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“If you could kick the person in the pants responsible for most of your trouble, you wouldn’t sit for a month.” ― Theodore Roosevelt (1858-1919)

by U.S. Medicine

June 13, 2017

Editor-In-Chief,
Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

I have spent the past week in a series of meetings hosted by the Federal Drug Administration (FDA) and National Institutes of Health (NIH) to provide a public forum to discuss the national response to the ongoing opioid epidemic. I was serving as the Uniformed Services University and Department of Defense representative on this issue.

I noted that these meetings were focused almost exclusively on what changes needed to occur among healthcare providers to combat the deadly problem of opioid misuse, abuse and diversion. As I have noted in other editorials touching on this issue, we have met the enemy on this problem—and it is us. Healthcare providers have relied on opioids for pain management to the exclusion of almost anything else because they work, are relatively inexpensive and readily accepted by patients. I made comments to this effect on one of the panels on which I was serving, and there was general acceptance of this premise. 

Following my panel, however, a panelist in the next session challenged my contention that healthcare providers were responsible for the current opioid crisis and reminded me, quite correctly, that patients themselves have responsibility on this issue. When one assesses the scope and magnitude of the opioid epidemic in this country, it is easy to recognize that the crisis is incredibly complex and assignment of blame to any one factor or group is an indefensible position. While I remain convinced that the healthcare profession has considerable culpability on this issue, there is plenty of blame to go around, and therefore I stand corrected.

Beyond the favor my colleague had bestowed on me by pointing out a flaw in my discourse on this topic, allowing me an opportunity to refine and improve my argument for the next audience, this exchange got me thinking about the role of patient responsibility in healthcare. Not just patient accountability with opioid use but more broadly with responsibilities regarding their own general health.

My parents come from a generation that tended to venerate physicians and essentially abdicate responsibility for health decisions to their healthcare professionals. Obviously this is a gross generalization, but in my professional experience I have had patients older than I often express, “Do whatever you think is best, Doc!” Perhaps in the distant past when health information was limited to a few physician members in a community and options for treatment relatively simple, this passive approach to health issues by the layperson likely made sense.

In today’s highly specialized and technology driven medical environment couched in the information age, abdicating one’s responsibility for their own health to the healthcare system not only seems imprudent but is likely dangerous. I am often reminding my parents that one medical professional’s opinion only has value until the next opinion is obtained. They are often reticent to seek additional advice after seeing the first professional over concern of offending the physician. I have made it a personal crusade to convince my patients that they must be informed consumers of their own healthcare and that becoming an informed consumer requires seeking diverse opinions from a variety of providers.

Certainly this approach is more difficult and time-consuming. Then again, many folks will visit dozens of dealerships and prowl the Internet for automobile reviews and comparisons investing hours of their lives in buying a car but fail to see the importance of this approach to managing their healthcare decisions. Obviously the impact of making an error in buying an automobile pales in comparison to errors made concerning ones health.  

As I have noted many times in this column, I believe a primary responsibility for healthcare providers is to serve as patient health educators within their own practices. I would suggest it is far more beneficial to the patient suffering from heart disease to discuss a heart healthy lifestyle involving changes in diet, life stress and exercise as opposed to avoiding this discussion until the patient requires medication or a cardiac stent for angina. I am not insensitive to the fact that reimbursement favors prescribing medications or placing the stent rather than taking time to talk to patients. Furthermore, I understand that our profession’s current focus on how many patients a provider sees (throughput) rather than the quality of care provided is also an issue. I am sure depending on your profession, you the reader, can come up with your own examples.

I imagine that nothing I have outlined in this editorial is news to anyone working within the federal or civilian healthcare systems. I am convinced that we, as healthcare professionals, clearly understand the changes that need to occur in how we interact with patients and what is reimbursed for that interaction. We should be rewarding time spent educating patients in healthy lifestyle strategies leading to improved outcomes with far less emphasis being placed on doing things to patients with medications and procedures. I am also confident that our jobs as healthcare professionals would be easier if our patients understood their responsibilities and roles in the provider/patient relationship. Obviously the cultural change in American healthcare delivery that I am suggesting will take considerable time and effort to achieve, which is why we should waste no time in getting started. From my perspective both patients and providers deserve a swift “Teddy” Roosevelt style kick in the pants to start advocating for these vital changes in our system.


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