While arguing against physician self-treatment, Dr Richer’s argument,1 paradoxically, supports Dr Bereza’s argument.2 I was disturbed that Dr Richer trotted out the addiction phobia to make her case. It actually highlights why the physician-patient in Dr Bereza’s case study might have felt the need to self-medicate. Repeatedly, patients with malignant pain are under-treated because of ill-founded fears of addiction to strong opioids, even though most of these patients need such drugs. The more appropriate argument would have been for Dr Richer to express concern for a physician-patient who might be self-prescribing strong pain medication; I would be apprehensive about the patient’s ability to recognize cognitive side effects, particularly as her illness progressed. Who would be the one to decide if her judgment was still intact? In Dr Bereza’s case study, the alternative offered was in-hospital care; however, her treatment there might not have been any better because of a lack of expertise. It sounds to me that we might have to consider this an example of Dr Richer’s first exception—“an acute and potentially fatal condition for which the physician must treat himself while awaiting the required assistance”1 (that might never come).
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