Transcription
We were sort of indoctrinated into the thought that opioids are bad and we really need to avoid them at all costs. When I started practicing, there was zero controversy in terms of opioids. The fact that a doctor might prescribe an opioid, it just was no big deal. But now the pendulum is shifted so far that it's such an anti-opioid bias in medicine. And there's so much misinformation that physicians have been given. And this pendulum has shifted so far against giving opioids to patients. It's been very destructive.
Welcome to the Dr. Patient Forum podcast. A no holdsbred podcast raising awareness to pain patient abandonment and the harmful results of forced opioid tapers and who's responsible for the suffering. Join us to learn how to advocate for change.
Yeah. So, David Alfrey, medical doctor, is joining us today on the Dr. Patient Forum podcast. Don't forget folks, if you like what you hear today, be sure to leave us a fivestar review. I'm told that's how people can find us. So, let's start with the be from the beginning. How I met David Alfred. One day, I was scrolling on TikTok and I saw David, he put out a video about fentinel and he was getting attacked. And I don't know if I sent you an email or a DM, but I said, "Oh, this poor bastard is [laughter] going to get attacked for and but I liked you, David, as soon as I saw you on TikTok. I I I thought I was a pretty good judge of character, but sometimes I'm not. [laughter]
I But uh I just found you to be very kind, very patient, very compassionate, and you are a retired anesthesiologist. Yes. Uh, and you live in Tennessee and your wife is a pain patient, correct? And that's think I think that's how I connected with you. And then we started to talk on email and uh David was kind enough to send me a copy of Saving Grace. So, be sure to check this book out. And we're going to talk about the book in just a few minutes. But I wanted to I want to tell Bev the other day, you know, my my boyfriend is having his hip replaced in two weeks and we were very nervous because he gets very sick following anesthesia. And I texted David and David, you were so kind to uh, you know, give me these suggestions and then and then my boyfriend was texting those same suggestions to the anesthesiologist in real time. Oh, good. Yeah. But no anesthesiologist wants to be told how to do their job. But so that's the type of guy that we're dealing with with David Alfrey. Uh so Tik Tok audience, be kind to him and your reals are pretty good, David. They're very informative and you know, you give a balanced view about opioids. I don't think you're one to encourage doctors to prescribe all the opioids in the world, but I think because you have a loved one who struggles with pain and you are an anesthesiologist, you understand the importance of opioids.
Yeah, I think I have a pretty good perspective. Um, and and I have to say getting on TikTok and interacting with the chronic pain community has really expanded my whole view of chronic pain. Even though I live with a a chronic pain person, you know, you I have that personal connection, but I I never really was able to see it on on a broader horizon. Right. Right. I think that's uh you know I think that's important for people to know because if you're not if you haven't been affected by untreated pain you wouldn't know that this is happening and I think even when you were practicing you probably have seen a huge shift in how we prescribe opioids from then until now right for sure yeah you know when I started practicing there was just about zero controversy in terms of opioids you know that the fact that a doctor might prescribe an opioid it just was no big deal. But now the pendulum has shifted so far that it's it's such an anti-opioid basis or bias in medicine and there's so much misinformation that physicians have been given that you know we we're sort of indoctrinated into the thought that opioids are bad and we really need to avoid them at all costs. Uh and this pendulum has shifted so far against uh giving opioids to patients been very destructive.
so destructive and I mean as we can tell like look around I mean the overdoses they have skyrocketed and I don't think there's any change in the near future until doctors start treating pain again but a few days ago the news was covering Matthew Perry's doctors being investigated for prescribing ketamine and so many different questions I have asked you know when Bev and I were texting last that were wondering why the Suboxone doctor wasn't investigated. Uh because the Suboxone, you know, usually they they keep hidden in the background as as it's the savior and they're so focused on this ketamine. And I think you were um Did you have a ketamine infusion center or were you involved in one?
Yes. You know, my my exposure to ketamine was during my entire anesthetic career where I've given it literally thousands of times to anesthetize patients. And then about 25 years ago, uh psychiatrists stumbled onto the the idea that it could be used to treat uh what we call treatment resistant depression. I've been tried on Zolaf, Willbutrin, I'm still depressed. And it's a really effective drug for that. And then from that experience, people stumbled onto the fact that it can be used as a painkiller. And after I left my clinical practice of medicine, we set up a ketamine infusion center in Nashville, and I helped staff that when our guy needed some time off.
Okay. Yeah. I I got to tell you, I have a friend, my my hairdresser, her brother was resistant to all anti-depressants and ketamine. I think it was nasal ketamine. it was the only thing that really worked for him. Uh, and I don't know much about ketamine as a pain patient. But I can tell you over the past six months I have heard from many patients whose doctors have stopped using ketamine in their practice because of fear from, you know, retribution from the government. And and now I'm afraid it's going to get much much worse with this whole Matthew Perry case.
Yeah. the the whole Matthew Perry case. I think people are losing sight of the fact that there were some really good doctors using ketamine from Matthew Perry. Uh I always said that if you had enough fame and enough money, you could buy the worst care in America. And Michael Jackson a good is a good example of that. The doctors that were giving him ketamine in a ketamine infusion center were good doctors. They said, "This is the safe dose. This is what we're going to give you. we're not impressed with your celebrity, we're not impressed with your money. And they were treating him and then you've got these charlatans that come along and you know are supplying him ketamine on the black market and it's a general anesthetic. Uh it's a dangerous drug unless it's in the right hands. So it's given a terrible, you know, blackeyed to ketamine whereas it's a it's just a lifealtering lifesaving drug for so many people.
Yeah. Especially people with CRPS. Let me ask you a question about the ketamine. So you can get it in infusion in a clinic. Are there tro what is the word? Troch. Does it dissolve in the mouth? How else do you take ketamine? I know there's nasal ketamine.
Yeah, it's it's usually IV or nasal. I think there are some lassages you can get. Your friend was getting uh something if it was prescribed. It was uh called esetamine. It's the FDA approved version. The problem with the nasal version is that you've got to take it once or twice a week. You've got to take it in a clinic setting and it is just horribly expensive. Yeah. Um and as a result, uh a lot of people will get ketamine infusions where you may need that only once a month or so. Now, the downside of that is they're pretty expensive infusions. It could be, you know, $500, $600 depending upon where you live.
Sure. Sure. They're making such an example of this. I'm afraid that OIG and DEA is is preparing to really go after ketamine doctors because that's what they seem to be talking about a lot. And I wonder, do ketamine doctors have good compliance plans? Like what do you think about that? You think they're going to start going after?
Yeah. If you if you are a legitimate if you're running a legitimate ketamine infusion center, you you have all the safeguards. You are locking your ketamine up at night, you are very assiduously recording how much you've given to the patient, how you've wasted the excess that day. And it's like any other controlled substance. I think ketamine is a I think it's a schedule three drug, but if you're a legitimate ketamine infusion center that ought to be giving it, you have no problems, no worries. I think it's charlatans.
How do you waste the leftover ketamine? I never thought about that.
We just poured it down the sink.
Okay. All right. Uh and you know, when I called you the other day about my boyfriend, we also discussed the RAS program, right? So, cuz I've gone after that a few times on Tik Tok, but I probably shouldn't have because it it's going to be pretty handy for my boyfriend's recovery because he just doesn't do well with anesthesia and so violently ill. So, let's talk a lot about the push for these. I would never agree to an opioid free surgery, me personally, but let's talk about the good, the bad, and the ugly with RAS. And what does RAS stand for?
for it's enhanced recovery after surgery. I don't think there's a a hospital in America that does not have programs. These things uh sprung up about 10 or 12 years ago as first of all as a response to the increasing opiate related deaths in America. And the if you could reduce your opiate use, reduce the prescriptions that a patient got when they went home and so forth, that that might be a good thing. And the idea that opiates in themselves have some side effects that can be unpleasant. You know, nausea and vomiting, constipation, confusion and elderly and so forth. So there was a drive first of all I think from a sort of a safety idea reducing opiates. But then the hospitals got a hold of this and said, you know, if we can get the h the patient out of the hospital faster, we're going to make more money. So a big driver of this has been money as well. So enhanced recovery after surgery programs minimize opiate use and the ultimate goal is to eliminate them. When RAS programs work and work well, they're fantastic. I mean, who wouldn't want to be able to have surgery, have their pain controlled, and not need an opiate? The problem is that practitioners often take the idea that if reducing opiates is a good thing, well then eliminating them peroperatively must be a great thing.
Sure. True. And you you have to be able to to treat what we call breakthrough pain. The typical RAS program would be pre-operatively it might give you some celre. Intraoperatively, you might get a nerve block to put your arm to sleep if you're having elbow surgery. Uh there's a variety of agents that we can give. Ketamine is one of them. Uh that reduce your opioid requirements postoperatively. Uh and hopefully you wake up, you have no pain or you have little enough pain that you don't need an opioid. But a lot of patients still need opioids. They just don't need as much.
Yeah. Uh, and the problem with IRAS is when people treat it like a religion and say, "I'm just not going to give an opioid." Well, that's not the point of it. The point is to reduce the amount of opioid. Uh, and then patients suffer if they have this breakthrough pain and they're not treated.
Yeah. So, they weaponized it. They pretty much hijacked what was what's something that could have potentially been good, but as with everything else in the opioid reduction movement, they weaponized RAS. And I think I'm pretty sure there's studies that show that people who received opioids intraoperatively did better following surgery than the people who didn't receive opioids intraoperatively.
Remember that study, Claudia, that they were doing for opioid anesthesia? There was a Yeah, there was a study about it and they actually had to stop the study because I think six people ended up they didn't die but they had like severe events and it was harmful so they stopped the study but it's weird no one likes to talk about that one. They became tacocartic I think. Yeah, something like that. Yeah. I I I remember there's a study out of France and they were using a lot of dex metatomdine. Now, dexito. I think that's it. I think that's what you're Yeah. And I've used that drug hundreds of times uh as part of my anesthetic regimen. I think they stopped that study because they had uh such an incidence of brada cardia very slow heart rate. Yeah. And I think the study you're referring to Claudia uh I did a real on it a couple of months ago. It was I think it was an analysis of surgery out of Mass General and I forget how many tens of thousands of patients they had, but they found that patients who had more intraoperative opioids and thus woke up with minimal amount of pain as opposed to those where the opioids were really restricted and now they hit the recovery room with a lot of pain. Those that had a more generous administration intraoperatively used less opioid in the PACUE, used less opioid when they were in the hospital, used less opioid after they left the hospital at one month and three months, and had less chronic pain. Yeah. So, interesting. Yeah. But they but they ignore those studies, Bev.
Right. Well, they ignore that because it seems that right now in in in health care, the number one goal is to eliminate opioids above and beyond anything else. And then everything else comes second to that. And so if you have patients who do well after surgery with opioids and patients who do don't do quite as well without, they're still going to do the ones where they don't have because in their minds, it's the root of all evil. And somehow if we eliminate them completely, there will not be any addiction left in this country.
Yeah, there's definitely a demonization of opioids in medical education. And I think for the majority of physicians, you know, they're not bad people in saying, "I don't want to prescribe an opioid." They have been told over and over again that opioids are inherently bad. They're dangerous, and so you better not be giving them. Every year in Tennessee, every practitioner had to undergo a 2-hour educational program on the dangers of opioids unless you were an anesthesiologist and because we just dealt with them all the time. Now, they even included anesthesiologists in this required mandatory training. Yeah. Um, but there's very little training in terms of how do you actually take care of a pain patient who might need an opioid.
That's right. There's such in in the CDC guidelines and in much of the education in someone who is on daily opioids, whether that's for pain or whether that's for opioid use disorder, anybody who's opioid tolerant on daily opioids, there seems to be very little focus on how do we treat them in an acute issue. And so we have people contacting us all the time who are on Suboxone for OUD or on opioids every day for pain and there not only is the hospital not giving them any extra, they're cutting their daily medication also. So now you have a patient patient in acute severe withdrawal also in pain. And so I want to ask you from your point of view with patients in that position and they're in a hospital and they're being treated like that. How do you suggest they handle that? What's the best way they can advocate for themselves?
Gosh. Um, I think the first the first thing to do is before you ever go to the hospital, and Claudia has has pointed this out over and over again on her reels, you've got a surgeon that's going to operate on you, make absolutely certain they're going to take care of your pain postoperatively. And when she says, "If you've got an orthopedist who's going to replace your knee and he or she says,"I not going to prescribe an opiate postoperatively," I wouldn't go to that doctor personally. Now, I hope I don't need one, but if I've got a knee operation, I probably will. I don't know what to do if you're in the hospital. Maybe you would try to notify the administration, get the administration involved, and to say, "Look, you can't have a patient like me suffering. uh there going to be consequences.
How do you do that? How do you do that, David? Because a lot of people don't know you're in the hospital and you're you're alone. You don't have or maybe you have your family member there, but people are so intimidated by the system. So, you know, would you ask to speak with the charge nurse first?
Well, yeah. And the charge nurse is, you know, they're limited in what they can do. They're basically following the doctor's orders. I think first of all every patient should have an advocate with them whether it's going to the doctor going into the hospital because it's such a highly charged environment for you that it's it I mean it's just asking too much for a patient to go through whatever medical experience they're going through and be able to advocate for themselves. So, I think you have an advocate. And I think if I was in that situation, if the physician refused to treat my pain adequately, my advocate would be down at the administration office banging on the door of the CEO to say this can't be allowed to go on. Come on and see my wife up there and tell me that this is good medical care.
That's what we did. And at one point I had I think I had seven people in the room with me including my mom and there was an attorney. It just so happened we went right to the the administrators and the next risk management was in there and I my my surgeon was mortified because it wasn't my surgeon, it was one of his residents.
And I think that's where a lot of the the trouble happens. But let's post like posttop. Claudia had we just had a mom reach out to us in the last few days. Her her daughter had some severe like uh jaw surgery. I think they had to break her jaw and reset it and they wouldn't give her any medication at all and she's like screaming in pain and there's nothing like they call the doctor and the doctor's like, "Oh, well you shouldn't be in pain anyway, so obviously you're drug- seeeking." They go to the emergency room and the ER doctor puts it down as drug- seeeking. And so it's almost like they want people to go to the street because that there's not a whole lot of other options at this point.
Another problem, David, is we're seeing uh people go to the emergency room. They don't have a doctor to treat them because the DEA has discouraged most doctors from treating people's pain. And you've got doctors like Dr. Don Stater from this anti-opioid organization, PROP, who's set up a nice career for himself, speaking out against, you know, testifying against doctors and he's an addictions doctor and also an emergency room doctor and his choice of pain medication is Hal Doll. Hal Doll. Have Have you?
And not just Hal Doll, Claudia, he he says don't tell the patient it's Hal Doll because they know what that is. So use the generic name. So, and and make them he said and then the patient he'll say he'll say tell the patient you're going to need a ride home and the patient will say oh I'm getting the good stuff and he's like yeah you're getting the good stuff. He literally teaches to mislead the patient and then give them hell.
Yeah. What's your experience David using held doll for?
pain in I don't even know where to begin with this. I mean, it is so uh when I first heard about this it was on one of your reels and I thought hald and I thought you know I've used haldall used it in the cardiac ICU for patients that are delirious now we there are other drugs we use but 20 years ago you'd get a small dose of hell if you were 80 years old waking up wild and delirious. Hell is an anti-csychotic medication. And when I saw your reel on Hald, I thought, I gota I got to learn about this. And so I searched PubMed. Now PubMed is the world's repository of medical articles. It has every medical article written since 1996, over 35 million of them. And it has selected articles that go back all the way into the 1800s. And I did a search for hell and pain. And the amount of articles that are written on the use of hell to treat pain is a grand total of zero. Yeah. There's it's I mean, it's stunning. I mean, you you see things done in medicine, you'd say, well, the the evidence is thin. Well, there hasn't been a lot of research on that. Well, on held doll in pain, there's no research other than the use in a condition called gastroparesis, but for treating pain, it's simply not an analesic. So, where do these ER docs get this? I went on the American College of Emergency Physicians website and they've got a statement that says, uh, when other methods have failed, you can try held. And then I found an article of a survey of er docs in New York. 89% had used held to treat pain. The majority of them felt that it had analesic properties. The majority felt that it had been effective in treating pain with some of their patients. Now note that they felt it had been effective. I think if you ask the patients, they might have said something different. and that they used it in an effort to avoid using opioids. There you go. So, that's right. They've got a professional organization saying, "Hey, you might try some hell." Yeah. But, by the way, it's not an analesic.
Um, I can It's crazy because what they say is if someone's in the emergency room with with kidney stones and severe pain, he's like, "Most often their pain is because they're really upset about having a kidney stone. They're really upset. So, we need to calm them down." And he's like, "Once they calm down and then we can actually have a discussion."
Yeah. It's just absurd. It's basically saying, "I'm going to give you a tranquilizer." Yeah. Well, if I go into the ER and I got a broken arm, I would like you to give me a pain medicine for the pain I'm having from my broken arm. It's just I mean, it's just to me as an anesthesiologist, as a person who treated pain every single day for 36 years, it is beyond beyond to be using.
TD Doll. What is your view of um ethics behind giving someone a medication like an antiscychotic and specifically not telling the patient what you're giving them?
I think it's unethical. You know, there there are well and you have to think about the medical ethics that doctors are supposed to work under first of all is uh to do well it's first of all is beneficence. I want to do what's in the for the benefit of my patient. Another one is it's better to do nothing than to do harm. Another one is it's called justice. And there's a there's a fourth one in there. But beneficence is I'm going to do what my oh the fourth is autonomy. So you're violating two of the e two of the basic medical ethics. Autonomy. A patient chooses for themsself the treatment that they receive. Now you can't you can't say I choose this harmful treatment you know you don't get to make that choice but of acceptable treatments patients have autonomy they get to make the choice and beneficence I'm going to do what is best for you so you're violating two of those ethics as far as I'm concerned and the idea that you got to slip something that's not an analesic and tell a patient they're they're basically getting an analesic um you know they're leaving them they're leaving them unattended in the emergency room after they're giving and but see these prop members they portray pain patients as we're all angry and that's why we need to be sedated and and there's this big push for anti-depressants for pain and you know what are your thoughts about anti-depressants for pain?
yeah, you know I I have to say way back when when I was doing a lot of pain I I prescribed elev for some patients uh that was really in vogue. But um, you know, that was another case of sort of misinformation. There really wasn't much medical literature, a little bit of medical literature to justify it. But now we know that uh the use of anti-depressants for uh pain uh should be limited really to diabetic neuropathy. Yeah. uh and deluxitine you can and there's something else uh malnopram or something like that those are acceptable for diabetic neuropathy but other anti-depressants I had just read a a huge review article on it and basically oh it was a Cochran review yeah and I know that yeah there's just there's just you can't justify it.
no and it fa I mean these anti-depressants have failed miserably in all of these studies And uh because I I follow your you do a great job in breaking down studies. So you do a great job. So maybe there's a place at the DPF home for David Alley and studies because you know people just you know my mom is going to be 89 and she believes what the media says and she believes what a doctor says and I said wait a minute we got to do our own research. Let's look at let's try to find some data. But then when you go to look at the studies, I'll call Bev. I was like, "What the hell is this mean? What is this word?" So, you do a great job in breaking down uh studies for us.
Thank you. You know, one of the things that bothers me, I think, the most about giving hell in that setting is that what you just mentioned, it's trust. Every two months, I have dinner with a a group of docs. were all retired and these are the these guys were the cream of the crop. And we were talking about trust the other night and and we said the whole basis of our profession and our treatment is based on trust and that's why we get taken sometimes financially because we just assume the whole world will be trustworthy. Yep. Because it was so important, at least of my generation, to be absolutely trustworthy to your patient and to understand that treating that patient was a privilege.
Well, because you're a gentleman, David. You're a gentleman. And I'm not I I'm not seeing a whole lot of gentlemen, especially on So, you know, physicians, male physicians who seem to have lost their way. I mean, the younger doctors are so different from the older doctors. And I think a lot of it has to do with with this. See this? They lost that connection with people. See, you weren't raised on a tablet, right? Yeah. And and I think, you know, I got a playlist on on Instagram and I think it's called money and medicine. And when I when I retired, I was speaking to one of the urologists and he was about retirement age. And one of us had said, you know, when we went into medicine, it was all about the patient. And then the other one said, "Yep, and now it's all about the money." I think money has just come to just dominate medicine. It's it's really sad.
Yeah. It doesn't seem to be about the patient anymore at all. And you know, it's interesting because the CDC guidelines in 2016, one of the main three goals that they stated was to improve patient doctor patient relationship with these guidelines. And I think it broke whatever was left in that relationship. Now it's totally broken because you have these doctors who are taught they actually believe like you were saying that opioids never work and that they cause pain. So if you have a patient in front of you saying they work for me, then you have what do you do with that? you have to assume they're lying or they're addicted or they're selling their medication. And so I think it destroyed the doctor patient relationship. We can't be honest. The doctor's terrified. They can't be honest. Yeah.
Right. Right. And David, you left a comment under one of my videos. Uh as as we now know, women are being denied pain medication if they have a history of sexual abuse. And to see these doctors who have created this niche for themselves where they're now teaching other doctors or they testify against, you know, a lot of our providers who have been sent to prison, they're older solo practitioners and they would continue to treat a woman's pain even if she had a history of trauma. And you've got doctors like Dan Berland's out of the University of Michigan or Tim King and they're getting on the stand and they're saying, "Oh no, you can't treat her pain."
Unbelievable. I I would challenge them. Where is the medical evidence to justify your testimony? Give me the studies which back up what you're saying. And they don't exist.
So they cite themselves. They actually site themselves. Yeah. And and as you know, I mean, pain is a is a is a subjective phenomenon. Um, I can't I can't deny your pain any more than you can deny mine. If a patient has pain, they have pain. And what and and how would how would sexual abuse manufacture false pain or false reports of pain? I mean, it's just I I mean, I just can't imagine how they how they could give that kind of testimony. I'm going to tell you what they say is that so there's two things. One, they say it it increases the risk of addiction. So never give opioids. They say that. But the other side is this concept of centralized pain. Um, they call it psychophysiologic disorders. This this like brain pain. This idea that uh trauma in childhood causes this centralized pain. And they put a lot of illnesses in there like uh fibromyalgia, CRPS, Eller's Danlo, trigeminal neuralgia, pelvic pain. some of these long co is there now um and and they say these are um psychophysiologic disorders like they took from John Sarno's work um and they this is out of Michigan and so they actually teach it's so disgusting they actually teach if you have a woman in front of you and and you have to get out of her if she was sexually abused as a child and even if her eye twitches when you ask that means she was and you have to give her a centralized pain diagnosis. They teach people to diagnose women based on whether or not they had trauma as a child. Then they say opioids are contraindicated in these women. It's it's unbelievable.
Well, why can't those women have legitimate pain? Exactly. Why why are they deprived of having the luxury of having real legitimate pain? And it's men. It's it's always men that are saying these vulgar I I just the only word that comes to mind when I think of doctors like Dan Burland who said well 90% of my patients were fi with fibromyalgia were raped as little girls. Doctors don't talk like that, but they have this penchant for g little girls and sexual abuse. And it's weird and it's creepy. And hopefully we're going to have strong doctors start to speak out against these scumbags because that's what we need. We need leaders. Right now, we are swimming in an ocean filled with followers and nothing is.
Yeah. There's nothing such a turnoff to me, David. I just hate a follower. But we're going to switch gears again. Well, Claudia, before we switch gears really fast, can you tell us your view of centralized pain because this is pushing the narrative right now? Um, this idea of centralized pain syndromes that they're not caused by any tissue damage just because they can't see it, right? Um, and and I've seen it increase over the last few years. What's your view of that?
Yeah. Uh it I don't know much about central pain, but what I do know is And you're an anesthesiologist, so it's not like this is it's not like the science has changed since David has gone to medical school practice for over 30 years and now there's brand new science. Yeah. Uh you can there you can have central pain as a result of uh strokes and that is an absolutely devastating situation. I've got a I've got a friend who's a cardiac surgeon and his wife has central pain uh as a result of some little mini strokes. The other situation where I think there's a central pain mechanism is in CRPS that when you get to the latter stages of CRPS, it's not a peripheral phenomenon anymore. Now it's a central phenomenon. And that's why people with CRPS and let's say the pain comes from their hand, you can amputate that arm and their pain doesn't go away. It's a central phenomenon.
Do opioids are opioids contraindicated in a situation like that like they tell in Michigan?
Nothing is contraindicated. You know, I mean, I think that you my approach with with medicine in general and pain in particular is whatever works. And if a person says, I've responded really well to um acupuncture, I'd say, well, it sounds like you should be seeing an acupuncturist. I've responded well to hypnosis. Well, go to the hypnotist, whatever.
It's so refreshing to hear that. Say, can you I wish we had a hundred doctors like you that we could give patients your name because we need to find older doctors who are retired who can come together and really start to debunk the nonsense that's being espoused by these younger indoctrinated doctors. It's actually quite simple. It can be done because the the retired doctors, they don't they don't have anything to lose, right? True. Yeah. Target them. But I think, you know, what what Bev said, there is such a bias in medical education that these residents get out and when they're denying that pain medicine to the person that had a history of of substance abuse and I've had a major operation, but we somehow can't give them an opioid. They think they're doing the right thing. Yeah. Right. And that was done on purpose. Gary Mandel and Andrew Coladney. Gary Mandel runs ShatterProof. He joined with Andrew Coladney. Then Judy Rumler uh runs Rumler Hope. They lobbyed to have this type of um education put into med school and nursing school. So this was done quite intentionally to indoctrinate people before they come out. And this is why you see people on TikTok, I'm sure you've seen them, pharmace, young pharmacists, nursing students, doctors, just absolutely mock somebody in pain and joke about it [clears throat] like it's just so funny.
And then the poor person, like several moms have contacted us. One mom found her son unresponsive. He had dry sockets after wisdom teeth removal. Uh doctor said absolutely not. This is a narcotic free practice. Kid went on what is that? Snapchat bought what he thought was a pain pill. Mom found him foaming at the mouth in his bedroom. He bought it was fentinel. Right. So, and this is happening, David. There's So, let's talk about the illicit fentinel.
Uh, and where it's coming from because in my opinion, I think the United States government created an epidemic that we didn't have and now they made a much much worse epidemic. We never had elicit fentinel. Europe doesn't have a fentinel epidemic, but the United States does. How do you think we can tackle this crisis?
Yeah, you know, I've done a lot of reels on this. Um, I made the point at one point that um I guarantee you that you either have a friend or a relative who's died from illicit fentanil or you know somebody that's had a friend or a relative that's died. over a million deaths in the last 10 years uh or 15 years. Um, you know.
and nidazine and nidazine. Oh. Oh yeah. Nazism. Great subject. Love to talk about it. All of a sudden that's really rearing its head. To me I think you've got to go you've got to get a really broad net. First of all you got to stop the fentil coming across the border. Secondly, you and I don't care if you're a Republican, a Democrat, whatever you are, Martian, we got to stop this the the drugs coming into the country. Two, as much education as we can give out there. One of the good things that the DEA does is has a one pill can kill program, but most people have never even heard of that. And the fact is that so many of these young people, 14 to 18, take that one pill and they're dead. uh we lose a classroom worth of 14 to 18 year olds every week. Same number that died in Yavaldi of the gunshot wounds. uh and we hear about that week after week after week, but we never hear about these poor kids that are dying. So, I think you got to educate. You've got to uh stop the drugs from coming in. The people that are pushing it, you've got to throw them in jail and throw away the key. Uh the only only time you'll be prosecuted for murder is if you are like the grandchild of a celebrity. Then they go after the pushers like uh Robert Dairo's grandchild. I think you've got to have rehab services that are as easy as picking up the phone. There are no impediments, no social impediments, no financial impediments. Uh, I think you've got to take the pain patients and give them the pain medicines that they need. Yeah. Um, you got to bring down those barriers and say, "You've got pain. I'm going to take away your pain. I'm going to prescribe for it. I'm going to do it do it in a uh in a safe manner, in a in a a good medically supervised manner, but I'm going to take care of you as well."
Because we Yeah. That's what's left out. It's left out of every solution.
Always left out. We didn't have a nidazine problem before the 2016 CDC guidelines came out. We we didn't have this illicit fentinel crisis in 2016. And all all these harms come. They still every time they give solutions even if it's now in 2024 part of those solutions is still you know it's nlloxxone which is fine elicit ventinal testing ships which is fine safe supply safe consumption sites but they still even now say continue to reduce prescribing still like I don't know how much lower sometimes I'm like just make it illegal because it's already down to what it was in the early 90s before Oxycontton How much lower does it need to go?
Yeah. The, you know, this is not a prescribing problem. Physicians have prescribed less opiate prescriptions every single year for the past 13 years. The and every state has mandatory reporting. Licensing boards are looking at it. Um, you know, I'm sure there's a few, you know, irresponsible physicians out there prescribing, but man, they are few and far between. Absolutely. Much much bigger issue is pain patients aren't being taken care of.
Right. And and with all of these safety measures that have been implemented, I think, you know, I just got back from Michigan, we have a presentation, the DPF presentation, we're going to be traveling across the country and one of our slides in the presentation was discussing since the implementation of the the datab program, right? So you all of those that p that PDMP has been visited how many times Bev? I don't remember but it keeps going up and up and up and up. Two one million two million three million and guess what it's none of it's working. Everything has been an abject failure but these anti-opioid uh and uh wackos I guess is the word they they just keep saying keep doing what you're doing because the indoctrination is so thick. But what something else you and I talked about the other day uh for my boyfriend's recovery was IV Tylenol. And you said, "Oh, I know you don't like it. I know you don't like it." But it's not that I don't like it. And because I I did 10 years in a hospital bed, but the only time I was ever given IV Tylenol is when I had pneumonia, 105 fever. We just couldn't get it down. And IV They But they didn't want to use IV Tylenol. And they said, "Oh, it's it's very expensive."
Yeah. And all of a sudden it's no longer very expensive and it's the panacea for pain relief. What are your thoughts on IV Tylenol? Yeah. Um plus opioids not just as a monotherapy for posttop.
Yeah. The problem with IV Tylenol is uh and I'll just talk about it in a post-operative uh setting is when people want to use it as a substitute for an opioid. It's not a substitute and it's certainly not a replacement for a strong opioid. Um it's it the the setting where I find IV Tylenol. Uh there's two two settings. One, if you want to be part of this multimodal analesia program and I want to reduce the amount of opioid that I have to use on you post-operatively. You're 80 years old. I would not like to use a lot of morphine. you're going to get confused and so forth. V Tylenol can be part of that regimen to reduce your requirements. The setting that I have found it most remarkable in is there are some patients that wake up from anesthesia and even operations that you'd say well gee it wasn't a big operation like a laparoscopic colaccystectomy. You got a couple of little incisions where the scopes went in. Uh, and you and I've given them 45 milligrams of morphine in the recovery room and they're still hurting and they're legitimately hurting and they're wide awake saying my pain's eight over 10 and I'm thinking, man, I've given you three times the dose that I would normally give. Then I would give IV Tylenol.
Were they redheads? [laughter]
Not necessarily redheads. Those they're troublemakers though. Uh, but u I'd order IB Tylenol. It's going to go in over 20 minutes and I'd come back 10 minutes later and the patient's sound asleep. Um, for whatever reason, it has it has taken away this other avenue of pain that that opioid wouldn't get to. So, I think it has it's got a place uh in post-operative pain management, but the the problem becomes when the surgeon says, "Well, I'm going to be giving you gabapentin and IV Tylenol after you've had your knee operation."
Yeah. IV Tylenol is not enough and gabapentin is not a somatic pain relief medicine.
Yeah. I listen I I wish I could go on all social media platforms and say Gabapentin is a great pain reliever. I don't know one per I've got we got over 30,000 members chapters in all 50 states. The only people have ever said gabapentin was effective was for diabetic neuropathy and shingles feet. It helps lose shingles. Yeah. I think if you if you have neuropathic pain, it's certainly worth a try. But even in that setting, um, and my my wife takes Gabapentan for her CRPS, uh, and but she's like a lot of patients doesn't it's not terribly effective. It's effective in maybe 30 to 40% of patients with neuropathic pain, but in virtually all of those, it doesn't take away all the neuropathic pain. So for her, it's part of the answer. Um, and uh for acute pain, that's just it's just.
it has no place. No, no place. Yeah. there in so I'm an anesthesiologist a member of the American society of anesthesiology the most premier our specialty journal is anesthesiology it's the it's the most premier anesthesia journal in the world in 2020 there was a review article on gabapentin and lica for post-operative pain reviewed 261 articles and they said it is clinically insignificant. Wow. In terms of treatment of pain postoperatively. It has no place for the use of treating pain postoperatively. Now, we're the people that put you to sleep and wake you up and take your pain away. So, you think we could speak authoritatively whether or not this is a good drug for post-operative pain. At the end of the day, it's a capital N and a capital O.
Can you send us the um link to that if you have it?
Uh I can find it. Sure. Thank you so much. Appreciate that. I want to do some light reading and I want to comb through those 261 [laughter] studies. It's a great article and I want to see.
It. Yeah. Well, it's the kind of article that kind of gives me hope because uh you're seeing some of things some things like this and the other article we talked about uh in terms of you know, giving patients adequate opioids while they're asleep and waking them up comfortably. Uh, that maybe for at least for some physicians, that pendulum is going to swing back a little bit to say, you know, we've gotten we've gone nuts with this opioid business.
I also think a lot of lot of pain, let's face it, the pain clinics are run by the anesthesiologists. The younger anesthesiologists have found a great way to capitalize off of this. Some of these doctors are getting eight hours of training doing the epidural steroid injections. And I, I think epidural steroid injections could be effective for some people, but I just, I just spoke with somebody who was forced to get 103 epidural steroid injections in order to get three pain pills a day. But these people don't know any better. How would they know, right?
That is absolutely, you know, when I did epidural steroids in our pain clinic, you know, the setting where it's where they're most effective is if you have an acute ridiculopathy. I've got a sudden ruptured disc. It's pressing on that nerve root. I have this excruciating pain down my leg and you know, I think I got to go to surgery and take that disc out. Well, an epidural steroid in that setting will act as an anti-inflammatory, anti-edema, take pressure off that nerve root. It doesn't. It's not a pain reliever in itself, but if you can get some pressure off of that nerve root until that extruded disc resorbs itself and moves away from it, maybe you can keep them out of the operating room. And I've had many patients that didn't go to surgery because they got an epidural steroid. But that's on one end of the spectrum. On the other end of the spectrum is I've got back pain. Well, the chance of an epidural steroid helping you in that setting is close to zero. And so you need to select your patients properly. Uh, and then you don't just repeat them. There's a sort of a general rule that you do a series of three. There's zero medical evidence that that's that nobody's ever studied that, but it's, it's just one of those things that's accepted in medicine.
I never knew that. I didn't know it wasn't studied. But that was also created by the insurance companies, right? You've got all of these. Yeah. The insurance companies are requiring doctors to do a series of three before a patient can move on to surgery.
Which there's no evidence to support that a series of three is helping people. No. And what, what, when, when, when we would do epidural steroids, um, if we didn't get a good response with the first, if it was a properly selected patient, we generally do a second. So some of those patients will respond after the second, but if they didn't respond after the second, I would tell the patient, you're zero for two. The chance of you responding to number three is about zero. I don't think we ought to be doing a third. So you wouldn't encourage an additional hundred.
Yeah. [laughter] I mean, it is just, and I find that so many of these pain clinics have just become these drill mills. They're not even owned by doctors. These drill, these are owned by, you know, business people, by corporations, and and you've, you got to deliver the procedures. I know by the end of the day, okay, well, how many procedures have you been given?
And I tell you what drives me nuts is when you see these places that are advertised as pain clinics, but we will not prescribe an opioid. That's exactly right. And they, or they take people that are on like 15 milligrams of Vicodin a day and doing really well, and they'll say, you, you can't have this, but here, let me give you a spinal cord stimulator. Like it's unre that Crohn's patient who had her colon removed and they post-op wouldn't give her opioids and they were trying to put in a spinal cord stimulator for that post-op pain. She called us from, I think it was Mayo Clinic.
Right? I had a doctor on LinkedIn who, you know, he was trying to sell me a spinal cord stimulator for Crohn's disease. And I'm like, what, what are you, kind of an idiot? But they're banking, or, you know, you've got these other pain clinics, David, who are, in addition to the the gimmicks, right? Forcing the procedures. They're taking people off of, you know, three pain pills a day and putting them on 24 milligrams of buprenorphine, these huge doses of buprenorphine, and then they'll call us because they're so, so sick, especially the elderly. The elderly are not, they're doing so horribly on this. This is a great medication for heroin addiction, but, you know, have you seen a lot of success in treating pain with buprenorphine? I have to say, I don't have any personal experience in this, but I did a real, just a couple of weeks ago on the use of buprenorphine for acute and chronic pain. It's highly controversial, and I think the problem becomes, uh, and if a patient wanted to try it, I'd say, fine, we can try it. Uh, the problem becomes when you ascribe to the religion that opioids are bad for you, and, uh, by God, that buprenorphine is going to be used for your pain, and if it doesn't take it away, what's your problem?
That's it. That's right. It's patient blaming, and I think it's so bizarre because they're taking. Opioid, but it is an opioid. Yeah. But it's a agonist antagonist. So it's got a ceiling effect. You know, it. It's an opioid. Yeah. It is. But I want to talk about. If a little kid was to, you know, get, get their hands on Suboxone, open that wrapper, put that in their mouth, that that kid could die because it is an opioid. And I think what we're doing as a country, misleading people into believing that it's not an opioid is is dangerous because.
But I want to, Claudia, I want to talk about this because I heard two CMEs just the other day. Two brand new CMEs. One, it was a pharmacist saying buprenorphine absolutely blocks full agonist opioids. So if you have a patient on buprenorphine like Suboxone for pain, and then you can't give them like Vicodin at for breakthrough because it will block it. And then another CME out of Michigan where they said it absolutely does not block the full agonist. So if you have a patient on buprenorphine and you give them Vicodin, if they say it's not working, it's because that patient is drug-seeking. Do they even know what it does? Because it's so contradictory in all the information. My understanding is that you can, you can give, when you have a mixed agonist antagonist, if you give enough other opioid, you can get the effect of the opioid.
You can. Okay. To my understanding, but I just want to say one thing about the pain clinics. You know, it ought to be pretty easy. There are invasive procedures which can really help patients. Sometimes a trigger point injection is really helpful for a patient. I get, uh, radiofrequency ablation of my cervical spine. I get the medial branch ablations. It's miraculous. But if I needed an opioid, I would have hoped that my pain clinic would give that to me. Why is it so complicated? Do the procedures that work and are effective and give the medicines that patients need.
Because they're teaching that it doesn't work. So why would they give it? And, but I want to talk about buprenorphine for a few. It's an easy way out too. It's an easy. It is an easy way out. And I think like even University of Michigan, they put Michigan Opioid Collaborative did this whole, uh, buprenorphine webinar series, and they actually said buprenorphine is our way out of this opioid mess. So it's being shown as like, it, it's so bizarre because it's being shown as the solution, and if a patient says it doesn't work, like you said, you blame the patient. But doctors get so angry if a pain patient, like on social media, if a pain patient says, you know, I took this, it didn't work, they get really, really angry about it. I was put on Suboxone in 2016. I didn't even know what it was, um, as a punishment because I took five pills from a dentist for abscess tooth and sepsis. And so they put me on Suboxone. One, I, I might have been on 30 MME before. I had no idea what it was. They didn't tell me. They took me from like 30 MME to 24 milligrams of Suboxone a day. It was the worst experience of my life. Like I couldn't get out of bed. Like I was so, I felt so drugged, but it also wasn't helping. I have Crohn's also and I get frequent kidney stones. And so when I had a kidney, it wasn't working for that kidney stone pain. And I kept telling the doctor, and he cut me off cold turkey also, not telling me what would happen. And it was such a horrible experience for me. But you're not, as a patient, allowed to talk about this on social media without being absolutely attacked, usually by addiction medicine doctors. Like, for some reason, there's they're more concerned about protecting buprenorphine than they are about the patient. Why is that?
Well, because they're paid. They're paid. There's a lot of angry people. All I can say is a lot of angry people on social media. You think? Yeah. [laughter] You know, there's, there's one addiction medicine doctor, uh, who shall remain nameless, but his name rhymes with Schmailer, Schmeichles. [laughter] And he is, uh, I find him so, so young and so arrogant that, and if you don't agree with him, he just attacks. And once again, I don't see that with the older doctors. I don't see this arrogance, especially in somebody like you, David. But listen, if buprenorphine works for you, great. But Suboxone and Subutex is not indicated for the treatment of pain. Buca is all oral buprenorphine is linked to denture decay, to dental decay, to excessive sweating, to feelings of flat affect. And we know that for sure. We have studies to support that. They, you cannot vilify a full agonist opioid and then glamorize another opioid. That's not what is going to happen because it's been allowed to happen for too long. And, and this is what we like about Dr. Alfrey is he's very balanced in his views. And I just want to, um, I've opened up to chapter six, suffering in your book, David. And because I was reading it, you don't see any of this anymore. That this is, you see David is so pleasant. He was such a compassionate doctor in his book. You don't see that anymore by these anesthesia teams, es, and the younger doctors. How can we, how can we make these doctors care about patients again?
Yeah. You know, there's, that's such a good question. They're getting into a system that is sadly driven by money. Uh, 75% of physicians no longer work for themselves. They work for a healthcare organization or a hospital or, or, or a big private entity, corporation. There's all of this production pressure that they're under. You got to crank the cases out. A lot of them go into medicine, uh, they go into practice with a lot of medical debt. The electronic record has separated us even farther from patients, right? And that was supposed to be the panacea for everything. But a disaster, right? We lost so many great doctors when the electronic health record system was created. I remember my gynecologist, she was crying. She said, "I can't do it. I've got to tell you, I'm, I've got to tell you, I'm retiring. I can't do this anymore. It's just too stressful." And I think the Obama administration, you know, created that the EHR was created under the Obama administration.
Yeah. Uh, think or whatever. But, but it, but it's been a disaster. I gave a talk, uh, to the Nashville Surgical Society about a month ago. Um, and these are mainly crusty doctors, a bunch of retired surgeons, some other surgeons still in practice, but they had a few people in training there. And, um, I think I talked about some of this stuff and reminded them of, you know, the key to having empathy in medicine, the key to to treating that patient like a human being. And that is to never forget that what you're doing is a privilege. You're there for the patient, not the other way around. And if you can get that, then this doctor-patient relationship, this shared humanity that you have with it, it's just the most incredible experience in the world. And for the, the people that are burned out, they need to remember, hey, that's, that's what you had when you went into medicine. And even though you've got all of these other impediments, you got that damn record, you got the pressure to to, uh, you know, to crank the patients out, remember that's a human being. When I would pre-op patients, I had my own little technique. I always touched the patient. Uh, if I listen, I always listen to their, to their, uh, lung sounds. I always put my hand on their shoulder when I did that.
My GI doctor does that. And when he first did it, I was like, "Oh, what are you doing?" Yeah. Because we're so not accustomed to that. But I love, like I'm just sitting here thinking, you are restoring my faith in in healthcare right now because it has been so long since I've actually heard anyone talk like that about patients where, you know, because they make fun, like I don't, a lot of the things we do is take clips from actual, you know, presentations from doctors about pain patients, and all they seem to do is make fun of us and mock us and laugh about us, like there's some knowing giggle, and it's so frustrating because, you know, the way they portray us, and it's like they all forget that, you know, we're sick. Like having Crohn's disease, I was in the hospital in and out for 10 years like Claudia, and I missed everything when my kids were little. I was so sick for so long, uh, before I was able to get into a good remission. And they just do away with all of that. They make it sound like it's all just psychological, and the whole reason why we're sick is to just get opioids. And thank you for saying that. I, I appreciate that a lot. The other thing I would do, uh, before I left the room, I would always ask them a personal question. How long have you been married? Do you have any grandchildren? Just to let them know that, you know, you're not just a gallbladder. You're a person.
That's sweet. And I also like that you didn't say the question you asked is, "Were you raped as a child?" Because that's what they seem to, that's what they seem to ask, and that's all they want to say. And, and, yeah. You know, these, I just have to say, these are the, the high-level, I mean, to me, these are the, these are the high visibility, infamous, famous, whatever you want to call them, doctors. When I, when I have this dinner, uh, every two months with these retired docs, most of them have read my book, and mo, and all of them have said the thing that resonated with them was the idea that it was a privilege to take care of patients, right? And there are docs out there that are young that that feel that way. You got to look for them. You may not find them. Uh, a lot of middle-aged docs still feel that way. Yeah. Um, there's a lot of impediments to remembering that that's what medicine is all about, but they're out there. And so, you know, for pain patients that that have had such a difficult road to find somebody with empathy, um, I would just encourage them, keep looking. Yeah. Uh, there, they are out there. My wife has a, a pain doc at Arsener in New Orleans where she goes for one specific procedure. He's probably in his early, um, you know, he's just, he's just the kind of person you want taking care of you. So they are out there.
Yeah. Well, and I could tell, just hearing you say that, you're these little sound bites of of how much it's a privilege to care for, like it could actually make me, I could actually cry thinking about it. And I know that, um, so many patients out there who, you know, we hear from them every day when they just, they're going to blow their brains out, like they just can't do it anymore, and they don't know what else to do. Um, I think just hearing that from a doctor is going to be really encouraging to them. So, I, I appreciate you're saying that. Let me ask one more question, David. So, you graduate. When did you know you wanted to be a doctor?
Um, I was in high school. I, uh, I, I went to an open house at a medical school, and it just seemed so fascinating to me. So, I was premed when I went down to Tulane. Sort of like, you know, I got waylaid in the French Quarter. I was the youngest legal bartender on Bourbon Street. Almost flunked out of college, really. Uh, but then somehow, you know, got back on the track.
So, you, so you get your undergrad. What did you get your bachelor's degree in? English. In English. And then you applied to medical school. Yeah. I, I, uh, I, I grew up by that time. And so I had to go back, uh, take premed requirements. Uh, got into LSU Medical Center. Mh. Um, and I never fit in at Tulane. It was all those rich kids from private schools, and I didn't have any money, and I was a public school kid. And then I got into LSU medical school, and I said, these are the guys I went to high school with.
Sure. Um, everybody was normal. Right. Right. So, you graduated from medical school and you decide you want to specialize in anesthesia. Well, I was going to be a surgeon. I was going to be a cardiac surgeon. Okay. Uh, so I did an internship in Kentucky, University of Kentucky, got totally burned out, and the chief of anesthesia there took me aside one day and said, "You ought to think about being an anesthesiologist." And, you know, um, as a result of about a 20-minute conversation, I decided to change specialties and do my training in San Diego, uh, based upon his advice and the fact that he knew the chairman there. And I thought the weather would be pretty good in Southern California.
Right. So, you, so you. Decisions. So, you went from Wisconsin to Louisiana, then from Louisiana to. Kentucky. Kentucky. And then San Diego. And then San Diego. And then how long was your, your training in San Diego? Yeah. Uh, back then the anesthesia residency was two years. So I did that, and then I stayed for an extra year of, uh, cardiothoracic training. So, what makes a, because Bev and I get confused when we talk about fellows. Yeah. What, where does a fellowship fit in in all of this? So, you, you go to medical school, and then you have to declare, I guess, some type of a specialty, and then you'll do your residency in that specialty, and that could be between two and four years. And do people usually do those? Because I'm trying to find out where, where the ball drops after somebody has surgery. I'm wondering if it's the residents who are anti-opioid, or because you worked in a hospital.
Yes. All right. Well, let's try and figure this out because. So, all right. Then you do your, your, your training in anesthesia. You're, you take boards, I would imagine. Now, you're an anesthesiologist, and you're working in a hospital. Yeah. And by the way, a fellow just basically means I'm going to get subspecialty training. Okay. So you can have a, you can have a fellow in surgery. I'm a surgeon, but I'm going to become an oncologic surgeon. So he's a fellow in that. Okay. And specialty anesthesia training. Well, I do a fellowship in pain. I do a fellowship. Oh, I gotcha. Okay. That now I understand. Yeah. So, let's try to figure out where it all goes wrong for somebody who gets admitted to the hospital because it always went wrong for me with a hospitalist.
But because, you know, when you have surgery, I always, I've had amazing anesthesiologists, but I always see them before I'm, you know, given anesthesia, and then you never see them again. And I would always say, "Oh my God, I have the nicest anesthesiologist." And they're giving you that little cocktail, and you're like, la [laughter], and you love your anesthesiologist. Yeah, we all love our anesthesiologist. It is so much fun to give that cocktail. And [laughter] then you, but then you never see them again. So you've got this great pre-op, and then now you're in the room, and you're, I just, I just spoke with a lady, Rachel, I saw on TikTok, massive, she had this huge spinal fusion, former heroin addict, and she's been taking us through her journey. So I emailed her. I said, "Hey, if you need me, let me know. I'll advocate for you." But where do you think the problem happens? Does the surgeon put orders? Who's putting these orders in?
It's almost always the surgeon. If you're in a teaching hospital, let's say you're Johns Hopkins. Well, it's going to be the resident who puts the order in. Um, and they're, you know, ostensibly overseen by the resident above them, who's overseen by the by the attending. But a teaching hospital, it'll be somebody in training, and they have just had all of the indoctrination about opioids. That's right. Uh, if you are at a private hospital, it'll generally be the surgeon. And unfortunately, they probably had the mandatory training each year about the dangers and the hazards of opiates, uh, without emphasis on, hey, this would be a, be a, a good way to navigate your patient post-operatively. Let's use some non-opioids as a, as a keto act, something like that, a non-steroidal, and then you add opioids as necessary. It's not, I mean, it's not complicated, but I think there's so much bias and indoctrination that you sometimes get in the hands of these people that say, you're going to get gabapentin and IV Tylenol.
Right. And at the hospitalist, I would imagine if you're at a teaching hospital, then you're going to have residents who are working under the attending hospitalist there's got to be, right? Well, yeah. You know, it used to be, you go into the hospital, and your internist who take care of you, right? Now it's just about entirely hospitalists, and these are an invention over the last 15 years.
I know. Yeah. Yes. When I was first sick in the '90s, my GI doctor, uh, would do direct admits, and then he was the one who did all of my orders, and someone from his office came every single day. There were, and it was such a better experience than it is now. Why did they change that? Why did they do that?
I think a number of reasons. First of all, uh, medicine gets more and more complicated, and, uh, the, you know, management of somebody in the office who has diabetes is far different than coming in with ketoacidosis, uh, and needing intensive management. So the whole specialty of a hospitalist was formed.
Um. They're like the jack of all trades, master of none. Well, you know, the, sadly, you know, these are internists, and internists are not trained in treating acute pain. No, mine didn't. My hospitalist didn't know what Crohn's disease was, and my mom thought he was kidding. No, mine was the same thing. Mine was the same thing. And then the nurse was like, "Oh, I've heard of it because my cat actually had it." I was like, "Get me [laughter] out of here."
But, but the one thing they all seem to know now is you don't ever use opioids. Opioids are bad. They cause pain, and so you can't have them. That's the one thing that's happening in the hospital. My cardiac surgeon friend who I mentioned earlier, he just got out of the hospital. He had a small bowel resection, and he was in there for quite a while, and he had the phenomenon of the silos. Each of the specialties practices as a silo, and, you know, do I need all that IV fluid? Well, I can't touch that. You know, um, that's the surgeon's going to decide that. Everybody's afraid to make a decision. Sadly, I think they, it's almost the only way you can get the kind of continuity of care that Bev described is with a concierge doctor. And I'm a fortunate guy. I can afford the concierge doctor. So, I have that.
My wife was in the hospital last fall with pneumonia. He admitted her. He saw her every day. That's a, that's a rare breed nowadays. Sure. Yeah. I, we really do love our concierge friends. Well, it was a real treat having you on this podcast. And once again, uh, David Alfrey, saving graces. He's one of my favorite people on TikTok. So, don't forget to give him a follow. Uh, thanks so much for joining us today. And thank you folks for tuning in to the Dr. Patient Forum podcast. We're trying to get you help.
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