In my years as a physician on the front lines of addiction and pain medicine, I have never encountered a medication as transformative as buprenorphine (Suboxone). I have seen patients, broken by years of opioid addiction, have their lives change within an hour of their first dose, ready to reclaim a life they thought was lost. For these patients, buprenorphine is as essential as insulin is for a person with …
The unfair war on buprenorphine
Across the world’s earliest civilizations, healers turned to nature as their pharmacy. Ancient systems like Ayurveda in India, Unani (Hikmat) medicine in the Middle East, and early European herbalism developed sophisticated therapeutic practices rooted in plants and natural compounds, many of which are still clinically relevant today.
Take turmeric, for example. Traditionally simmered in milk or prepared as a paste, it was used for its healing and anti-inflammatory properties. Today, biomedical …
How nature is inspiring the future of pain medicine
The ongoing opioid crisis, claiming over 70,000 lives annually in the U.S. according to the CDC’s 2023 data, presents a perplexing scenario where regulatory bodies, in their attempt to curb misuse, have inadvertently intensified challenges for health care providers and patients. The Centers for Disease Control and Prevention (CDC) issued its 2016 guideline for prescribing opioids for chronic pain, with revisions in 2022 to address misapplications, yet these efforts have …
How restrictive opioid policies worsen the crisis
Imagine a dedicated physician, after years of rigorous training and countless lives saved, facing a medical board complaint over a minor issue—perhaps a clerical error in documentation or a subjective interpretation of a clinical decision. What should be a straightforward matter escalates into a career-threatening ordeal. State medical boards, endowed with significant authority, often wield it with little accountability. Armed with prosecutors who prioritize winning over truth, boards can distort …
Why reforming medical boards is critical to saving patient care
In today’s interconnected society, individual health shapes the well-being of communities. This is evident in the role of pain clinics, which have evolved beyond their traditional mandate of managing chronic pain. A recent peer-reviewed research publication in the SVOA Medical Research journal highlights how pain clinics are contributing to societal safety by addressing risks that extend beyond the clinical setting; promoting safer roads, stronger families, and healthier workplaces.
The clinical …
How pain clinics contribute to societal safety
At age 81, I am one of “the old guys” who writes in online chronic pain support groups. I get a lot of emails from people in pain. One recent inquiry was from a lady named Marisa, who asked questions that are combined in the title of this article. The following is my response to Marisa and others.
My wife is a chronic pain patient who has multiple medical issues. I …
Why chronic pain patients and doctors are both under attack
Pain management physicians, who often prescribe controlled substances like opioids, face intense scrutiny. Critics argue that investigations are overly aggressive, resembling fishing expeditions where investigators search broadly for any evidence of wrongdoing, often beyond the original complaint. A 2023 Los Angeles Times report noted that nearly 10,000 investigations were conducted in 2021–2022, with pain physicians disproportionately targeted due to outdated guidelines predating modern evidence-based practices. For example, the reliance on …
Why pain doctors face unfair scrutiny and harsh penalties in California
In the bustling environment of modern health care, the loudest voices frequently attract the most attention. Yet, a special category of physicians who are less visible but no less significant exists: the efficient, quiet clinicians who are usually underestimated. This physician type blends high productivity with a calm demeanor, allowing skill and results to speak louder than words.
Underestimation can undermine leadership opportunities for quiet physicians because visibility may play a …
How the quietly efficient physician can turn perception into power
I have been fortunate to practice in several areas of medicine in my career. This has led me to triple board certification in family medicine, palliative medicine, and addiction medicine. I speak Spanish fluently, have a spotless record, and have dedicated my career to caring for underserved patients.
Despite this, after years of applying to prestigious health systems in a major city, I’ve never once been contacted for an interview in …
Physician hiring bias in one of America’s most progressive cities
Historically, health care has approached safety with a Safety-I lens, emphasizing the prevention of errors and investigating failures. While this method remains significant, contemporary health care’s complex, dynamic, and interdependent nature necessitates proactive and adaptive safety strategies. The emerging Safety-II and Safety-III frameworks provide novel perspectives on safety by prioritizing resilience, real-time adaptation, and learning from success, rather than from failure.
Safety-II shifts the focus from what goes wrong …
From errors to resilience: a smarter approach to patient safety
In principle, the judicial system is founded on fairness, requiring that guilt or innocence be established based on evidence.
All parties including judges, defendants, and plaintiffs should be engaged in a rigorous process of fact presentation and scrutiny.
However, in stark contrast, political systems often prioritize rule manipulation and fact distortion, seeking validation over truth. This critical distinction between politics and jurisprudence becomes dangerously blurred when examining the conduct of medical boards …
Why medical boards are facing growing backlash for abusing power
Health care systems acknowledge that how they respond to mistakes significantly impacts their workforce’s morale, retention, and overall productivity. The consequences of a punitive culture are costly in terms of financial and operational costs, as it discourages reporting, promotes burnout or fatigue, and aggravates staff turnover. Conversely, implementing a just culture promotes psychological safety, continuous learning, and fairness, which enables health care staff to remain engaged and resilient throughout their …
How just culture can reduce burnout and boost health care staff retention
The transformation of care delivery is driven by value-based health care (VBHC). In addition to its cost-effectiveness and clinical efficiency, the success of VBHC depends upon its ability to exemplify empathy and equity. Usually disregarded in pursuing metrics, data, and integrated payments, these two pillars are indispensable for implementing a system that provides dignity and equity to all patients. Embedding empathy and equity into health care delivery is no longer …
Emphasizing empathy and equity in value-based health care delivery
Theft, in its essence, is the unlawful taking of something valuable from another. While usually associated with material possessions, it also extends to intangible assets such as time, reputation, and emotional well-being. When authorities like medical boards or the Department of Justice (DOJ) engage in unfair practices grounded in presumptive guilt, they are not just misusing their roles but actively stripping individuals of these invaluable resources—an abuse of power that …
Time theft: the unseen harm of abusive oversight
In the noble pursuit of healing, physicians, especially those in pain clinics, are increasingly caught between the growing burden of patient expectations and a tightening web of regulatory scrutiny. A recent clinical study and a related article on KevinMD converge to highlight a deeply troubling reality: Clinicians are not only being harassed by distressed patients but are also being punished by the systems meant to regulate or protect health care.
A …
Harassment and overreach are driving physicians to quit
Specialist pain clinics and addiction management services are vital in addressing some of the most complex and costly health care conditions. However, their success depends on stable and robust primary care systems. Without strong primary care as a foundation, these health care initiatives risk fragmentation, poor continuity, and low patient accountability. Stable primary care ensures timely access, coordinated care, longitudinal monitoring, and patient engagement, all essential elements for the value-based …
Why specialist pain clinics and addiction treatment services require strong primary care
Canada is one of the few countries permitting Medical Assistance in Dying (MAiD) for individuals with non-terminal chronic pain. While this respects individual autonomy, it also introduces a duty of care: We must ensure that death is not chosen because of inadequate care. Some Canadian advocacy groups, like the British Columbia Civil Liberties Association (BCCLA), have expressed deep concerns over how MAiD is being expanded in Canada.
The BCCLA initially …
Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering
Health care regulatory bodies have embraced a dangerous “accuse first, prove later” strategy that is eroding the foundation of our health care system. Physicians, the bedrock of patient care, are being subjected to accusations based on flimsy, illegitimate reports or random audits. Rather than building cases on substantial initial evidence, these authorities thrive on retrospective scrutiny—analyzing old notes, reframing past actions, and bending interpretations of guidelines to validate their accusations. …
How regulatory overreach is destroying innovation in U.S. health care
In the face of worsening health workforce shortages, Canada must shift from a culture of personal likability to a system of objective qualifications or merits in recruiting and retaining physicians. While team cohesion and interpersonal compatibility are essential, an overemphasis on “fit” or likability excludes talented physicians, particularly immigrants and racialized minorities, who may not share the cultural background, communication style, or social behaviors preferred by decision-makers. This practice undermines …
How subjective likability practices undermine Canada’s health workforce recruitment and retention
Pain is a signal. It gets our attention. It arrests, alarms, and demands we listen. C.S. Lewis wrote in the problem of pain: “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pain: it is His megaphone to rouse a deaf world.” And what a deaf world we have become.
Pain is physical—a sign of tissue damage. It’s defined as “physical suffering or discomfort caused …
Pain is more than physical: the story your body is trying to tell
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