Wednesday, June 10, 2009

Non-physician, Heal Thyself

I'm not sure that a word exists for the practice of obtaining prescription medications from friends, acquaintances, or (for whatever price the market will bear) from vending strangers. "Med-seeking" we designate the practice of sending health care providers to an early grave with endless and inappropriate pleas for pharmacological relief. "Self-medication" is the hypothesized use of alcohol, most classically, but also illicit drugs in an effort to treat some supposed mental disorder. "Substance abuse" is, well, substance abuse.

But the word I'm looking for involves co-opting the tools of doctors without having to resort to the doctors themselves in the same way that an autodidact bypasses educators or a vigilante bypasses law enforcement. It is surprisingly common for folks, lacking access to a doctor for reasons of money or transportation, to obtain meds from whatever source they can find. To be sure, these are often opioids or benzodiazepines, but by no means always. I saw a woman recently with bipolar disorder who had been obtaining Seroquel samples from her sister, who is a nurse. And if someone is going to run out of Effexor a week before he can get in with a doctor, who could blame him for scrounging up seven doses wherever he can? After all, it's not as if the medical system is flexible and easy to work with.

If someone has been prescribed Xanax for anxiety symptoms with positive results in the past, and finds himself between doctors for whatever logistical reasons, is it wrong for him to obtain Xanax in unconventional ways if he never exceeds a typically prescribed dose? The Drug Enforcement Agency would say yes, presumably, and certainly this isn't a practice one should condone, but does it constitute substance abuse? I don't think so, if he has a legitimate anxiety disorder and no substance abuse history. In this case it would be no different from someone using a friend's unused antibiotics for a (self-diagnosed) sinus infection. And consider that, because doctors are often understandably hypervigilant and restrictive as regards controlled substances, it may be hard even for patients who quite appropriately need and use them to gain access.

To be sure, medicine has a procedure for enabling this practice in cases where it's considered safe: it's called making a drug available over the counter. And doctors have a way of frowning on any circumvention of their alleged wisdom. Indeed, patients who engage in this practice (for which I can't think of a name) may simply have below average respect for authority in general (but perhaps above average resourcefulness). This practice has family resemblances both with people who decide on a medication for themselves based on television commercials and with physicians who liberally prescribe themselves medications (not recommended). All of these undertakings stem from the natural assumption that if you want something done right, you'd better do it yourself. "Self-doctoring" may be the term, but I wish there were something more felicitous...


Anonymous said...



DIY Medicationalist

N.N.F.A.D.S (No Need For a Doctor Syndrome)

Descartes' Syndrome (I think I am a Dr, therefore I am)

Eco-Self-Medicationalist (hates to see good meds go to landfill or pollute waterways)

therapydoc said...

Not all docs bow to the pressure, and certainly, probably most won't go with a non-physician making a diagnosis or taking an anti-biotic from a neighbor. This is a great post, thanks.

Retriever said...

Good post. I don't ask anyone besides the family phalanx of physicians for medical advice or drugs.

However, with the ever present threat of layoff at my workplace, I stockpile every single leftover medication from meds changes or reductions by the family's physicians. Given that some of the meds cost 500 a month, I most certainly won't throw them out. Furthermore, after having two internists quit practicing in my area within a year, I am myself without an MD for now. SO, until I find a replacement (I am never sick, but in middle age one might as well brace for the inevitable), I am holding on to the 3/4 full bottle of cough syrup left from bronchitis a year ago. If I can't sleep after three days coughing, I will take a teaspoonful without spending a hundred dollars to see a strange doctor and more for medicine.

Further, with three people in the family with similar meds and variants of the same diagnosis, and doctors who do not return phone calls in a crisis, I would definitely rather give the child some of the medicine previously prescribed by their now retired shrink to be used as needed, than traumatize him and the family dragging him to the ER Saturday night to spend hundreds of dollars and end up with a scrip for the same thing.

People don't just bypass doctors because they are drug seekers, or fancy themselves medical experts. They do so because they can't find an MD who will take them or their kid on, because they can't afford the customary procedures but aren't eligible for a clinic.

However, I should add that our family does not stockpile opiates (with the exception of one bottle of cough syrup which usually lasts us six years, to the point of losing all original effectiveness), and would never mess around with antibiotics or benzos. But low dose atypicals to somewhat rein in a kid heading for mania? If it keeps them out of the ER, hooray.

Anonymous said...

PAYING to see a doctor so you can a get a script?! I know, I've seen 'Sicko' and I know all about the criminal health care system in America; but I still can't get over the fact that you have to pay just to see a dr. Wow...

I'd self-diagnose and borrow meds too. Good thing you have the internet and tv drug ads so you can make accurate self-diagnoses and informed med decisions...

Retriever said...

Frankly, Anon, Wow is unnecessary snarking at people who scramble to save money somehow or other on medical costs. I have forked over 300,000 to my family's doctors in the last ten years (copays overages, and deductibles over insurance)

I don't self-diagnose or watch TV and drug ads. But I have to feed and keep a roof over the heads of five people. Spouse unemployed, two kids in college, autistic kid. A fair weight of responsibility. One has to save money where one can.

Anonymous said...

Oh f#$k, how wrong did that come out...Sorry Retriever. My snarkiness was DEFINITELY not directed at the 'people who scramble to save money', but rather at those responsible for implementing the crap health care system which forces the 'scramblers' to scrimp on necessary medical care on account of cost. The dire choice between bread and a doctor visit for your desperately sick child - that's not even ethical to warrant contemplation, let alone indirectly sanction; but it's a choice some are forced to make often.

And I wasn't being sarcastic when I said 'I'd self-diagnose and borrow meds too'. Desperate measures for desperate times. A half-arsed self-diagnosis & borrowed/stolen meds is the best option under certain circumstances, irrespective of probability of successful health outcome. It's a game of black dice throwing, and some people are playing God.

Retriever said...

Anon, thanks for your response. I tend to go from 0-Snarl in less than a second when angsting about the cost of all this. It does seem cruel that on top of all the suffering of the patients and/or their familes should be added the threat of financial ruin such illnesses entail. Or having to give up normal activities for the healthy ones or deny them for the sick one because of the necessary and life saving expenses for meds and docs.

Many conservatives deplore a "culture of entitlement" that they feel makes patients snarky, ungrateful and extravagant in their use of care, (see a typical comment by Dr Joy Bliss in Maggie's Farm that I couldn't let myself respond to or profanity would have ensued. Also, she linked to our friend, Novalis, so she can't be all bad! But the caricature she creates: that private pay patients are grateful and non litigious as versus obnoxious suing clinic ones, is somewhat inaccurate (my internists quit practicing not because I am an obnoxious Retriever, but because my rich neighbors sue anybody and everybody, especially their MDs) and misses a crucial point. Those who can pay for their own care are different, yes. The rich are different from thee and me: they have more money. That occasionally contributes to greater happiness. If you pay for your care, you can usuallyl choose your provider, and get (perhaps) a better, and more congenial doctor. Obvious exceptions (the kid's clinic doctor proved better than the goldcoast lickspittles who wouldn't take him on)

The conundrum for me (as for those who share some of my political views and many of my social ones) is how to pay for it without burdening one's neighbor. The blessed one who are neither sick or themselves nor have chronically ill relative, just don't get it. People do not choose these illnesses. People with these illneses are still scapegoats or revoltingly patronised without real help. Or discriminated against.

There I go again. Now off to the cubicle in a boring job I have stuck with for ll years for the sake of the health insurance for the family. I am grateful for honest work. I will work myself exhausted as I do evey day. Grateful for the mostly good medical care it has made possible for my family. But I still wish I hadn't been a Brewster after all. That I had turned out to be adopted after all, the kid of a sea cook, like Cary Grant in Arsenic and Old Lace. That our family could have chosen jobs and everything else on the basis of gifts, abilities and loves, not had to do oeverything "for the sake of the health insurance" An adolescent howl.

Anonymous said...

I think the idea of a 'culture of entitlement' can be attributed to opposing socio-economic classes: you have some private patients whose position of entitlement is self-perceived as proportionate to their financial contribution; and then you have a proportion of public system condemned patients - that owing to their perceived fatalistic disadvantage or bad luck - feel a sense of compensatory entitlement in order to offset their misfortunes. It's probably more temperamental than class related.

Higher tax contributions, fairer system. No other way, practically.
'But I work so damn hard for my ain't fair!'.... really is fair, in the humanist scheme of things; maybe not very Darwinian, but ethical.