A pervasive belief exists that physicians take an oath to “first, do no harm” to their patients.
Whether or not doctors raise their hands solemnly, the concept endures because: 1) it signifies the profession’s good intentions 2) acknowledges that patients are vulnerable to their doctors 3) is a humility check.
Because doctors don’t always know best.
Rather “best” changes with the times. Like anything else, we’re supposed to live and learn ... if we survive that long.
We’re bolstered by recent comments that show tolerance for different methods of opioid disorder treatment, as the crisis shows the folly of allowing a single-track approach to set the standard.
Like the oath, it started with good intentions — fixing undertreatment of patient pain.
The pain scale joined baseline assessments of temperature, blood pressure, breathing, heartbeat, height and weight. Trouble was, there was a singular answer — opioids.
The doctors driving the pain train relied on a “study,” saying that only 1 percent of people taking opioids became addicted.
Come to find, the study turned out to be a misinterpreted letter to the editor; the doctors and their institutions had taken millions from Big Pharma; and meanwhile opioid prescriptions quadrupled and the overdose death toll mounted.
A Missouri Medicine publication estimates 165,000 people died from overdosing on opioids from 1999 to 2014, and that physician prescriptions are to blame for half of them.
Authur Gale’s insights point back even further to unintended consequences of a 1970s antitrust lawsuit — that in medicine it emphasized market over patient; that abolishing restrictions meant to lower prices have over time increased them; leaving the health system to shareholders who swear a different oath.
So we can appreciate recent comments that show tolerance for different ways of approaching the harrowing mess that followed.
“What we’ve learned is that to impact the individual, you have to have a conversation,” said Caroline Brunt, a street nurse from Canada who recently spent an evening discussing the problem on a harm reduction-focused panel.
Needle exchanges and opioid-use in treatment are a part of harm-reduction strategy.
“We need to be working together and we need to be meeting people where they are.”
We agree. Individualizing treatment for pain, and opioid use disorder makes sense to us.
Munson Medical Center recently received a $1.5 million grant from the Federal Substance Abuse and Mental Health Administration to expand its opioid use disorder treatment with peer-to-peer recovery coaching and a program for pregnant women.
Twelve-step groups may take a different tack.
The longer we study, the more we learn — about addiction, about pain, about health.
We do know that true listening leads to better outcomes — and that we are stronger together than divided.
The road to recovery may split into many paths, but we see multiple routes as better than a single, fast highway on the journey ahead.