You're just a DEA number

Yesterday I found myself sitting in group therapy for addicts- no, not what you're thinking- as part of my psych rotation.

No one had given me a heads-up about what I would be doing, and the first few minutes were a blur.  I was snapped out of it by an older gentleman pointing his finger at my face (I soon figured out he was moderating the group).

"YOU.  Tell us WHY WE SHOULD LET YOU STAY HERE. IN 10 SECONDS."

I'm still not sure what I said, but I know I stuttered through my name like 5 times, and that I was a student.  I wasn't really nervous, so to speak, I just had no idea what was going on and what was about to happen.  Was I going to have to get up and sing and dance next?

The others obviously understood my embarrassment and they all voted to let me stay.  (Otherwise I may have had to sit outside the classroom for three hours.)

Experiences like this are an untapped resource in the battle against the lack of empathy in medical students.  I walked into an AA meeting my first year, thinking it'd be interesting to see what kind of patients I would eventually treat.  I walked out of the meeting with the feeling that I had mentally exposed and scrubbed raw every single one of my personality flaws.  Ironically, it was absolutely cathartic.

Not that I have any "addictions" as defined by society- drinking, drugs, etc.  But everyone has dysfunctional ways of dealing with things in life- whether as simple as ignoring a problem or as serious as shooting someone.  Being in the group yesterday, and being forced to participate in my own way, made me really face my own deficiencies.

Medical students have terrible coping skills, in my opinion.  Not that we don't know what is appropriate, it's just that with the amount of constant stress we're under, everything else seems trivial.  It seems ok to use nicotine patches or caffeine pills (at the LEAST!) for marathon studying, or not finding time to eat and hydrate your body during a busy admitting day.  Those aren't necessarily addictions but they're definitely dysfunctional.  During the meeting I had to come up with my own "denial statements," or reasons you give yourself to justify your addiction, like "I'm not going to drive after I drink" or "I had a bad day" or "No one else will know."  Medical students' denial statements would be something like, "Everyone else is doing it..or worse," or "If I don't, I'll fall behind," or "If I fall behind, I'll be a bad doctor and might hurt someone later."

Dysfunctional is an understatement.

I also heard stories of how the healthcare system failed these people, which broke my heart.  How the doctors who gave them their first prescription suddenly abandoned them when their medication regimen exploded into full-blown prescription drug addiction.  How no one had explained to them how bad life could get.  And how families, hurt and betrayed by addiction, stayed quiet in the background feeling helpless to save their loved one, at the time they needed support the most.

The facilitator again walked over and looked down to me sternly, telling me, "YOU'RE JUST A DEA NUMBER." I'm still trying to figure out if he was suggesting a deeper meaning, possibly a reminder that physicians are merely pawns in an era when reimbursement has more impact on clinical practice than outcome.

There are a million lessons to learn here, but at the least:

It's important for us as students and future doctors to realize how we are judging addicts and non-compliant patients for the same poor coping mechanisms.  I would advocate requiring med students attend similar meetings at least yearly, both to be reminded that addiction has a face, a family, and a story, but also to remind ourselves that we can't be the best clinician possible until we fix our own issues.