“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)

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.

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