2017 Issues   /   Editor in Chief

“We learn from history that we learn nothing from history.” —George Bernard Shaw (1856-1950)

By U.S. Medicine

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

This past week, I attended the Uniformed Services Academy of Family Physicians (USAFP) annual meeting in Seattle. I was there representing the Defense and Veterans Center for Integrative Pain Management (DVCIPM.org) as the organization director on behest of Maj. Gen. Jeffery Clark the current director, Operations Directorate Defense Health Agency (DHA), and a family physician. Maj. Gen. Clark has made pain a priority topic for DHA and wanted DVCIPM, the Center of Excellence for Pain in the DOD, to be on hand exchanging ideas and leveraging our pain management products with primary care docs.

Since most pain in healthcare is first managed in the primary care environment, this effort not only makes sense but probably is long overdue. Perhaps that is why Maj. Gen. Clark is a general.

The meeting went well, and we had the opportunity to expose federal primary care physicians from across the nation to new ways of thinking about and managing pain in their patients. For the pain discussion, the highlight of the meeting was an afternoon session on primary care pain management co-chaired by Maj. Gen. Clark and Dr. Diane Flynn, who serves as the Madigan Army Medical Center primary care pain management adviser. This session was a refreshing exchange about new ideas concerning nonpharmacologic approaches to managing pain.

Frustratingly, despite general agreement that integrative medicine approaches to pain were critically needed, there was considerable discussion about the overall lack of these services, because many treatment approaches such as acupuncture or massage are not covered by TRICARE. This discussion was particularly disturbing to me because of what I had observed on my short walk to the meeting conference center that morning.

Our DVCIPM team was staying at a hotel near the USAFP meeting. The walk to the meeting venue took us past McGraw Square in downtown Seattle. As we passed the square, we were shocked to see drug use paraphernalia casually scattered on a stone bench. A colleague took a cellphone photograph of the appalling scene (Figure 1). To be clear, this is not an indictment of the fine city of Seattle which I have always enjoyed visiting. Based on the growing death rate from illicit opioid use, I am sure the scene I witnessed is a common sight in many American cities today. What struck me was the juxtaposition of this public display of the tragedy of addiction being played out next to a conference filled with physicians struggling with the challenges of managing pain with anything other than pills. Sadly, with the exception of our interest, the local Seattle passersby barely even noticed the occurrence as extraordinary.


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