Tuesday, 10 June 2008

Diary: Are My Doctors Committed?

DIARY: Something happened the other day which made me re-evaluate the commitment of the doctors handling my treatment. I have been regularly reporting on my switch from methadone to Slow Release Oral Morphine (SROM) and the vast changes it has made to my life. Prior to switching over, I was desperate to try anything to fight off the massive depression I got from methadone, which prompted my doctor to refer me to a pharmacotherapist. Since morphine is not on the list of medications that can be used to treat heroin addiction, a special application to the health department was made for a permit. This changed my life but my tolerance levels were at risk of rising and I would have to find a suitable level to meet my requirements for pain, addiction and depression. As expected, my tolerance increased and I needed to up my dose. I had mentioned previously in another post.
Now that my tolerance is rising, I need my dosage to increase which is common for long term morphine patients. I was told flat out that I would need to see the pharmacotherapist again to get another recommendation, return to my doctor and he can then make another submission to the health department. All this will take about a month. [Link]
Well, it has now turned into 2 months and all for nothing because my pharmacotherapist has denied the increase to meet my tolerance levels. From the start, it has been a cock up from a lack lustre attitude and a complete disregard for my well being. About 2 months ago I went to my usual monthly appointment and explained that the SROM wasn’t working as well. My doctor informed me that I needed an increase but he was going on holidays for 3 weeks and he could only apply for an increase of half of what I needed without a further consultation with the pharmacotherapist. Since he had to apply to the health department for a permit, it would take a day or two so he wouldn’t be available to process it anyway. This was a dilemma which meant I would be under dosed for this period and still have to see the pharmacotherapist for my increase. He told me to ‘hang in there’ until he got back but in the meantime, go and see the pharmacotherapist so he could organise the permit and act on it immediately when he returned from holidays. I asked if I needed another referral and he said no. He explained that he had already provided one previously for my first visit and I could just ring and book an appointment. Of course my doctor was wrong and they would not see me until my doctor returned and gave me a written referral. I explained the urgency but the pharmacotherapist would not see me again and I couldn’t even pre-book the appointment until I had seen my doctor first. I was getting worst every day and this news pushed me further into a growing depression. After 3 weeks, my doctor returns from holidays and I finally got to see him. He gave me a referral (which he must fax as well), and then I have to wait another 8 days to see the pharmacotherapist. Once I see him, I will then have to go back to my doctor and then wait for the approval and then get my increased medication. incidentally, my doctor didn’t fax the referral which I only found out later. Well, the pharmacotherapist doesn’t want to increase my dose. Although I was told by my doctor that my tolerance would probably rise, he was still concerned that it did. He completely ignored the difference SROM had made to my life and wasn’t interested in trying an increase. He seemed suspicious that I might be diverting my meds and I was required to do a urine test, although he didn’t say it directly. He also mentioned that I haven’t seen the D & A councillor so I informed him that I had rang to book an appointment but he said I am not required to see him if it didn’t suit me. This point was raised to my doctor for some reason and he asserted that I had done something wrong. His final assessment was that he needed to think on it and speak with my doctor so he asked me to push back my doctors appointment from two days to a week so he can consult with him. I was now heading towards where I was when on methadone and the fact that my life had improved greatly on SROM was somehow not as important. I wasn’t sure if my dose would be increased and I had a week to sweat it out. I still felt confident though because my doctor recommended it in the first place and was prepared to increase it as much as he could except his holidays got in the way. Eight weeks later, I finally get to see my doctor for the increased dose but he seems confused. The pharmacotherapist hadn’t rang him or even sent a letter like he usually does and I start to wonder why I had to push back my doctor’s appointment. All very unprofessional. A quick phone call to the pharmacotherapist by my doctor and ... yep, you guessed it ... no increase. I am about to breakdown as the chance of a semi-normal life has just been taken from me in a phone call. My doctor doubles my Aropax (non opiate) dosage and after a short discussion is standing at the door, holding it open for me to leave so he can see his next patient. I hadn’t even noticed him get up as I was in the middle of explaining the panic I was feeling. I felt abandoned. What was I supposed to do now? His solution was, ‘just see how you go’. WTF? I have been doing this for nearly two months and somehow my problem might just get better. I left the doctor’s surgery very bitter and scared about the future. The series of events raises some important issues. Are the doctors scared they will reprimanded by the health department? Are they really doing the best for me, the patient? Have they really considered what effect being under dosed will have on me? Being under dosed is scary when you have an addiction and might ultimately lead to self medicating. That usually means heroin. I have been coping so far but unless something is done, I fear I will have no alternative but to seek relief from heroin. My days are getting longer and the pain is becoming much more of an issue. I am also starting to get the ‘doomsday’ type depression again that leaves me with mild - mid level panic attacks. I am seeing my doctor next week so again, I have to wait until he has reviewed the written report from my pharmacotherapist. It’s hard work!


Anonymous said...

THat's a tough blow, my friend. What did they say when they first put you on SROM regarding the periodic need for an increase? I mean, obviously with a med like that you would need increases as you go along in order to keep the same level of stability--that would have been my concern at the outset if I were you--would they increase me as needed or would I be left to suffer? Does the pharmacotherapist simply think you should stay at that level forevermore, or what?

Terry Wright said...

Thanks Anon.
Fucked if I know? There's been no follow up at all. They must consider that this might drive me back to heroin to make up the difference? ... Surely?

It is appearing to be a case of covering their own arse in case something goes wrong. Good for them, disastrous for me.