When asked how I manage wearing the different hats of pediatrician and president of the Tennessee Medical Association, the state's largest professional organization for doctors, my answer is always the same. It's all about the patients.
As physicians, we endured years of education and training to earn the right to become a physician because we want to help people. We are healers by nature and view the medical profession as not a job, but a calling. That inherent passion is still what drives me on a daily basis, whether I am interacting with my patients and their families, or working with my peers in TMA to advocate for our profession and our patients.
Of course I become frustrated when parents make poor choices that adversely affect their children. I can see the long view of what medical and psychological problems those choices will yield. However, that frustration leads me to understand that I have information that the parents don't have. And they have challenges that I can't always see. It's a partnership, and my job is to love, to educate, to support, to encourage, and to anticipate consequences of the choices made.
That role for me is as consultative as it is medical. We have a responsibility as physicians not just to diagnose and treat, but also to actively engage our patients in conversations around important healthcare topics and good decision-making. I work hard to develop a rapport of trust with my patients and their families who look to me for advice and answers to their questions. It's an incredible responsibility, and one that I do not take lightly.
The pediatric community has a responsibility to challenge parents and their children to make the lifestyle changes they need to improve their health status - changes that our society needs to ease the financial burden on our healthcare system. We must encourage families to eat healthier, more nutritious meals. We must teach patients who are less educated and living in lower socioeconomic strata how to overcome food deserts. We must be a resource to support parents in moving away from sugar and fast food to fruits and vegetables. We must help them understand that nutrition is not just about weight and appearance; it directly affects a child's sleep, energy level, alertness, performance in school, and emotional well-being.
We must also counsel our patients and families to get more physically active. Physical education is all but gone in public schools, making it even more important for parents to promote physical activity at home. My generation and those before me played outside. More recent generations are inside in front of a screen - TV, computer, smartphones - obstructing their sleep, and their intellectual and physical development. Electronics and smart phones didn't come with instructions, and we are just now seeing the aftereffects of the electronic invasion into our families.
Switching hats as TMA president, my primary focus is still on patients and finding more effective ways to fight the biggest public health crisis affecting our state and nation - the opioid crisis.
Tennessee for years has been ranked among the worst states for prescription drug abuse, overdose deaths and Neonatal Abstinence Syndrome (NAS). Physicians have contributed to the supply of what we initially thought were helpful drugs. Now that we know the risks of addiction, we have worked hard to change the prescribing culture within the medical community. Data shows a drop in the total amount of opioid prescriptions for pain in the past five years, and a report last year National Safety Council listed Tennessee as one in just four states "making progress" in the fight against prescription drug abuse.
TMA and other concerned stakeholders in and outside of the healthcare community have helped create rules requiring pain management education for prescribers, issued state-sanctioned opioid prescribing guidelines, and strengthened laws regulating pain clinics or pain management services. The Controlled Substance Monitoring Database (CSMD) has reduced the incidence of doctor shopping by 50 percent since 2011. It's much harder now for addicted patients to fraudulently obtain prescriptions from a legitimate healthcare provider in Tennessee.
We have made progress and can point to some measurable results, but we still have a lot of critically important work to do. The number of overdose deaths continues to rise even though prescriptions are going down. We have to continue identifying, educating and penalizing healthcare providers who are overprescribing, inadvertently or otherwise, and weed "pill mills" out of operation. The CSMD, along with stronger regulations for pain clinics and pain management services, has helped, but we must do a better job educating doctors, nurses and physician assistants on safe and proper prescribing habits by incorporating screening based on diagnosis and patient scenarios.
Options and funding for addiction treatment are limited across the state. We will continue to advocate for more funding to treat addition. We have to decrease the stigma associated with opioid addiction and treat it as a chronic disease, routinely requiring more than 24 months of medical intervention.
Finally, we have a responsibility to continue educating our patients and the general public at every turn about the dangers of opioids and how to safely and properly dispose of unused drugs.
As the Tennessee Medical Association continues to support physicians in navigating patients through this complex world of medicine, our focus will always be patients first.
National Safety Council Prescription Nation
TDH Controlled Substance Monitoring Program