The Hippocratic Oath or Hypocrisy

The Hippocratic Oath or Hypocrisy

(Editor’s Note: In November, California voters will decide the fate of Proposition 46, which would require random drug and alcohol testing of doctors. The California Medical Board would be required to suspend a doctor pending the investigation of a positive test and take disciplinary action if the doctor was impaired while on duty. Proposition 46 would also raise the state’s cap on damages in medical negligence lawsuits to over $1 million from the current cap of $250,000).

Physician groups have expressed dismay at a requirement to be drug tested under a stipulation in California’s Proposition 46. The fact is that doctors who treat chronic pain often require their patients to submit to random drug tests in order to receive pain medication. Moreover, the entire medical literature contains approximately zero objections by any healthcare provider or researcher to this drug testing.

I discovered by accident that Medicare was being bilked by physicians through drug tests. Medicare data reveal that between 2000 and 2009, drug testing increased over 4,000%, while the Medicare population grew by only 16%. More specifically, office drug testing by anesthesiologists during that same time period increased over 3,000,000%, and anesthesiologists commonly treat people with pain.

urine testAs a result of the huge increases, Medicare began investigating and changed their reimbursement rules. Also, drug testing labs have been prosecuted and fined for misconduct, including providing kickbacks to doctors for drug testing their patients.

Let me repeat that: Doctors were receiving kickbacks for drug testing their patients. It is worthy to note that the California Medical Board neither investigated nor took action against any California physician who may have received kickbacks.

Medical errors in the United States cause an estimated 100,000 deaths per year and 1,000,000 injuries. The California Medical Board estimates between 10% and 15% of California licensed physicians have substance abuse problems (10,000 to 15,000 physicians), while the national average is around 14 percent.

Anesthesiologists are especially vulnerable to addiction and have some of the highest rates relative to other specialties. Doctors are human and suffer from addiction and other maladies like everyone else, but they should not be practicing medicine under the influence. This is a public safety issue.

There is a large power disparity between the doctor who heals, and the patient that is in need of help. Physicians can do great harm to people if they are abusing drugs and alcohol and thus it is unconscionable that any doctor would argue against their profession being drug tested.

I ask the same question that pain doctors may ask about their patients — what do they have to hide?

Although many physicians drug test their patients, they oppose being tested themselves. Apparently, doctors are confused between the Hippocratic Oath, and being hypocrites.

Mark Collen is a chronic pain sufferer, patient advocate, founder of, and serves on the editorial board of the Journal of Pain & Palliative Care Pharmacotherapy.

National Pain Report welcomes opposing points of view on issues affecting the chronic pain community.

Authored by: Mark Collen

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Pay me $150 an hour to go take the drug test. Allow me to sue you for tens of thousands of dollars if you get my test wrong and let me randomly drug test you as well, since well, you drive, climb ladders, have to fill out taxes, interact with children and do many other important things. Doesn’t sound good to you? Didn’t think so. Don’t like it, then don’t come to my office and take care of yourself when you get sick.

Brenda Alice

I think its a great idea. All should be randomly tested several times a year along with the office staff please. It should apply to all doctors. I lost my loved father because of a incompetent surgeon that is still operating. All hospital nurses are randomly tested.

I recently had a drug screen come up + for alcohol. Not necessarily illegal, but I do not drink & answered as such to the pre-?’s. I also had a kidney (NOT bladder) infection, which can cause a false + if the urine sits in the kidney/renal tubules too long w the bacteria. As an RN I knew this but my practitioner did not-& refused to look it up. Cross contamination if running large test batches will too. The lab told her it was prob false positive, but I have been subjected to unnecessary UA’s for 3 mo now. What kills me is that other than this, I haven’t had a single + drug screen since starting w this clinic in 1999. Its for the $, as she charges for doing a dipstick test, then.sends it to the lab for a $360 retest! Before Medicare raised hell- the charge for both UA’s was $1200+ !!! All for someone w a 15yr history of clean drug screens & is active in anti drug programs for school kids!

As a medical professional I have worked with medical providers who were obviously inebriated while on the job, seeing patients This is not only an embarrassment, but should be scrutinized by the profession who is doing the scrutinizing of their own clientele. The very idea this group, if any representation of the group as a whole, thought this was above them is the height of irony on my opinion.

Show, by example to your patients, that you are above reproach and submit to the very same testing you demand of them. This would go a long way in making a pain patient feel less like the drug addict they have been made to feel like by this relentless proving that they are on the right medications and are not on the wrong ones.

Enough is more than enough. Maybe medical providers would feel this way after test number 6 for the year.

************** SEPTEMBER IS PAIN AWARENESS MONTH ***************


Drs and especially surgeons need to be drug tested for drugs that may affect their judgement, randomly and frequently. This includes alcohol and drugs like ambien. Maybe the cap being raised in damages in medical negligence lawsuits will also have a impact.


What many people (including physicians) don’t understand is that urine drug screening test have high levels of inaccuracies. Even the gold standard of GC/MS is no better than 90% accurate at all of these newly formed “testing labs” for 3 reasons. 1) They do not take the time to maintain the equipment properly. 2) None of them employ competent employees that can correctly prepare and analyze samples and interpret the analysis. 3) They all purchase sub-standard equipment pushed on them by sharp tongued salespeople. They use terms like “ultra-fast triple quadruple scan speeds.” and “100-fold increase in full scan MS/MS sensitivity, to enable powerful workflows” plus the term 99.9% accurate. The best research labs in the country with equipment that cost 5 times more than these high throughput labs use, plus they have chemist with a Masters Degree operating them. They are not over 97% accurate for the easiest test which is for cocaine. If a urine sample from someone that has liver disease, kidney disease or have had radiation/chemotherapy treatment for cancer the research labs cannot get better than 93% to 94% accuracy. A high throughput lab will not get higher than 90% accuracy. So, If anyone ever receives a positive for any reason you should request a confirmation test from a laboratory of your choice. Chose somewhere like the Mayo Clinic, John Hopkins University or Stanford University Research Lab.