Prescriber’s Narcophobia Syndrome (PNS):

Physicians’ disease and patients’ misfortune

Prescriber’s narcophobia syndrome (PNS) is a professionally disabling neuropsychiatric malady. It strikes physicians who, as medical students, wished to alleviate suffering and improve patients’ wellbeing. Once afflicted, physicians become frustrated by patients in pain and treat them without compassion.

Physicians succumb to PNS early in practice and often for decades. However, brief remissions occur when treating a malpractice attorney, hospital administrator, or someone who reminds the physician of himself or herself. PNS is highly infectious, passed at the bedside from teachers to students.

Usually the victim of a physician with PNS projects obvious verbal and behavioral cues of severe pain. He sees PNS may reveal sadistic sociopathy o a physician wishing for the patient to suffer. This explains forced discharge of patients with persistent pain and prescribing ineffective non-narcotic agents with poor side effect profiles. Alternatively, PNS may uncover a variant of autism in a doctor who is unable to perceive the patients emotions or read behavioral cues. Such doctors avoid eye contact with patients in pain and are hyper focused on their diseases instead of how they feel. Alternatively, paranoid schizophrenia may explain physicians’ bizarre thinking that every patient requesting effective pain relief is a “drug seeker trying to get high.” Supporting evidence includes physicians’ delusional belief that not treating pain will cure the “addiction” caused by desire for pain relief.

The “modified” CAGE questionnaire can identify PNS:

• Do you ask a colleague to Cut down on their narcotic prescribing?
• Do you become Angry when patients claim that narcotics work for their pain?
• Do you feel Guilt after writing a narcotic prescription?
• Do you avoid Eye contact with your patients in pain?

Answering Yes to two or more makes PNS more likely. Initiating prompt therapy for PNS stops the vicious cycle of oligoanalgesia and professional frustration. Educational literature shows the inadequacy of non-narcotic agents for treating severe pain and highlights the safety of judicious narcotic use. Behavioral counselors literally “hold your hand” while you write a prescription for oxycodone and point out increased patient satisfaction.

However, the traumatic approach works best. Begin by kicking the narcophobic physician in the shins to create a non-disabling, continuously painful disruption to daily function and enjoyment of life (the doctor’s recent patients will gladly do this part). Then, the physician is given his or her choice of non-narcotic analgesia o show its relative impotence. Finally, narcotics are administered, offering rapid relief. Consequent is a life altering realization of how much good the physician may do for patients by a change of behavior.

Remember the ethic reciprocity, or “golden rule”. One day every physician will find himself or herself in enough pain to seek out another physician. How would you like that physician to approach your pain?

While I would love to claim this was a satire piece that myself or another CPP wrote, it is actually published in the BMJ (British Medical Journal). The BMJ is one of the world’s oldest general medicine journals. Below is the exact text from the above titled publication in the BMJ. Here is that link.

Citation: BMJ 2009;339:b4987

Here is a QUIZ to determine if you or your physician is narcophobic.