{"id":18212,"date":"2019-05-16T12:33:31","date_gmt":"2019-05-16T17:33:31","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18212"},"modified":"2023-03-03T15:40:36","modified_gmt":"2023-03-03T20:40:36","slug":"my-mom-didnt-get-the-chance-to-flourish-she-got-painkillers-instead","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/patient-stories\/my-mom-didnt-get-the-chance-to-flourish-she-got-painkillers-instead\/","title":{"rendered":"My Mom Didn’t Get the Chance to ‘Flourish’"},"content":{"rendered":"

I always knew my mom was sick. I knew she went to the doctor a lot, sometimes multiple times a week, and that every day, she took pills from the orange bottles that lined our kitchen cabinet. But until she died in 2009, I assumed my mom\u2019s frequent visits to the ER and our family doctor were par for the course for someone with Addison\u2019s disease, a rare adrenal gland disorder.<\/span><\/p>\n

Last year, to process my mom\u2019s illness and death, and to understand my own risk for her disease, I ordered a copy of her medical records from her primary care physician. What I found astounded me: Visit after visit, my mom would show up at the doctor with an array of symptoms, from headaches and stomach pain to muscle strains and bone injuries. No matter what was wrong, she\u2019d leave with a prescription for an opioid like Oxycontin or a benzodiazepine like Xanax. <\/span><\/p>\n

To this day, I wonder why and how<\/span> this happened. Maybe the doctor\u2019s intentions were good, and he just didn\u2019t know how to treat her complicated illness.<\/span> But did he consider whether his treatment approach truly helped her live a better life?<\/span> Did he think about her teenage daughter in the waiting room? My mom was more than a set of chronic pain symptoms. She was a wife and a mother, and a woman with interests and passions and future goals. When she became addicted to pain medication, she lost it all. <\/span><\/p>\n

I thought about my mom\u2019s battle with opioids<\/span> when I read a recent <\/span>op-ed<\/span><\/a> on the concept of patient flourishing. The article, written by Harvard researchers and published in <\/span>JAMA,<\/span><\/i> makes a fairly straightforward argument: Too many clinicians approach patient care with an \u201canti-disease\u201d mindset, spending most of their time and energy monitoring health metrics, such as blood pressure, and alleviating symptoms. But the ultimate goal of care should be maximizing patient well-being, the paper says, not merely fighting sickness. <\/span><\/p>\n

How can doctors do a better job promoting patient well-being? According to the Harvard team, they can make patient \u201cflourishing\u201d the primary goal in treatment decisions. Flourishing is a multifaceted measure of wellness that accounts for physical and mental health, as well as happiness, life satisfaction, purpose and meaning, character and virtue, social relationships, and financial security. Essentially, by making a conscious, systematic effort to learn more about patients\u2019 personal lives, doctors will be better equipped to assess the benefits of different treatment options.<\/span><\/p>\n

I don\u2019t know exactly what flourishing looks like for every patient with a serious, poorly understood illness. But I know it doesn\u2019t look like the life my mom led and then lost.<\/span><\/p><\/blockquote>\n

\u201cThe idea of flourishing is important when physical health and years of disease-free survival might come into conflict with quality of life, or being able to continue working, or with relationships,\u201d says one of the op-ed\u2019s authors, <\/span>Tyler J. VanderWeele<\/span><\/a>, an epidemiologist at the Harvard T.H. Chan School of Public Health and director of the <\/span>Human Flourishing Program<\/span><\/a> at Harvard University.<\/span> \u201cIn those cases, physical health may be in tension with happiness, or purpose in life, and it is important to weigh those tradeoffs.\u201d<\/span><\/p>\n

For example, if a patient experiences occasional but severe mental illness symptoms, should they take medication that would alleviate their symptoms but most likely cause gastrointestinal distress? <\/span>What about medication that would interfere with cognitive skills essential to their job? Or a form of behavior therapy that\u2019s promising but time-intensive and expensive? The best treatment plan for a single parent finishing out their college degree might not make sense for a childless research scientist. The details matter. <\/span><\/p>\n

In a way, VanderWeele and colleagues aren\u2019t proposing anything new or radical. A flourishing-driven approach to care jibes with the definition of health articulated more than 70 years ago by the <\/span>World Health Organization<\/span><\/a>: \u201ca state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.\u201d It\u2019s hard to imagine anyone sincerely objecting to the idea that quality of life should be an important consideration in treatment decisions.<\/span><\/p>\n

In practice, however, clinical guidelines aren\u2019t always conducive to flourishing. In 1996, the<\/span> American Pain Society introduced the concept of pain as the <\/span>\u201cfifth vital sign<\/span><\/a>.\u201d By establishing a goal of \u201czero pain,\u201d the campaign effectively encouraged doctors to do whatever they could to help patients lead pain-free lives. That same year, the pharmaceutical company Purdue Pharma began vigorously<\/a> <\/span>marketing the painkiller OxyContin to doctors, (criminally) misrepresenting<\/a> the drug as a “less addictive opioid<\/a>.” <\/span>By the early 2000s<\/a>, the FDA noted a substantial uptick in reports of prescription painkiller misuse. And we all know what happened next \u2014 an opioid epidemic swept over the country, derailing and ending<\/a> American lives in record numbers.<\/p>\n

I don\u2019t know how close my mom ever was to \u201czero pain.\u201d But I do know she was far from happy, or able to function, once she became addicted to pills. I don\u2019t know exactly what flourishing looks like for every patient with a serious, poorly understood illness. But I know it doesn\u2019t look like the life my mom led and then lost. <\/span><\/p>\n

Some doctors<\/span> have made it their mission to leave the \u201czero pain\u201d campaign in the past. \u201cWe have an entire generation of physicians who have been taught to treat the pain score, when treating the causes of pain is really the way to achieve flourishing,\u201d says Dr. Stephanie Vanterpool, director of comprehensive pain services at the University of Tennessee Medical Center. \u201cIf we are able to accurately identify and treat the cause of pain, we can help patients improve their function and quality of life, and many times, we don\u2019t even have to use an opioid to do that.\u201d<\/span><\/p>\n

“Sometimes what we need to do is accept limitations. We can still flourish living with our illnesses.\u201d<\/span><\/p><\/blockquote>\n

Vanterpool\u2019s approach, called Targeted Pain Treatment, provides a framework for doctors to consider four possible causes of pain \u2014 anatomical, physiological, functional, psychosocial \u2014 and in turn, treat patients more quickly and effectively with the right combination of localized injections, pain medication, physical therapy and mental healthcare.<\/span><\/p>\n

Flawed approaches to pain treatment aren’t the only barrier to flourishment-driven care. Another issue is time, according to Keith Humphreys<\/span><\/a>, professor of psychiatry and behavioral sciences at Stanford University. <\/span>\u201cThat\u2019s just part of the assembly-line nature of American medicine,\u201d Humphreys says. <\/span>\u201cYou come in in the morning for primary care and there are already 30 people booked, and then you have walk-ins. So even if you want to, there may not be time to find out more about the person.\u201d<\/span><\/p>\n

Humphreys suggests incorporating more healthcare providers who aren\u2019t physicians into primary care. \u201cSome clinics or hospitals bring in clinicians who have more time, like a psychiatric nurse or a behavioral health specialist, after seeing a doctor,\u201d he says. \u201cYou can talk to these people about your struggles, and they can get a little more perspective on your life as a whole.\u201d <\/span><\/p>\n

Still, to make flourishing an achievable goal, patients might need to recalibrate some of their attitudes too. For instance, a patient with chronic nerve pain or a recurrent injury might need to give up the expectation of a zero-pain life.<\/span><\/p>\n

\u201cThere\u2019s something in American life that doesn\u2019t quite want to deal with the thought that not all problems are technically fixable, and that you can\u2019t always be all you can be and have it all,\u201d Humphrey says. \u201cSometimes what we need to do is accept limitations. We can still flourish living with our illnesses.\u201d<\/span><\/p>\n

These kinds of big changes are possible. They require personal work, but they also demand systemic overhauls. In 2017, my home state of Wisconsin enacted a <\/span>prescription drug monitoring program<\/span><\/a>, requiring doctors to review a patient\u2019s records before prescribing medications like narcotics. The same year, the U.S. Department of Health and Human Services issued $800 million in grants for opioid addiction treatment and recovery, which supports the research of <\/span>non-addictive alternatives for pain treatment<\/span><\/a>. And just this year, the Centers for Disease Control and Prevention designated $475 million to fund <\/span>state-based overdose prevention efforts<\/span><\/a>.<\/span><\/p>\n

A decade after my mom\u2019s death, I keep wondering how things would have gone if her doctor had helped her accept her pain. What if she\u2019d sought out mental healthcare, instead of relying on painkillers to get through the day? Would she still be here, playing with her grandkids? I also wonder about myself. I suspect, for me, flourishing means doing the best I can to live in the present moment \u2014 even if it comes with a little bit of pain.<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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