The Awkward Conversation

With the media revolving around how alarming the current Opioid Epidemic, fingers are being pointed in all directions like a broken lawn sprinkler. And one of the largest pools of blame is starting to drown some physicians. More and more doctors are being held accountable for the amount of pills that they are prescribing, and the gavel is coming down hard.

To be clear, there is no excuse for the profiteering of some doctors that have developed pill mills, passing out prescriptions left and right and being paid off by large pharmaceuticals. There has always been a gray area relating to the pharmaceutical reps wining and dining healthcare providers and how much influence that has on the on prescribing practices. Even if physicians actively say that they are not going to prescribe a certain medication just because they were introduced it by a representative, pharma reps have a large amount of influence.

One of the most overlooked aspects of this situation, however, is the patient-physician relationship. This has been incredibly fascinating for me to explore in the past couple of months and I will definitely dive in further in the future, but right now, we need to pay attention to what it means for doling out opioids.

A physician was killed by a patient's spouse because of his refusal to prescribe opioids. Dr. Graham was known for always encouraging patients and trying to empower themselves to push through the pain--a humanistic approach. And he was shot in the parking lot. There are many other intricacies to this situation like mental health issues of the shooter, but the detail that sticks out to me in this account is that Dr. Graham did not think his standoff with the patient was anything out of the ordinary. That is wild and telling.

Doctors have to constantly confront their patients and take the difficult position, even when it is incredibly uncomfortable. They have to have the awkward conversations that I doubt many other people (even in a relatively confrontational society like here in the States) would like to have. He was trying to do what was best for the patient in the long run, even when it could be easy to just prescribe the pills and have a patient leave the office satisfied and prevent personal harm. That is almost a no-brainer. We should commend the physicians that are trying to wean their patients off of opioids with tough love.

The point is that part of the reason that we are in the situation we are in is because of human nature. Most physicians were not trying to be greedy or evil; they just wanted to do what they thought would make the patient feel the best. And they wanted to avoid the awkward conversation of how to tell someone in pain to just deal with it. That's the difficult part and something that really needs to be examined more.


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