Without a Net: The Extraordinary Risk of Pain Medicine

Everybody makes mistakes, but some people pay for mistakes far more severely than others. The tightrope walker who stumbles and falls into a net might wrench her back. The tightrope walker without a net risks dying.

In the realm of medicine, pain doctors are the ones who are operating without a net. In spite of the fact  that these doctors have gone through years of exhaustive classroom education, hands-on training, and arduous licensing procedures, they can be demoted to the status of common criminals and sentenced to decades in prison simply by exercising poor judgment in the way they do their job.

The recent rash of doctors who have been searched, arrested, prosecuted and convicted for the way they prescribe pain medication illustrates this issue. Individuals like Dr. Hurwitz,Dr. Spear, Dr. Zolot and Dr. Volkman are accused (and, in Dr. Hurwitz’s case, convicted) of using poor judgment while prescribing controlled substances. In some cases, some patients were injured or died while under the care of these individuals. For this, they face the total destruction of their careers and the prospect of being treated exactly as if they had sold heroin or crack cocaine on a street corner. With a flick of a prosecutor’s pen, they are transformed from a productive member of the community into someone who is treated as if they have never done anything positive in the world, as if their entire practice has been the moral equivalent of a backwoods meth factory.

For almost any other type of behavior involved in the practice of medicine, there is a “net” that prevents total catastrophe for the practitioner when something goes wrong. If a surgeon uses poor judgment while in an operating room and a patient dies as a result, we don’t throw the surgeon in prison for twenty years. Perhaps there will be a lawsuit, perhaps the doctor will face an administrative reprimand. But prison is almost entirely out of the question. If a pharmaceutical company lies for years about the addictive risk of a drug that it manufactures, we don’t throw the executives of that company in prison for twenty years. We just fine them, and we let them get on with their business.

These types of practices are protected by the net of a reasonable social policy. It’s a policy that acknowledges that individuals who contribute to the overall social well-being may nevertheless, in certain ways, make mistakes that need to be corrected. When such corrections happen, they shouldn’t be so severe that they entirely obliterate the incentive to engage in positive activity.

In pain medicine, though, it’s another story. We’re seeing the implementation of a public policy that has no slack at all, no “net” to respond to human error, no willingness to tolerate any deviation from perfect compliance. It’s a policy that will lead most doctors to steer clear of pain medicine altogether, because walking a tightrope without a net is simply not a viable path for somebody who hopes to hang on to their career.