Monday, November 9, 2015

We Have Met the Enemy, and He is Empathy

We have met the enemy, and his is us.

Walt Kelly (1913-1973), Saying on Pogo Poster

The first patient I saw as a medical student was a middle-aged man asking for demerol to relieve retro-orbital pain. I was empathetic. I asked the attending what dose we should prescribe. The internist supervising my work said, “ Did it occur to you that his man is an addict?”

Richard Friedman, MD, a Cornell professor of psychiatry , says too much empathy on the part of physicians may be killing more white Americans between 49 and 54 from overdose from opioid painkillers than in other advanced nations (“Doctors Enabling Americans, New York Times, November 9, 2015).

Friendman explained the problem:

“ Starting in the 1990s, there has been a vast expansion in the long-term-use to treat nonmalignant medical conditions, like low back pain and various musculoskeletal disorders…through aggressive marketing by drug companie that made new and powerful opioids , like OxyContin…the pitch to doctor seemed sensible and seductive. Be proactive with pain and treat it aggressively. After all, doctors have frequently been accused of being insensitive to pain and undertreating it. Here was the corrective, and who in their right mind would argue that physicians shouldn’t try to relieve pain whenever possible.”

In short, show empathy towards those in pain. But doctors underestimated the addictive power of OxyContin and similar drugs. Opioid use is now reported in 39% of ER visits, costs of opioids skyrocketed 8 times those of non-users, and overdoses from opioids and heroin and deaths rose to staggering levels.

Friedman suggests medical students, residents, primary care doctors and internists, should be intensively educated , trained and warned about opioid risks.

Friedman ends his article with this sad comment “It is physicians who in large part, unleashed the current opiod epidemic with their promiscuous use of these drugs; we have a large responsibility to end it.”

A little too empathy when it comes to relieving pain can be a dangerous thing.