The doctor-patient relationship is based on trust. The patient trusts the doctor. The doctor trusts the patient. This two-way street is undermined by urine drug testing. When a patient is presented with a cup, the doctor is in essence telling the patient that "I do not trust you". Because of this, I have been and continue to be uncomfortable about urine drug testing in medical clinics. For years, I have relied on my observational skills to determine if someone is showing signs of inappropriate chemical use.
Why do I care about inappropriate chemical use? I am not the police. However, I am concerned about safety: safety of my patients and safety of the public. If a man is using his wife's Valium in conjunction with what I am prescribing him, I need to know about it because he just drove himself to my clinic. If a mentally challenged woman is using methamphetamine along with the medications that I am prescribing, I need to know about it so that she can get more appropriate care that addresses her addiction. Both of these scenarios occurred in my clinic this year. If it was not for the fact that I started a urine testing program late last year, I would not have known about these potential dangerous situations.
Quite frankly, I am sad that I feel obligated to do urine drug testing. On the other hand, I know that not everyone is honest. Until someone invents a "truth meter", I have to use more than just my observational skills to guide me. I would hate to miss a potentially dangerous situation that leads to a death or great harm.
Urine drug testing is a diagnostic tool that provides a piece of a puzzle just like an EKG or an X-ray. A person should not be judged solely based on one piece of the puzzle. All diagnostic tools have limitations and should be used wisely. As a picture crystallizes and becomes clear, a dialogue can begin to take shape with full transparency.
Even though urine drug testing is part of many clinic protocols, a doctor must be able to recognize variability and individuality. Seeing this entire picture requires independent thought, not clinical pathways and protocols. Practicing medicine is still about the doctor-patient relationship. And trust is always between people. So, how do my patient's feel about my new urine drug testing policy? Some did leave my practice; most trust me to do the right thing for the greater good. I only wish that someday I can trust everyone.