In late March, several news outlets1,2 ran headlines stating that hundreds of Iranians died and others went blind after drinking adulterated alcohol for protection against COVID-19—some of them were children. On a similar note, the Journal of Histopathology documented the case3 of a 41-year-old American who was hospitalized after drinking disinfectant leading to the severe injury of her small bowels.
Other stories include a father who died of COVID-19 after delaying medical help because he believed that COVID-19 was just like the flu, and the couple5 who ingested chloroquine (not intended for human use) leading to the death of the husband and hospitalization of the wife.
[The following post by Monique Tello has been shared with us by Harvard Health Publishing where it originally appeared in April of 2018. In light of increased emphasis on engaging patients in shared decision making, we invite you to add your thoughts about, and experiences with, trauma-informed care in the comment section after reading this post.]
Trauma-informed care: What it is, and why it’s important
by Monique Tello, MD, MPH Contributing editor, Harvard Health Publishing
Why do so many healthcare providers find it difficult to treat chronic pain patients? I have not seen colleagues roll their eyes or audibly groan upon hearing that a patient that is new to their panel has diabetes or cancer, so what is it about a pain patient on opiates that fills so many with dread? Continue reading “The Harried Doctor & Chronic Pain Patients”→
The commonly cited proverb, “The road to hell is paved with good intentions,” was coined in the twelfth century by a French abbot named Bernard of Clairvaux. In no case is this adage more apt than as applies to chronic pain patients, who have been cut off from their longstanding and stable supplies of opiates by physicians who have been convinced, cajoled, intimidated, mandated, and cowed into no longer prescribing high-dose opiates for chronic pain patients in response to the current opiate epidemic. Continue reading “The Orphaned Patient: Treating Chronic Pain with Opioids”→
I came across a 2001 article by Puchalski titled, “The role of spirituality in health care” that I would strongly recommend to anyone who takes care of patients. In her article, Puchalski writes: “Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity.”
According to Puchalski, physicians should incorporate spiritual practice into their interactions with patients. This could happen by physician’s being “fully present and attentive to their patients…actively listen and allow their patients to share “fears, hopes, pains and dreams.” She also recommends that physicians pay attention to “all dimensions of patients and their families: body, mind, and spirit.” Puchalski supports physician’s involving chaplains as members into the interdisciplinary health care team.
Puchalski is an advocate of “compassionate care,” which she defines as physicians walking “with people in the midst of their pain, to be partners with patients rather than experts dictating information to them.” Merriam-Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.”
Puchalski writes that compassion is important because:
While patients struggle with the physical aspects of their disease, they have other pain as well: pain related to mental and spiritual suffering, to an inability to engage the deepest questions of life. Patients may be asking questions such as the following: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me? Will I have time to finish my life’s work?
Studies support Puchalski’s contention that physicians generally underestimate patients’ spiritual needs. Ehman and colleagues performed a self-administered survey to 177 patients in a hospital-based pulmonary clinic: only 15% were asked about spiritual or religious beliefs. Nearly two-thirds of the patients said that they would welcome a question about whether they were spiritual from their doctors while they were taking the medical history. In another study, also a survey, but in primary care clinics of six academic medical centers in three states, MacLean and colleagues report that many patients want their physician to ask them about spiritual beliefs; indeed, this desire for inquiry about spiritual beliefs increases strongly with the severity of the illness. The MacLean study enrolled 456 patients who were dying. Seventy percent of these patients said that they would welcome physician inquiry into their religious beliefs, 55% said that they would appreciate silent prayer, and 50% believed their physician should pray with them.
So what’s the bottom-line? While most physicians focus on the physical aspects of illness, a more holistic approach may be what patients want. Arguably to be complete, physicians should consider discussing spirituality with patients. Christina Puchalski concludes: “I think we can be better physicians and true partners in our patients’ living and in their dying if we can be compassionate: if we truly listen to their hopes, their fears, and their beliefs, and incorporate these beliefs into their therapeutic plans.”
Dr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.
*OPINIONS EXPRESSED BY OUR AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.
It is not enough to simply say addiction is an illness. If we truly believe this, then we must ensure our language and approach mirror how we care for patients with other illnesses.
The need for treatment modification is a hallmark of disease management, particularly for complex, chronic illnesses like diabetes or HIV. We expect that for many patients a typical treatment course will include periods of remission and recurrence with associated adjustments in medication or other interventions. We even have a term for treatment for the most severe cases of refractory disease; we call it “salvage therapy.” For cancer, salvage therapy refers to “Treatment that is given after the cancer has not responded to other treatments.”1 Note that the lack of response is focused on the disease, appropriately, and not the patient. Continue reading “Who is Failing Whom? Moving Towards Person-Centered Addiction Treatment”→
(photo: Massachusetts General Hospital, Boston. Ma.)
June 29, 2017
Dr. Sarah Wakeman speaks about the process that informed her opinion on supervised injection facilities:
Opening supervised injection sites to address the opioid crisis in America is a controversial subject. Dr. Sarah Wakeman, the medical director of Massachusetts General Hospital’s Substance Use Disorder Initiative and Addiction Consult Team, has something to say about it.
As a staunch supporter of evidence-based treatment for patients with substance use disorders, you may hear her expert opinion by clicking on the brief video below…
Do you have an opinion to share as well, or questions for Dr. Wakeman? Use the comment section to start a conversation about supervised injection sites.
Harvard Medical School is offering free online accredited CE/CME courses in identifying and treating opioid use disorder for physicians, physician assistants, nurse practitioners, nurses, and social workers. Each course contains additional resources to assist health care providers in treating patients with opioid use disorder. Select a course below to learn more and enroll:
Dr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School and course director for Understanding Addiction. Twitter
In a 2016 research letter to the New England Journal of Medicine, Dr. Sigmon and colleagues describe the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.1 Interim buprenorphine dosing means offering medication alone to people on a waiting list to get into a buprenorphine treatment program, which generally involves medication plus counseling. This study randomized patients to either staying on the waiting list or getting just the buprenorphine administered at home by an automated and locked pill dispenser. The results were compelling. All of the participants who remained on the waiting list continued to use illicit opioids. In contrast, the majority of those treated with buprenorphine stopped using opioids completely, with abstinence rates of 88%, 84%, and 68% at 4, 8, and 12 weeks (P<0.001 for all comparisons). Continue reading “Waiting for Addiction Treatment: A Deadly Proposition”→
“There is a tide in the affairs of men
Which taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries” William Shakespeare: Julius Caesar, Act 4 Scene 3
This idea of opportunity versus regret from Shakespeare was recently addressed by Anjana Ahuja a science writer for the Financial Times as she discusses the conflicting emotions generated around Brexit: opportunity in the minds of some and regret among others.