data behind it.
deleted by creator