Improving medical students

Archive for June 5th, 2007

Chronic Pain Sufferer or Faker?

Posted by medliorator on June 5, 2007

From Chronic Pain or Drug Addiction by BENJAMIN BREWER, M.D. [The Doctor’s Office,]

Doctors are often accused of not adequately treating pain and being insensitive to patients’ needs. But they also have found themselves prosecuted or disciplined by licensing boards for prescribing too much pain medication. Trying to find a balance can be tricky.


Multiple calls to my house outside of office hours for pain meds is a red flag for a patient with a drug problem. So is using extraordinary measures to work around my on-call partner. I’ve seen both of these warning signs before.


Sometimes what patients really need is a drug-treatment program rather than a steady supplier for their Vicodin scripts. They doctor shop, and often come from a distance when every doctor in their own community and their local E.R. has wised up to their activities.


Patients with prescription-drug addiction seek narcotics by feigning or magnifying common ailments like chronic daily headaches, a bad back or chronic abdominal pain. They complain of pain from disorders that often can’t be objectively verified, and they often ask for their drug of choice by name. They claim to be allergic to essentially any pain medication that can’t give them a mind-altering buzz. Drug seekers tend to tell lies about their past evaluations and activities.


Having the old records is the key to the real story. A review of one patient’s records showed she had requested a refill of her medication after “her cat knocked it over in the sink.” She had told the same story to three different doctors over the span of five years.


Patients who call the office after a few days claiming intolerance to a drug I just prescribed are often looking to get an extra script of a similar drug. It worked the first time, but now I’m wise to the ploy.

via Kevin, M.D.

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Grammar Refresh: Who vs Which vs that

Posted by medliorator on June 5, 2007

1. Who refers to people. That and which refer to groups or things.
Anya is the one who rescued the bird.
Lokua is on the team that won first place.
She belongs to an organization that specializes in saving endangered species.


2. That introduces essential clauses while which introduces nonessential clauses.
I do not trust editorials that claim racial differences in intelligence.
We would not know which editorials were being discussed without the that clause.
The editorial claiming racial differences in intelligence, which appeared in the Sunday newspaper, upset me.
The editorial is already identified. Therefore, which begins a nonessential clause.
NOTE: Essential clauses do not have commas surrounding them while nonessential clauses do contain commas.


3. If this, that, these, or those has already introduced an essential clause, use which to introduce the next clause, whether it is essential or nonessential.
That is a decision which you must live with for the rest of your life.
Those ideas, which we’ve discussed thoroughly enough, do not need to be addressed again.


NOTE: Often, you can streamline your sentence by leaving out which.
Example: Those ideas, which we have discussed thoroughly, do not need to be addressed again.
Better: The ideas we have discussed thoroughly do not need to be addressed again.
Example: That is a decision which you must live with for the rest of your life.
Better: That is a decision you must live with for the rest of your life.
You must live with that decision for the rest of your life.

Who vs. Which vs. That [The Blue book of grammar and Punctuation]

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