05/20/2016
May President's Message
I was all ready to write the annual recap of the Chapter visit to Washington, D.C., for ACEP's Leadership & Advocacy Conference: “We stormed Capitol Hill, solved all the country's problems while guaranteeing more money for everyone, etc. etc.” I wish. But as I started writing, I kept coming back to an issue very familiar to anyone who works in an emergency department. In fact, this issue has become so familiar, I think many of us have become somewhat numb to it. I know I was. But not anymore. Not after what I heard this week.
Each year the ACEP staff and advocacy folks have a few issues on which we receive training before we meet with our Senators, Representatives, and their staffs. Here were this year's major advocacy issues:
1. Opiate epidemic
2. Mental health reform
3. EMS standing protocols for controlled substances
4. EMTALA-related liability reform
While writing this message, I found myself coming back to number one on the list over and over. I know many of us are just tired of hearing about opiates, and I was no different. When asked about what's going on with advocacy, I would often sarcastically reply "All opiates. All the time." Unfortunately, it was this casual indifference by me and by too many physicians that, in part, landed us where we are now.
I can't work a shift without taking care of at least one opiate overdose, and if it's only one, it now seems unusual. I am no longer surprised by "normal-looking people" coming in by EMS after receiving Narcan. Listening to physicians tell overdose story after overdose story to our legislators on Tuesday, I started to think about it really for the first time. To hear AMA President Steve Stack choke up about pronouncing a 28 year old last week from an overdose, I realized perhaps I had become too numb to the problem.
We can blame our patients and call them addicts who have to live with the choices they make. We can point the finger at the evil drug companies and the FDA. We can yell and scream about CMS, JCAHO, worthless pain scales, and stupid patient satisfaction surveys. But after reflecting on this for the past week and reading Steve's Stack open message to physicians and hearing him speak in Washington, I can only conclude that it is time for a change.
Will I withhold pain medication from patients with acute pain? Of course not. Does this mean that I won't prescribe opiates anymore? No. Will I prescribe opiates less often? Yes, and when I do, it will be for fewer days. Talk to your partners, your group, your hospital.
Remember those Opiate Prescribing Guidelines that Ohio ACEP worked on with so many others that had to be taken down from our waiting rooms and exam rooms because of EMTALA concerns? You can still use them at the end of the visit to help show patients why you're prescribing what you're prescribing. I sometimes print them out and give them to the patient. Here's the link. Use it. Print out a stack of them if you need to for your fast track.
One of my favorite motivational workout phrases is "If nothing changes, nothing changes."
It is time for a change.
Michael
Michael J. McCrea, MD, FACEP
President, Ohio ACEP