I am watching medicine collapse in my area.

Doctors are leaving, leaving, leaving.... the US.

Wait times for the specialists are rising fast. The two neurologists in Clallam County left, ours retired five years ago and now there is a rumor that one of the Kitsap County neurologists is going to work for the VA in Seattle. Oh, Lord, I hope it's just a rumor. There are two others in Kitsap. 350K people Kitsap, 27K in my county and 75K in Clallam. Two seems a bit low.

I have 3 people being treated for hepatitis C, now that we have a treatment. And one with hepatitis B. They had to wait three months to see one of the two Clallam gastroenterologists.

The Seattle Pain Clinics all closed at once: https://www.wsna.org/nursing-update/2016/update-closure-of-seattle-pain-centers-treating-patients-and-reminder-on-pain-management-rules. Some of those patients have implanted pain pumps. I am not trained in that. Adjusting the doses is tricky. The Swedish Hospital Pain Clinic and UW Pain Clinic put those people first....

I saw a new patient recently. P has been on pain medicine for years. He moved here to our town. He is transferring to me because the doctor he saw was doing urine drug screens and all this other weird stuff.

We have an hour, so I can explain. He was seeing a pain specialist. I am not one, nor was the other provider. We are primary care. Washington State has the strictest law in the country currently, but the feds are working on a law. I don't know what the hell it will require, but I am sure it will require something different.... And I give him the links to the state law.

"I have to follow the law because I am a primary care physician. It does not apply to specialists." Ok, like that is crazy and stupid, because it's not like I can police the specialists. If my patient is on something where I've told them they cannot take a benzodiazepine because of safety.... well, the specialists have not read the law. So I give the patients a list and say, "Do not take these. Do not take them from friends, from the ER, from the other doctor, from the specialist.... and YOU have to be the one responsible because the specialists have ignored the law." I called and asked our sleep specialist a year after the law was in place. "What law?" he said. "I don't know anything about that." So that is a pain in the rear because my letter to the specialist has to say, "On buprenorphine, the UW Pain Clinic protocol says no benzos, no alcohol, no ambien, no soma, etc". Because over 90% of the doctors in the US have not gone through the buprenorphine training. If I were the feds, that is what I would require, but hey, I am just a rural doctor and female to boot......

I say to my new patient, "You can read the law. I have to do what it says and it is not that complicated. Or you could return to the Pain Specialist." By ferry, it'll take at least two hours to get there. "We will do the requirements over 3-4 visits. But be warned, it is going to change when the federal law goes into effect." He rolls his eyes.

Make America great again... maybe we won't need as much pain medicine.

It hurts to watch...

Seattle Pain Clinics: http://www.seattletimes.com/seattle-news/health/dea-state-crack-down-on-pain-doctor-over-opiate-prescriptions-citing-18-deaths/
Really, says WA State, you should take care of these patients even though we can come in and arrest you if we decide you haven't followed the law correctly: https://www.wsna.org/nursing-update/2016/update-closure-of-seattle-pain-centers-treating-patients-and-reminder-on-pain-management-rules
WA State pain law: http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement

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