To Heal, Not Harm

What role should health care professionals play in the response to opioids? How can reflection help individuals rethink their prescribing practices and identify individual or office-level initiatives to support patients with chronic pain while minimizing the risks of dependence?

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Introduction: One Word Written Responses (5-10 Minutes)

  1. Pose the following questions to the audience prior to reading “To Heal, Not Harm.” Instruct the audience to only use one word as a response to each of the questions:
    1. What view do you believe patients with opioid dependence have of physicians?
    2. What view do you believe physicians have of patients with an opioid dependence?
    3. What is one word you would choose to describe how a patient with chronic pain feels when interacting with a physician?
    4. What is one word you would choose to describe how a physician feels when interacting with a patient who has chronic pain.


Engagement: General Discussion (30-40 Minutes)

  1. Give the audience a copy of “To Heal, Not Harm.” Allow 5-10 minutes to read the passage or simply read the passage out loud.
  2. Ask the audience if they had any questions or concerns. Were there any initial thoughts or reactions? If so, provide a brief window for discussion.
  3. Use the following questions to help generate a much larger discussion amongst the participants.
    1. Who would like to volunteer what their one word responses were for the questions posed earlier? Did anyone have the same ideas? Were any drastically different?
    2. In reading the passage, do you think your one word responses were correct? Where there any sections of the passage that surprised you? If so, what were they?
    3. If you had the ability to change your original one word responses now that you have read the passage, would you? If so, what are some of the ideas that you would change?
    4. How does this passage challenge any preconceived ideas we have about physicians and patients?
    5. How can reflection help physicians assess their prescribing practices and fulfill their aims to improve patient functioning?


Conclusion: Wrap-Up and Next Steps (15-20 Minutes)

  1. Announce that 15-minutes remain for the session.
  2. Summarize the main points of the discussion. What were some of the key takeaways? Were there any differences in opinions? Any controversies? Were any major points about establishing place not addressed in the conversation? 
  3. Wrap up the session by speaking about the manuscript, further efforts, additional resources, etc. Exchange contact information and continue further conversations if needed.


Reading: Excerpt from “This Is Not the Medicine I Want to Practice: One Physician’s Journey to Heal, Not Harm” by Katy Kropf

October 8, 2015

A patient I saw yesterday already had tears in her eyes and a tight face as I entered the room. She was the last patient of the day, so I experienced both that sense of ease that I could take the time I needed, and the sense of fatigue that comes with carrying the stories, concerns, and diagnoses of the ten people before her.

Over the past month, we had tapered her opioid dosage considerably--ten percent decrease for two weeks, then another ten percent for two weeks, then a twenty percent drop. Clearly she was not happy. She is scared that she will be back in “the chair” and not mobile and less functional.

As we talked, her face relaxed a bit and some of her anger dissipated. Toward the end of the visit, she could even offer that her thinking is clearer and she’s less drowsy. But the fear of being “back in the chair” has her scared, and that trumps all.

In each of these interactions, there are moments of panic. How am I going to get through this without reversing my plan or feeling like a jerk? Patients are asking me — and when it comes to opioids, often begging and pleading — how I will fix them? I take a breath, remind myself that it is not my job to fix these hurts that have existed a long time.

I feel the tightness in my face relax a bit.

Somehow I figure out how to steer us toward talking about alternatives. I pull out the sheet of paper with pain management options. Together we work toward some ideas. She agrees to see one of the docs who does Osteopathic Manipulative Medicine (OMM) full time. I had referred her months ago, but now the motivation is greater.

Progress. Softer faces, less tears, still fears. But we are moving forward, both of us a little more confident in the other than when we started.


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