The foundation of medicine is standardized care; the idea that all medical personnel with a certain level of training will have access to the same or similar information, and will be able to administer the same treatments, no matter where they are or who they are dealing with. Usually a particular problem will have several treatment options that have been studied and proven to be effective, and that treatment is what you will receive no matter where you go.
It isn’t perfect, but it is something doctors take very seriously, and it is a major factor that helps to protect patients. For example, if a patient has chest pain, it doesn’t matter who they call within the medical system. A general physician, a gynecologist, a dentist, and an optometrist will all say the same thing: go to a cardiologist, who will be able to administer the correct standard of care. No matter where the patient first enters the medical system, they will end up in the same place; that cardiologist’s office, which is the best place for them to be.
Addiction medicine is a new field, and standardization of care hasn’t taken place yet. The major care providers generally don’t communicate with each other as they do in other fields. This is partly because of the stigma on addiction that sometimes keeps physicians from broadcasting that they take care of addicted patients; it is also due to the differences in ideology that still divide medicine-based care providers from non-medicine-based providers, and the fact that many treatment facilities are competing against each other for a market share of patients.
For this reason, patients will often not receive the same advice no matter who they first call. Any particular treatment facility will be very motivated to convince the patient their facility is the best, and may not always give the patient a comprehensive overview of all treatment options. I have patients every day who had no idea that medicine was available to treat them, because the first place they called to get help told them that a non-medicine-based approach was the only way. Conversely, physicians may try to prescribe medication without a proper assessment to determine if a particular patient might benefit more from a counseling-based approach.
Medical personnel shouldn’t be devoting their energy to being salesmen, but until a universally recognized standard of care is put in place, differing schools of treatment must compete and sell themselves to patients. This creates an environment where patients may not necessarily recieve the treatment that is best for them, if another treatment is advocated by better salesmen.
Obviously this arrangement isn’t ideal for anyone; patients are not being helped effectively, and treatments are landing themselves patients that may not fully benefit from the treatment they offer. In fact, no rehab treatment facility has been proven to produce better results than any other, and patients should be wary of sales pitches from care professionals, and should double-check all information they receive.
It is regrettable that a patient should be forced to hold that kind of mistrust when it comes to their medical care, but I am confident that the field of addiction medicine will be brought up to the standard of care within a few years, as more physicians enter the field and bring with them the drive for standardization, certification, and accountability.