The Doctor's Dilemma

“First, do no harm.” As we weigh the strategies for tackling the opioid epidemic, I have been asking myself how we, as physicians and educators, can best honor that primary ethical commitment in a situation where there are no easy answers. As a psychiatrist, I have seen well-managed pain medication bring immense relief to patients suffering from debilitating pain. But I have also seen lives destroyed by opioid abuse, addiction, and overdose. How do physicians find the right balance between providing treatment and preventing abuse?

The statistics are staggering. More Americans now die from overdoses every year than in motor vehicle crashes. A majority of these overdoses involve prescription medications. Heroin-related overdoses nearly doubled between 2011 and 2013, and four in five heroin users started out by misusing prescription pain medication. This has become a full-blown public health crisis. As health care anchors in their communities, America’s medical schools and teaching hospitals see the impact of this crisis every day.

In education, research, and care, academic medicine is constantly evolving to keep pace with public health challenges and meet the needs of patients and communities. Nowhere is this more evident than in the current opioid epidemic. Nationwide, medical schools are building on existing substance abuse and pain management content that is part of required and elective coursework at nearly all U.S. medical schools. Medical schools augment lectures with a variety of hands-on instructional methods, such as simulated patient exercises, case-based instruction, workshop assessments, and clinical experiences. This strategy of weaving content throughout all four years of medical school strengthens knowledge retention. As they move into residency training, learners continue to work directly with patients to treat pain and learn the best practices for safely prescribing pain medication, especially opioids.

While medical schools and teaching hospitals are bolstering instruction in these areas and providing varied clinical learning experiences, medical educators continue to develop and refine training in other competencies that are necessary to address and prevent patient issues with pain management. For example, integrating effective communication skills into medical school education will serve a physician well throughout his or her career in any number of situations, including navigating difficult conversations with patients suspected of misusing medications or with patients seeking opioids when other options have not yet been considered. Similarly, understanding the physical effects of depression can help physicians treat the underlying cause of a patient’s heightened pain rather than just the pain itself. In some states, including Massachusetts and Michigan, medical schools are working together to identify competencies related to pain management and addiction that they will expect of all graduates.

Medical education, like medicine itself, is evidence based. Educators use emerging information to adapt the ways they teach the next generation of health care professionals to provide care and to prepare physicians with the skills they need to keep up with changes in medicine. While we have a long way to go to fully understand the science behind pain and addiction, NIH-supported research at medical schools and teaching hospitals is generating new knowledge about pain management and pioneering new approaches to treating pain and addiction. And by bringing together teams of health care professionals and partnering with community facilities, medical schools and teaching hospitals are working with local providers to advance these new and evidence-based approaches beyond academic medical centers so that they may reach all patients. For example, when an HIV outbreak in rural Austin, Indiana, was traced back to injection opioid use, the Indiana University School of Medicine worked with the British Columbia Centre for Excellence in HIV/AIDS, the National Institute on Drug Abuse, public health officials, and local providers in an interprofessional and collaborative effort to deploy evidence-based interventions rapidly to contain the outbreak and prevent new cases.

Last October, the Association of American Medical Colleges (AAMC) joined the White House and a number of public and private partners to address the opioid crisis. Working with our nation’s medical schools and teaching hospitals, we are sharing professional guidance and best practices to better educate the future health care workforce about opioid misuse and substance use disorders. Guided by our ethical commitment to “do no harm,” our shared goal to strike the right balance between avoiding medication abuse and preserving access to medication for patients who rely on it to alleviate suffering.

Unfortunately, there is not a single, quick solution to this challenging public health issue. Rather, it will take a sustained, collective effort across multiple sectors. For our part, medical schools and teaching hospitals are committed to equipping the next generation of physicians with the necessary knowledge and skills, promoting cutting-edge medical research, and ensuring access to high-quality patient care to prevent and address opioid dependence and the harm that all too often follows.

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Source: Black Voices Huffington Post
Link: The Doctor’s Dilemma