What Your Patients are Hearing

Pain doctor explains liberal opioid prescribing; actor uses skills for science


 

Barry Schultz, MD, once operated a thriving pain clinic in Delray Beach, Fla. Now he is serving a 157-year prison sentence after a conviction of selling opioids on a massive scale.

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In an interview with Bill Whitaker of “60 Minutes,” Dr. Schultz explains: “I’m a scapegoat. I mean, I was one of hundreds of doctors that were prescribing medication for chronic pain. I see myself as a healer. … In my mind, what I was doing was legitimate.”

This role included prescribing more than 1,000 opioid pills to a woman during her pregnancy. She and thousands of others sought drugs from Dr. Schultz, who complied. In 2010, he prescribed nearly 17,000 of the highest-potency oxycodone pills to one patient over 7 months. Another patient was prescribed more than 23,000 pills over 8 months – more than 100 pills a day.

In 2009, more than 2,900 people died in Florida of drug overdoses, mostly from prescribed opioid pills. “In one 16-month period, Dr. Schultz dispensed 800,000 opioid pills from his office pharmacy,” the report says. The massive prescribing spree netted Dr. Schultz more than $6,000 a day, “60 Minutes” reported.

“When I started treating people with chronic noncancer pain, I felt it was unethical and discriminatory to limit the dose of medication. And if I had known that the overdose incidents had increased dramatically the way it had, I would have moderated my approach,” he says in the interview.

According to Mr. Whitaker, more Americans died last year of drug overdoses than during the entire Vietnam War.

Medicine and empathy

For years, actor Alan Alda was TV’s favorite doctor. His 11-season stint as Dr. Hawkeye Pierce on MASH garnered him critical acclaim for his portrayal of the empathetic side of being a physician and human in trying circumstances. In his post-MASH life, Mr. Alda has rechanneled his TV persona and become a spokesperson for the power of empathy for health care professionals and scientists – and anyone who can benefit from better communication.

In a Canadian Broadcasting Corporation interview with Brian Goldman, MD, of “White Coat, Black Art,” Mr. Alda explains that “empathic behavior is medicine.” He cites an example of a physician who had to let a patient know of her cancer diagnosis. “[The doctor] went in and he sat across from her at her level. Took her hand in his hand and talked in very plain language. Didn’t use the word ‘metastasis.’ And, for the first time, she reacted. ... And, for the first time, she asked a question. He came back to us and said: ‘It was just like the mirroring exercise. I was helping her face death, and she was helping me be a better doctor.’ ”

The mirroring exercise he refers to is a part of a workshop Mr. Alda conducts at the Alan Alda Center for Communicating Science at Stony Brook University in New York. The program, which focuses on the role of human connection and communication, has proven popular – and is now taught at 17 medical schools and universities worldwide.

Mr. Alda has proven to be an apt teacher. Now he is a patient, having been diagnosed with Parkinson’s disease about 3 years ago. Only recently did he decide it was time to let everyone in on the news.

“The main reason that I made a statement about it publicly was that … I didn’t want the story to come out in a maudlin way. If somebody saw me, saw my tremor on television then somebody might write an article about isn’t it sad and terrible and awful,” Mr. Alda says.

“I mean [Parkinson’s disease] is not a good thing to have. There’s no doubt about that. But there’s a stigma associated with it which is not helpful to people. And that is as soon as you know you have it, as soon as you get a diagnosis that’s the end of everything, and it’s not.”

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