I work in a methadone clinic with people who are “opioid dependent,” as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Most patients are addicted to heroin, although we see an increasing number of pill people.
I have a very small office, and I try to make it cozy and comfortable for the patients. When they are examined for treatment admittance, patients are usually in withdrawal and not feeling at their best. This may be marked by vomiting, nausea and other symptoms of opioid withdrawal.
A focused physical exam is part of every intake appointment, and this usually includes having the patient sit on an exam table for vitals and a brief screening exam. It is at this point in the visit that patients face my Fisher Price medical kit, still in the box and on the wall from when I graduated from physician assistant school almost 14 years ago — a gift from some friends who helped me celebrate my graduation.
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Seeing the toy medical kit almost always lightens up the mood. This is the case even when patients are in florid withdrawal and feeling terrible. When they sit on the exam table eye-to-eye with the exam kit, they all smile. “That is SO cute,” they say, or “That reminds me of when I was a little girl!”
These comments often come from patients who are living completely marginalized lives, living on the street, in shelters, in cars or in gutters. Many have housing, because we see a diverse patient population spectrum, but they all have two things in common: opioid dependence and a soft spot in their heart for toy medical kits.
This experience reminds me every day that the patients have a mother and father and hopes and dreams like the rest of us. They are not from another planet.
Finding ways to relate to patients by remembering what we have in common can help when treating difficult patient populations. Do you have something similar in your practice? Please leave a comment and tell us about it.
Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.
