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PostPosted: Tue Jul 28, 2015 4:09 pm 
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I am writing on behalf of a close friend who is currently on Suboxone treatment. I’m not just saying that, I’ve had my own dealings with this treatment and was able to kick it which wasn’t easy. I will post more about this in the appropriate category.
Yesterday, the office had to cancel his appointment because the doctor took ill. My friend called back later to ask if they could provide a script for him either from another doctor or a phone in. The call got cut off and he called back an hour later. He was told that the doctor was in the hospital and there was no one there who could sign a script. They didn’t specify whether no other doctors were certified to or if they just weren’t in the office.

Today my friend had to go back to work, so I called the office to find out the status of the doctor, or if there was another doctor they were referring patients to. When I asked and told the person the patient’s name, she just said “He was really rude to me yesterday”. Now, I had overheard the conversations and he was not rude at all – in fact, he expressed concern about the doctor. But, I didn’t want to argue, I simply asked again what we should do. I was not asking for information that they aren’t allowed to give out to anyone but the patient yet was told that he would have to call himself.

Anyway, regardless of their attitude, what are they obligated to do in such a situation? Ethically, I feel they should do all they can to set up the patients with another doctor, to make sure that treatment isn’t interrupted. Legally, I don’t know and we really don’t want to go down that road anyway. I can understand if they refuse treatment due to non-compliance. And, it’s not like causing a situation of sudden discontinuation of a medication, like a benzo, which can be dangerous. But suddenly stopping 8 mg of Suboxone can reasonably and easily lead to relapse, or loss of work because of the withdrawals.

During my journey, I dealt with my sub doc, family doc, eye doc and two visits to the ER and I would say that I was treated with contempt over compassion about 80% of the time. This from a variety of the health care workers one encounters along the way. And I’m frustrated and angered with this. At first I wrote it off, that is was all in my head because of my own guilt. But after so much, it becomes clear. Patients do have the right to file complaints and take legal action as necessary – it’s just that even these things don’t change the hearts and minds of those who treat patients poorly.
Also what I’ve seen is that it’s often the office workers, not the actual doctors, like a good cop-bad cop thing. But I would like to know where the buck stops, and what the obligations are in cases like this. Not looking to threaten or play hardball – the real solution is to find a better doctor. It’s about what to do in the meantime. Such as, I happened to notice just by accident how much nicer I was treated when I took someone with me. It didn’t even enter my mind until the third time, that all they saw was not my advocate or support system, but a witness.

Thanks and good luck to all.


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PostPosted: Fri Aug 07, 2015 9:16 pm 
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It's too bad your friend got backed into a corner. That is a question a patient needs to ask before anything happens so maybe this post will do some good. I asked my doctor who to go to in case of him being unavailable and he gave me a doctors name who is a bit far from me but okay if I was in need.

I hope it works out somehow.

rule

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PostPosted: Wed Nov 18, 2015 11:56 pm 
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Thank you for your response. So sorry that it's taken so long to get back, my comuter has been down for repairs.

It turned out that the doctor wasn't as ill as they made it seem and he was back in action in just a few days. The question still remains, and you're right, this is somethign that should be taken care of before it becomes a crisis.

I've also noticed that sometimes the patient needs to talk with the office manager - I've seen where the doctor tells me what I want to hear, but the manager makes the final decision. Kinda like a good cope-bad cop routine. And it takes a bit of finesse sometimes (also with pharmacy workers). Ask too many questins and they get suspicious, but all I was trying to do was find out the rules and policies so I could make sure to abide by them.


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PostPosted: Thu Nov 19, 2015 10:16 pm 
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I get SO angry about these stories. Just today, a patient told me that she was seeing a local psychiatrist for treatment of both bipolar disorder and addiction. She was on buprenorphine products and also mood stabilizers, and she had a history of PTSD and suicide attempts as well.

She had a breast biopsy, and when she went to her appointment the psychiatrist confronted her on the oxycodone in her urine. She told the doc about the surgery, but the psychiatrist told her she violated her 'contract' by not calling her about the oxycodone. The patient was instantly discharged-- left to detox off buprenorphine and the clonazepam the psychiatrist had been prescribing. The patient also was left with none of her mood stabilizer or antidepressant.

I cannot imagine how this situation could be seen as 'ethical'. I encouraged the patient to file a complaint with the state licensing board-- which is very easy to do online in most states. Of course I suspect that the board will think that this is 'just another addict' who screwed up.... but you have to start SOMEWHERE. Addiction is a disease--- and is protected by the Americans with Disabilities Act. The courts and regulators will never pay attention to people who are active addicts--- so the people who are doing well MUST stand up for themselves, and push back against discrimination and abuse.

I would never kick a person out of treatment for struggling once or even a few times. 'Struggling' is the nature of addiction, after all! I have so many patients who took a few tries before they got it right... and simply cutting someone off life-saving treatment is EVIL.


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PostPosted: Fri Nov 20, 2015 1:47 pm 
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Dr. Junig,

We must put a LIKE button in here so we can all say Thank You for such a good post!

In my case, the two physicians I've dealt with have been kind and compassionate. The first time I was put on Suboxone it was a man/wife team. I had called asking for an addiction specialist and his nurse wife talked to me for almost 3 hours on the phone convincing me to come in and get on Suboxone. I credit them both for saving my life and career. Then I moved to Nevada and found another very similar to him in my home town. Is it a west coast thing? Are California and Nevada doctors more educated on Buprenorphine? All I know is my life is good and my gratitude is through the roof.

Thanks again for the great post.

rule

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PostPosted: Fri Nov 20, 2015 2:07 pm 
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Dr. Junig, I wish our collective passion could blow a wind of change across this country! If new people come here and have doubts about who you are and what you believe, they should just be directed to this post.

Please keep being angry at the injustice and keep telling us about it. I know that there are many doctors, including my doc, Andreas Edrich, that feel the same way. I know that my doctor wishes there were a way to get in contact with like-minded addiction physicians. He just started a methadone clinic so I know he is super busy just like you are. He has talked to me wondering how he might find an online platform for doctors who want to connect over these issues. Perhaps after I'm done with my studies I could make it a goal to create such a platform, although I have no idea how I'd begin.

But again, thank you so much for being a light in the darkness.

Amy

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PostPosted: Mon Nov 30, 2015 12:11 pm 
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Something similar happened to me during Hurricane Sandy. Many buildings were left without power for weeks, including my sub doctor. Before my appointment, I called and they told me they were closed because they didn't have power. I asked what I should do or who I should see and her response was to "call around or ask the pharmacy to give me a few". Long story short, no doctors were available (either no new patients or were closed themselves), the pharmacy couldn't give me any without a prescription and my insurance company was useless. After 2 days of freaking out, the doctor finally agreed to call in a few to hold me over until the office reopened. No one should have to go through that and I'm glad to know now there is a way to make an official complaint!


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PostPosted: Mon Nov 30, 2015 9:42 pm 
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wow! in spite of my distaste for the NY Jets, I feel for you!

I went to med school at the U of R (Rochester), so I rooted for Buffalo at the time... and I was an intern in Rochester one foggy day when Buffalo played the Jets. Not sure if it was home or away-- but I was called to 'disimpact' an elderly man with dementia (i.e. manually remove fecal material that was causing constipation). I was kneeling on the floor, picking away at the hard-as-rock piece of stool as the poor guy cursed at me: 'what the hell are you doing back there?! Get the F away from me!!'. Meanwhile the game was playing on the TV attached to the ceiling. Every time I'd pluck away a good-sized piece, a bit the trapped and pressurized air/gas mixture would escape from behind the obstruction.

I remember thinking 'is this REALLY what I want to do the rest of my life?!'

Later that year Scott Norwood was 'wide right'. That bastard...

THAT'S what I think of when I think of the Jets. That and maybe Joe Namath... other than signing Brett Favre, have they accomplished ANYTHING since then?


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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