To the Editor:

While I respect Dr. Sanford Brown’s judgment not to do what he’s not comfortable doing, I’m sure I’m not the only one rather shocked by his statement in the July/August 2001 issue [page 48], “I don’t do pain management except for terminal care patients” on the grounds that, over the long term, opiates “are addictive and can often do more harm than good.”

Surely pain management is an essential part of a family physician’s work, and it’s not something that always needs a subspecialist. There are many tools and techniques family physicians can use to increase confidence that long-term opiates are being used appropriately. Patients with chronic pain can live productive and happier lives with the appropriate use of these medications, and the questionable risk of addiction in such patients is of minimal importance compared to the benefits they can bring. All medications can do more harm than good. We should not shy away from using whole classes of effective medication on the basis of vague fears.

Author’s response:

If my judgment not to do what I don’t feel comfortable doing is truly respected, then what is the difference why I beg off the long-term prescribing of opiates, particularly in patients whom I feel are conning me? Besides pain management, it is also within the scope of practice of family physicians to do C-sections, joint injections, herbal medicine, treadmill testing, no-scalpel vasectomies, endometrial biopsies, slit lamp biomicroscopy, breast biopsies, direct nasolaryngoscopy, thoracentesis and chest tube placements. Do all family physicians do all these things as well to help their patients live productive, happier lives, or do they, too, do what they are comfortable doing?