This past week I was speaking with a patient, let’s call her Marcy, at her regular appointment. “You’re just not like other doctors,” she said. “How is that?” I asked.
This seems like a good place to talk about the reason that Marcy comes to see me. Marcy has a history of opioid use disorder. She has been on medication assisted therapy (MAT) for many years. For those who are unaware, opioid use can change people’s brains. Some patients are able to taper off of MAT. Others, however, require MAT for the rest of their lives. In fact, they need the medication, much as a diabetic patient might need insulin, to function and to be productive members of society. Inconsistent with popular opinion, the majority of MAT patients do not use their medication to get high. Instead, it is just the opposite, they take their medication in order to treat a brain that fires differently than does one that has not been addicted to opioids.
At this point I must interject that not one MAT patient, that I know of, made the choice to become “an addict.” Instead, something occurred (often many somethings) in their lives that made medicating their pain more tolerable than enduring it. If we go back to the diabetes analogy, this is similar to a person’s body becoming unable to produce, or to react to, insulin. The vital difference, however, is the way that society views the MAT patient versus the way they look at a person with diabetes. The former seems to be viewed as a judgment issue whereas the latter seems to be a case of bad biologic luck. Often the MAT patient is perceived as “less than” and not worthy of compassion, while the diabetes patient somehow is more deserving of this. Perhaps the stigma has been alleviated, just a bit, by the recent fervor surrounding, the mini-series Dope Sick (Macy, B. (2019). Dopesick. Head of Zeus).
Marcy went on to tell me that over the many, many years she had been on MAT, she had had experience with quite a few physicians. According to this patient, most MAT doctors write prescriptions but don’t really speak with their patients. If they do, the questions seem to be cursory. To be honest, I’ve heard this sentiment from a number of MAT patients. More often than not, the patient ends up feeling like a number, rather than a person.
This is even worse when it comes to some specific MAT clinics. Oftentimes patients are given no appointment time and wait for hours to be seen. At many such clinics, patients are required to go through this daily - making things that the rest of us take for granted (like holding down a job) very difficult.
I told Marcy that I view my job, as a MAT doc, as a privilege. I am given the unique opportunity to help a person get their life back. I am afforded trust as I am given the chance to hold space for someone as they recount extraordinarily painful memories. Oftentimes these memories have been “factified” and the feeling and emotion has been erased out of them. This in order to survive.
“No one has ever said that being my doctor was a privilege.” Marcy said, “It’s been just the opposite.” “Then they’re missing the point of doctoring,” I said. And she reiterated, “You’re just not like other doctors.”
That sad statement was meant to be a compliment as Marcy distinguished someone who truly cares from what she has come to experience as the norm.