I wanted Vicodin, not Herbal Tea (nytimes)

We are in the midst of a national opioid crisis. It is a crisis, partially, of our own making. In the past decade we physicians were criticized for not adequately addressing the pain of our patients, to the point of creating another vital sign: “pain score.” And then dutifully tracking this score and catering to it, and addressing pain, often with rehab therapy, with more aggressive interventions, injections, surgeries, and, yes, sometimes with pain meds, including narcotics and anxiolytics.

And on top of this, we layered “patient satisfaction” as a rubric, and now a method of affecting physician reimbursement. What could go wrong? Isn’t satisfying our patients a core precept of our identity as physicians?

Actually, come to think of it… no.

We are here to help our patients get better.

To cure sometimes, to relieve often, and to comfort always.
–15th century folk saying

But there’s nothing in that saying that says “and always write for a narcotic script if you’re in danger of getting a low satisfaction score.

So, here we are, with an opiate crisis, and faced with the very difficult task of reducing or eliminating opiate use in patients whom we have PUT on chronic opiates. So, this NYtimes article is timely and fascinating.

In fact, we are in the midst of designing and implementing an ERAS program (Enhanced Recovery After Surgery) in our health system, to entirely eliminate the use of opiates before, during and after surgery. Apparently pioneered by surgeons at Duke University, we are well on the way to experiencing similar benefits for our patients, faster recovery, reduce hospital stays, higher patient satisfaction.

This is reminiscent of Atul Gawande’s book “Better” where he describes the idea that “If even elite athletes have coaches to improve their game, maybe surgeons should have coaches.” And then finding that having a former mentor observe him during surgery, he received pages of notes on how to improve his operating technique and outcomes. Hmm. We should do more of this, inspecting our usual practices, and working out how to continuously improve.

CMIO’s take? There is always something new to learn.

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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