Thursday, January 16, 2020

The Politics of Blame

Over the last couple of debates, as I've been watching Amy Klobuchar and have been mostly impressed with her performance - notwithstanding her calling Medicare for All a "pipe dream" - I have been aware that I have had reservations about her since last summer because of something she said in a debate. And it didn't have anything to do with her policy positions being "pragmatic" instead of "progressive."

No, it was something she said to which I recall having had an immediate, personal, visceral reaction. And today, having watched the last debate before the Iowa caucuses, earlier this week, I tried to remember what it was.

So I searched my memory, and then Google. It was something she said that reflected on my profession and my specialty. It was about addiction to opioids. And it wasn't in response to a question on that topic. It was the lead in her closing statement - a part of the debate when viewers tend to listen very closely.




After thanking the city of Detroit for hosting the July 30 debate, she said:

"To win, we have to listen to people. And out there today is Casey Jo's mom. Casey Jo was a champion high school swimmer from a small town. She got sick, went to the emergency room, and got hooked on opioids. The last thing that she said to her mom was, "Mama, it's not my fault."  And she died."

To be fair, Senator Klobuchar did blame pharma, but that seemed to me an afterthought, probably because she led with "the emergency room." And we all know that what you lead with gets the most attention.

And the way she related it?

"She got sick, went to the emergency room, and got hooked on opioids."

I can tell you this: in emergency medicine we don't typically prescribe opioids for "sick," unless "sick" is terminal cancer with spread to places where it causes severe pain, or maybe kidney stones. And broken bones, which are not "sick."

I am fed up with people blaming emergency physicians for opioid addiction. There are studies that show even an initial, very limited Rx for opioids can put some people at risk for addiction. My colleagues and I know this, and we are judicious in prescribing. The percentage of all Rx pain killers prescribed by doctors in my specialty is tiny - and getting smaller all the time.

How sensitive are we to this issue? I'll tell you how sensitive.

In September of 2018 I fell and broke ribs. I knew I had broken ribs the moment I picked myself up off the floor, because I know anatomy and patterns of injury. And my diagnosis was confirmed by the fact that the area was very painful with breathing or movement of my torso and stayed that way for 6 weeks.

Guess what I didn't do? I didn't go to the hospital. I didn't need x-rays to make the diagnosis, and I knew no one would treat my severe pain with a prescription for a narcotic pain reliever. The cowboy in me would have to "walk it off." That's fine when you're walking, but I didn't get a decent night's sleep for over a month.

You read that paragraph right: I knew no one would prescribe a narcotic pain reliever for one of their own. That is how sensitive we are to the risk of addiction.

Yet Senator Klobuchar led her closing statement by talking about opioid addiction, and said it happens in the emergency room, to people who go there because they are "sick."

She's not my first (or second) choice, but I think Amy Klobuchar would make a fine president for this nation. I hope and trust that she would have smarter people advising her on matters of policy and how to frame them in her public speaking.

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