[umvi]

> What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor.

That kind of rubs me the wrong way, but I'm not sure why. I like having the option of overriding the doctor if I disagree.

[toomanybeersies]

I understand where you're coming from.

I have a little stack of benzos (valium, xanax, some others) that I use on the odd occasion, despite not being prescribed. Obviously possessing them is illegal. I know that I'm sound enough to know when to use them and when not to, and they've saved me a lot of avoidable pain. I wouldn't go so far as to say they've saved my life, but they've come damn close.

I also use my fair share of recreational drugs, as I've mentioned in previous comments. I know I'm good for them, I practice harm reduction strategies and rave safe. However, I am aware that not everybody is me. There are people who have amphetamine habits, or benzo habits, or {{drug_of_choice}} habits. It's by luck,good planning, and good friends that I don't have a habit and manage to use drugs without causing excessive harm.

That's something that a lot of readers here seem to forget. The average HN reader is very intelligent and usually very capable of looking after themselves (although I am aware there is a fair share of HN readers who've had struggles with addiction). Not everyone is as switched on as the average HN reader though.

[amaccuish]

In the NHS, that isn't possible. You either take the doctor's treatment, or you get no treatment at all. You can go around, asking different doctors, or having a discussion with your doctor, but you will not be prescribed something you don't need. The incentive being, that with a tax payer funded system, money should go to those who actually need it. It is understood here I guess that the doctor is the expert, not you.

[toomuchtodo]

I can totally appreciate this. As an American though, I have gone around my doctor and ordered prescription medications online when they would not prescribe them (ivermectin, anti-parisital, non-controlled substances, almost zero risk to myself if my diagnosis was inaccurate).

[umvi]

Slightly related, sometimes I just want a new pair of glasses without the hassle of going to/paying the eye doctor. I can still see 20/20 with my current prescription, but since it's "expired", physical retailers won't sell me glasses nor will they use their refractometer to read off the prescription of my current pair. So I instead go online and order a pair from Zenni using my expired prescription that I wrote down.

[toomanybeersies]

That's an interestingly unique problem to the USA I think.

Here in Australia, I haven't been to an optometrist in 5 or 6 years. I just keep ordering new glasses for $60 a pair online, my vision hasn't changed enough that I feel that I need to go to an optometrist again. The optometrist is legally required to give me my prescription, which I can then use as I want.

I haven't bought glasses in a brick and mortar store for 5 or 6 years (last time I got an eye test), but I'm fairly sure they won't/can't refuse to make me a pair to my specifications. Actually, I did get a pair made in the shop in Vietnam 2 years ago, and they were more than happy to make them (overnight too, I might add), although they did laugh at how blind I was.

[cm2012]

Could you email me (in profile) which sites you've used? Would love to pick up non controlled stuff online but the sites are all shady.

[toomuchtodo]

Unfortunately, this was almost 6 years ago, and I don't recall the site I used. My apologies!

[skookumchuck]

> The incentive being, that with a tax payer funded system, money should go to those who actually need it.

The idea that people, absent the profit motive, will work solely to the benefit of society is not correct. They're always selfishly motivated - career advancement, risk aversion, corruption, etc.

For example, if the doctor gets punished for prescribing to junkies, he's going to reduce his risk by avoiding prescribing to legitimate pain patients, just to be on the safe side.

Pray you don't get into a situation where you've got painful, terminal cancer and the doctor won't prescribe opiates because you might get addicted.

[roenxi]

Maybe one of the following? These are a couple of takes of that attitude from a few slightly different viewpoints.

* Removal of agency from the patient in relation to how their body is treated; anti-individualism.

* Decision making power assigned to an agent who does not have skin in the game; anti-system-thinking.

* Attitude runs counter to having a strong sense of personal responsibility; anti-some-morality-systems.

* Imposition of doctors value system overrides patient values; not-sure.

[sangnoir]

> That kind of rubs me the wrong way, but I'm not sure why. I like having the option of overriding the doctor if I disagree.

If you're American - my guess is it is cultural: you don't want someone else making decisions for you, rather, they should be making suggestions and you have the final say. American culture extolls autonomy/individualism.

I think this is explains some of the differences between the US and other developed countries when it comes to drug abuse and over-prescription. In the US, the doctors tend to defer to the patient on what's good for them more than elsewhere, especially around pain management.

[stef25]

It would be fair to make choices in the sense of picking a longer treatment that doesn't force you to stay home from work, vs a shorter treatment that would. And of course "another round of chemo" or "I can't be f*cked anymore" are valid choices.

But really, when things like opiates are involved patient input is rarely useful.

[skookumchuck]

> But really, when things like opiates are involved patient input is rarely useful.

Since there is no method for determining the level of a patient's pain, and opiates are for pain management, how can you conclude that?

[stef25]

Yeah, I didn't phrase that properly. Of course patients should communicate how much pain they are in, but they shouldn't communicate the type of painkillers that are to be prescribed.