Ever Sign An Agreement With Your Doctor?

Dec 16, 2014

At a public hearing yesterday at the Dept. of Health, doctors, dentists, physician assistants, and advanced practice nurses voiced their opposition to the department's proposed regulations governing the prescribing of opioids. The new rules would require prescribers to sign a fairly lengthy agreement with patients, alerting them to the risks of taking prescription painkillers like OxyContin and Vicodin, and agreeing to certain kinds of monitoring. Many health care providers feel these agreements aren't necessary and that, in fact, they're patronizing.

What do you think?

Medicaid is now asking doctors to have patients sign agreements before they treat them with expensive hepatitis C drugs. The agreement asks them to acknowledge the importance of sticking with their treatment, among other things.

Is that appropriate?

Perhaps the two cases are too different to compare. In the first, the agreement is mainly designed to alert patients about the dangers of these addictive painkillers, that taking them any other way than how they're prescribed, or taking them with other drugs, or with alcohol, could be fatal. The second case is in part about preserving the state's investment in this expensive treatment, in my humble opinion.

Doctors seem to hate these kinds of agreements, whatever their purpose, saying they want to establish and maintain a relationship with their patient, and educate that patient, the way they see fit.

On the other hand, we have an epidemic on our hands. It's first and foremost an epidemic of opioid addiction. And second, an epidemic of opioid overdose deaths. Some doctors are careful about their prescribing - not giving out more pills than are needed to conquer a patient's pain in the short term, not allowing refills, checking the state's prescription monitoring database, counseling patients, helping those who may have a problem with addiction into treatment. But other doctors aren't so careful. They prescribe too much, they don't track patients' dealings with other doctors and pharmacies. If you look up the records of prescribers sanctioned for opioid prescribing, you'll find it's often a lack of education on the prescriber's part, not necessarily something malevolent.

But the fact remains that careful prescribing of potentially addictive, and dangerous, drugs is not consistent.

Whether than means regulating what prescribers do in the privacy of their exam rooms, offering optional guidelines, or mandating more education isn't clear to me.

It's clear to many prescribers of course. They don't think new regulations are necessary. Just more opportunities for education, and guidelines.

It's also clear to some advocates from the recovery community. To people who have lived through opioid addiction, the regulations seem like one more layer of protection keeping others from going through the same.

So, are patient agreements a good idea? Thoughts?