I recently attended a state medical society’s annual meeting where the agenda consisted of an awards program, several speakers and a keynote address. The highlight of the evening, however, was listening to patients share their stories with the local medical community. We’ve all heard from patients in a formal setting before, so it wasn’t necessarily unique, but as one young mother told her story of being the recipient of a heart transplant, she said something that resonated and has stuck with me since. As her eloquent story unfolded, she expressed gratitude to everyone involved in her care (from her heart surgeons to the personnel cleaning her room whom she befriended) for giving her extra years to enjoy her children and watch them grow. She then pleaded with the medical community to give her even more than that. “Don’t settle. I’m not OK.” Despite her new transplant, she recognized she still only had a limited number of years and movingly described how much a daughter needs her mother when she becomes a teenager, and how much she wants to be there for her. “I’m counting on you. We, your patients, are counting on you.”
I’ve heard from patients over the years about how much we, as physicians, have made a difference in their lives, but it’s usually past tense. This particular story was a stark reminder that even though our job as a physician may often appear to be done, our patients’ struggles continue. As a physician anesthesiologist, one of the most rewarding parts of my job is shepherding a patient safely through their surgery. Developing trust and rapport with a patient and their family, ensuring they have a smooth medical course throughout their perioperative experience, minimizing their discomfort, and seeing them wake up safely provides for an immediate sense of gratification of a job well done. But our job is never really done. We must always remember our patients’ struggles continue for hours, days, or even years to come.
So, why write about this? What is it about “We’re counting on you” that stuck with me? It’s the idea that even in a specialty such as anesthesiology, where immediate gratification is a rewarding part of the job, our role is much greater. Currently, one of the most pressing public health concerns is the opioid crisis. Because of our expertise in perioperative medicine, chronic pain, and critical care, physician anesthesiologists have been helping to battle this crisis on multiple fronts and continue to look for others.
For example, one aspect of the opioid crisis is the concern and struggle parents face given the reports that a large percentage of opioid addictions start in the teen years. A recent nationwide survey commissioned by the American Society of Anesthesiologists asked more than 1,000 parents of children aged 13-24 questions related to pain management and opioid use. Of those surveyed, one-third of the children had been prescribed opioids. Demonstrating the conflict parents struggle with, more than half of all parents surveyed were concerned about opioid addiction, but nearly two-thirds said opioids are more effective than non-prescription medication or other alternatives at managing their child’s pain after surgery or a broken bone. The use of opioids is but one possible component in a comprehensive pain management plan, whether that be in the acute or chronic setting, but are parents getting this information?
In the survey, 59 percent of all respondents said they would talk to their physician about pain management options, but only 37 percent of the parents whose children were prescribed opioids actually did. Additionally, only 50 percent of parents said they stored or would store opioids in a safe and secure place, while only 39 percent of parents disposed or would dispose of leftover opioids as recommended, including taking them to a local pharmacy or health clinic, flushing them down the toilet or mixing them with dirt, kitty litter or coffee grounds before throwing them away. These results demonstrate the need for everyone in the anesthesiology field to intervene and make a difference in the short- and long-term health of our patients. Perhaps it’s the preoperative discussion of pain management goals and expectations about an upcoming surgery and the alternatives available to meet those goals. Perhaps it’s the management of an individual’s chronic pain condition. Maybe it’s educating the public and policymakers about the risks and benefits of opioid use as well as proper storage and disposal, or maybe it’s engaging in research on pain management alternatives. At all levels, we do make a difference, and we can always do more.
Given the current opioid crisis, this example is certainly a timely one. And it’s also an important illustration of how what might be a simple medical issue for our patients in the short term could affect both them and their families for days, months, and potentially years afterward. Their struggles will continue.
It is very easy nowadays to get discouraged. Increasing financial, regulatory and emotional burdens placed on physicians make it difficult for us to do what we love to do … take care of patients. But we should not get discouraged. We should continue to search for ways to help our patients. We should remember those words, “We, your patients, are counting on you.”
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