The President’s Podium: Physicians, Opioids, and Guns

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

From Medicare to electronic medical records to telemedicine, physicians are facing a variety of issues this year. Here’s a look at three that our medical society will focus on in the months ahead.

A renewed spirit by physicians about our profession
In my inaugural address upon becoming president last May, I spoke about the declining satisfaction within our profession. While Dr.DimitriMMS (4)recognizing that physician stress and frustration have increased, and that the business of medicine has added roadblocks to our practice of medicine, I urged physicians to remember how we affect the lives of our patients, that they look to us to help them overcome their problems, and that it is our privilege to do so.

As we continue to deal with the changing aspects of our profession, let’s remind ourselves that we enjoy enormous public respect and prestige, and that we make a difference, every day, to our patients and to our communities. I believe this topic to be so important, in fact, that our Educational Program at the annual meeting in May will be built upon the theme of Sustaining Joy in the Practice of Medicine.

Reducing opioid and prescription drug abuse
The MMS has taken a leadership role in the Commonwealth in combatting opioid abuse, and our efforts in this area are a prime example of how physicians can make a difference. We have developed prescribing guidelines for physicians that address pain management and addiction and have educated patients about safe storage and disposal of opioids. We have sponsored forums and summits related to opioids, and worked with public health and elected officials in improving prescription monitoring and creating strategies to reduce prescription drug abuse.

Despite those efforts, along with those of law enforcement, state officials, legislators, and many others, the numbers of overdoses and deaths continue to rise. Further, a recent study by Boston Medical Center, showing that more than 90 percent of people who survived a prescription overdose were able to get another prescription for the drug that almost killed them, demonstrates just how hard this problem is to solve. Though many of us understand the complexities that drive continued prescribing in some of these situations, studies like this can cause physicians to close what the study authors suggest are “major gaps in communication, education, and oversight” despite our deep concern about opioid abuse.

I told MMS delegates at our Interim Meeting in December that the opioid crisis is our medical society’s top issue. It remains so, and we will continue our efforts to curb opioid misuse, while at the same time ensuring that those patients who truly need help for chronic pain will be able to get it.

A new focus on physicians and gun violence
Gun violence has continued to be one of the major issues in public health. Last March, MMS took the occasion of Doctor’s Day to raise awareness about this issue, and specifically, preservation of the right of physicians to discuss the subject with their patients. Unfortunately, the 2011 Florida law making it illegal for physicians to ask patients if they own a firearm or record information about gun ownership in their medical record was upheld in December for a third time in a decision by a three-judge panel of the U.S. Court of Appeals for the Eleventh Circuit.

According to reports, the panel’s opinion was that “the law fits well within the traditional authority of the states to define and regulate the practice of medicine.” Not to be deterred, physicians will appeal for a third time to have a full court review. This remains a critical case for physicians, as it has national implications and directly affects the physician-patient relationship.

MMS physicians have addressed violence intervention and prevention in many forms, and gun violence is as appropriate for physicians to study as youth violence, partner violence, or human trafficking. To that end, our 2016 Public Health Leadership Forum, Firearm Violence: Policy, Prevention & Public Health, will seek to provide practical information for physicians on gun violence and what we can do to protect patients from harming themselves or others.

Physician satisfaction, opioids, and gun violence certainly will not be the only subjects commanding the attention of our medical society in 2016. But each of these three is a major issue growing in importance with critical implications for both physicians and patients. Each also speaks to the mission of our medical society: to “advocate for the shared interests of patients and our profession.”

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dimitri’s commentary on a range of issues in health and medicine.

  1. Michael Nancy Amsden MD says:

    Been out here working since 1973. This epidemic has for its beginnings the physician bashing that “we were not listening to our patients and not treating chronic pain.” Next doctors gave pain meds. Then the prescriptions suddenly disappeared or were stolen. Then the patients came in droves to the Emergency department after hours(of, course). Begging, conniving and doing anything for Vicodin and Xanax and Soma. Now this continued. We were judged by patient surveys which were returned by the angry patients because their narcotic requests were declined. Then came pain mills. Personally I only took narcotics for 2 days after my c-section and my lap chole. Yes it hurt but I managed. We seem to have a culture which is unable to endure even minor discomfort. I have cared for hospice patients since 1979. They get what they need. We monitor carefully and teach,teach,teach. The only way EMR could help is to see who got what, from whom, when….. so far that is a pipe dream. I hope we can stand together on this ….

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