From the
President
Wayne Tuckson, MD
GLMS President | [email protected]
SAFE Harbor
O
ne night while driving I-64 treat, their illness often controls them. Their regulations whose intent may be as much
back to Louisville, I noticed
I was low on gas. The Trav-
el Stop sign at the Waddy/
Peytona exit was visible from
the highway so I pulled in and, like others
around me, got gas and a cup of coffee. As
I left, I thought back to a time not too long
ago when I would have been denied such a
simple but essential service. needs and our treatments may adversely
impact family life, social experiences and
employment opportunities. They need help,
not judgment. to frustrate the practitioner as an honest at-
tempt at ensuring safe patient care. Clearly,
much needs to be done in these areas.
Jim Crow laws severely restricted Afri-
can-American travelers’ access to such sim-
ple, but essential services such as lodging,
eating and getting gas throughout the US,
especially in the South. The recent mov-
ie and play, both entitled “Green Book,”
highlight the precariousness of travel for
African-Americans during those times.
“The Green Book,” the more familiar
name, was compiled and published by Vic-
tor Hugo Green as “The Negro Travelers’
Green Book: The Guide to Travel and Va-
cation” and was in print from 1936-1966.
It was a compendium of facilities that were
favorable to African-American travelers.
These “safe harbors” were places where
weary travellers knew that they would be
received and treated with dignity.
Now, imagine the struggles of the chron-
ic pain patient. This is a group that is too
often portrayed as a pariah. In many cases,
not unlike other chronic illnesses that we
The pain patient is unique in that unlike
patients with other illnesses, we often blame
them for their problem. However, just as we
don’t blame patients who contract malaria
after travelling down the Congo River, nor
should we judge the pain patient for the cir-
cumstances that have led them to our care.
I will not be so naive as to deny that there
are some patients who are only interested
in receiving narcotics. These select patients
should not bias our attitudes against all pain
patients, nor negate our humanity as we
care and attempt to return them to a state
of balance and function.
In spite of publications such as the
“Guideline For Prescribing Opioids For
Chronic Pain” by the CDC, many of us are
not comfortable with prescribing the medi-
cations that the pain patient seeks or needs.
In our current climate, to care for the pain
patient is to expose oneself to scrutiny and
the possible threat of legal or regulatory
punishment. Then of course, there is the
paperwork, the endless need for pre-au-
thorization, and finally the need to navigate
through a byzantine maze of both govern-
ment and private health insurance rules and
Physician access for pain patients is de-
creasing by the day. We are all familiar with
the closure of pain clinics and practices.
True, most of these closures are of the bad
actors, but there is still the lingering concern
by many of us that the next hydrocodone
prescription that we write could be the one
to trigger an investigation.
This is no way for us to practice or for
the pain patient to exist. The pain patient
deserves a safe harbor where they know that
their concerns will be validated, and they
will receive compassionate care.
Victor Hugo Green compiled The Green
Book and Victor Hugo wrote The Hunch-
back of Notre Dame. In both, the issue was
sanctuary. Sanctuary, a safe harbor, is what
the pain patient wants and deserves, and
what we should ensure is there for them.
Dr. Tuckson is a practicing colon and rectal
surgeon.
APRIL 2019
5