Those practitioners who remain find time in short supply. How much time does it take to distinguish between the genuine patients who need drugs like tramadol to get a better quality of life, and the drug abusers who want to get high or the dealers looking for product to sell on the streets. There is an alarming rate of prescription medication abuse in the U.S. and the physicians don’t have the time to make a proper diagnosis.

It’s a sad fact of life that not enough doctors are coming through their training and entering general practice. The majority reject the longer hours and poor pay in favor of the high status and better paid work in hospitals. The result is towns and cities find themselves without primary healthcare, an accelerating problem as older doctors retire.

The best that they can do is to react to the symptoms described by their patients. That means a quick prescription of tramadol instead of a more holistic approach. In a perfect world, the physician would look at the patient as a person losing mobility, under threat at work because the lifting and carrying is too difficult, friendships and marriage under pressure because this is all too stressful to manage. As it is, there is a single irony. Patients come to doctors because they cannot cope. The few doctors struggle to cope because so many people are in pain and need help.