Tuesday, July 3, 2007

A Different View

I thought I’d show you an alternative version to my most recent post. Dr. J, over at Adventures in Medicine, has studied addiction for a bit and works with people in areas of Canada where, I imagine, addiction is a major social and economic problem. He has a differing opinion of the drug seeking behavior that is in stark contrast to what many physicians would agree with, but it’s one that definitely holds merit.

Personally I’m not saying that drug seekers should be instantly turned away. After all, they are someone’s kid, possibly a parent, and most likely have at least a couple people who love or care about them. Therefore they should not be instantly vilified for poor life choices and neurologic or chemical changes that force them to “seek”. What I was trying to convey in my post, though, is the tremendous amount of resources that are lost on people like this just so that they can satisfy their “Jonesing”. It’s really quite sad to know that someone might lose a bed because a Demerol junkie needed a fix and the hospital caved.

Now, after reading the well formulated post by Dr. J, I would admit that his method seems to be a better way to handle drug seekers at their intial intake: by being forthright with them. Let them know upfront you’re not going to give them drugs, but that you can help them with treatment should they want it. Make it their decision to seek the proper healthcare rather than shuffling them off onto inpatient teams many times over who will spend days and thousands of dollars “treating” a malingerer. It’s a good thought process and I think, as medical personnel, it is essential to always remember that the vagrant, the asshole, the annoying drugged out jerk in bed 3 is still a human being.


Liz said...

Thanks for linking to Dr J. The post was really interesting but i assume that i will end up acting/thinking like you instead. I guess it's hard not to be mad and frustrated. After suggesting "detox" to 10 patients with maybe 1 accepting and the rest going elsewhere to seek their drugs, i think i might be a little jaded or fed up with Dr J's approach. But it's great that he can be so patient! :)

Dr. J. said...

Thanks for the link MSG! Yes most people will refuse your offer for detox or treatment, but the trick is in how you present it. When you give folks with addiction an honest assessment and offer them help, in a kind way, without blame or judgement, but with very clear boundaries, they may initially refuse (Forget it doc! I'm going to find someone who will help me!), but suprisingly over the coming days and weeks some of these folks will trickle back in when you happen to be working and rather than their usual presentation they will want to talk about what you offered them when they saw you previously.

Like Liz says above, it's easy to get angry and frustrated. The problem with anger and frustration is that they really sap your own energy to live a good life, while patients tend not to notice. For me, a systematic and consistent approach no only offers better care to the patient (I think), and cost savings to the system, but also eliminates a lot of the personal emotive response to difficult patients that saps my own energy.

Getting angry or frustrated about other peoples bad decisions is a road that leads to a bad ending for doctors (not just with addictions.....people make amazingly bad decisions when it comes to all aspects of their health). The whole trick of this approach (from a personal perspective) is that it ties your job satisfaction more to your ability to offer good care, than to the patients decision about accepting care or to the conflict that may result....
Dr. J.

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