The opioid crisis is an example of a harm reduction program failure in your country. Replacing a substance of abuse with another less potent but similarly acting substance is not a solution to the probIem specially knowing the biological issues in addiction (these substances actually cause adaptive changes in the brain neurochemistry leading to a defective satiety centre thereby causing cravings and urges). Recovery from addiction is truly a life long process just like in any chronic medical condition (diabetes, hypertension, heart disease, etc) if we don’t go for abstinence, we will not be able to allow the brain to recover from the adaptive changes that has occurred. As far as we are concerned, abstinence coupled with behavioural and family support programs is still the way to go in addictions treatment. The statistics in our program for the last 18 years has a cumulative data of 36% relapse rate after finishing a one year residential program and a lifetime aftercare program made available for free. We also believe that family support and involvement is very important in the process of recovery of the person with addiction that is why we run two programs – one for the person in recovery and the other for the family. I am not sure how the American family gets involved in the process other than allowing the person to just live his/her own life. Over the years, studies have shown that at least 50% of people with substance abuse problem also have a co-occurring psychiatric condition. This can never be ignored since it puts the person more at risk and the process of recovery becomes even more difficult.
We understand that opiate withdrawal is indeed very difficult hence the process of detoxification needs to be comprehensive and all symptoms controlled. They should not be immediately brought back to the community because of the high risk for relapse. Our cultural differences also makes it difficult for me to understand why it is only the right of the substance abuser that is being greatly considered in your programs. The families and the communities also have rights. While they are not the ones addicted, they are greatly affected by the problem. The families specially the children are put in situation of stress and distress, deprived of opportunities and of peaceful lives. The community also bears part of the burden because resources are being poured to this problem when it could be handled better. I am also distressed by what I have recently seen in the streets of New York (last week to be exact) – people slumped/lying on the streets evidently intoxicated and people just passing them by as if it were the most natural occurrence. Also, I have this thought that the programs in this country are highly influenced by what can be covered and not covered by the insurance and what the pharmaceutical companies would like us to believe.
The earlier the results be communicated to the patients the better to avoid any anxiety. It should be done in the most honest, respectful and compassionate way. The patient has the right to know in detail the results and they should be guided and given all the options that they have.
No show for out patient can also be improved on the following strategies:
1. Texting/Emailing/ Social Media and maybe even calls 2 to 3 days prior to consult.
2. Provide a transportation that will shuttle clients to and fro the hospital (if cost efficient)
3. Do a survey on the reason for not showing and address the problems as soon as possible.
4. You can issue them a card to track down their attendance to check up, like point system and they can redeemed their points with something valuable to the clients.
5. You can offer games and other recreational activities that will motivate them to show up or make them look forward to their next check up. It is like offering them an experience rather than check ups alone.
6. Staff training on quality service, same quality in five or more starts hotel.
Physician Dysfunction can be either of the following: incompetent (lacks the skills in providing care), impaired because of medical/psychiatric/substance abuse and disruptive (they are competent but with limited operational style. Almost all problematic physicians belong to the last which is termed disruptive physicians. According to the code of ethics of the American medical association, disruptive physician is defined as a personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care including actions that interfere with one’s ability to work with other members of the healthcare team. Sometimes physicians are not aware of their behaviour so proper education regarding this topic may help you educate them and proper policy should be in place on how to assess them, then after assessment, their fitness for duty should be determined on whether disruptive physician is still capable of practicing without jeopardising patient safety. There are some principles that can be implemented to help promote positive Working relationships:
– Treat colleagues and co workers as valued individual who deserve to have their points of view listened and validated.
– Respond promptly to calls from those with whom you work and show up for meetings on time. Both behaviours indicate respect for others.
– Make a point of trying to mentalize a coworker’s perspective on a situation, recognising that it may be different from one’s own but equally legitimate.
– Be aware of competitiveness and try to minimise this disruptive effect on the working relationships.
– Always be aware of the hierarchical nature of the the work setting and the power differential that is present even when you think it is not operating.
– Remember that racial and ethnic issues may be the most difficult one to talk about and maybe undercurrents in working groups that are never discussed but are secretly observed by all.
– Give feedbacks to other in private so that it can be heard without the effects of humiliation.
– Be aware that strong emotional reactions occurring toward others may be influenced by individual patients and groups/institutional dynamics that are largely unconscious.
Source: Disruptive Healthcare Provider Behaviour An Evidenced Bases Guide
Author: Rade B Vukmir
We have to be professional at all times in terms of our work. Hiring should be based on skills and attitude. Having this problem is quite difficult for you because you are invested in the both of them personally. My suggestions are the following:
1. Bring them to the table for a dialogue and if you are not confident (because they are your friends, then bring somebody neutral and to explain to them the impact of their behaviour to the program.
2. If the dialogue will not succeed then maybe ask them on how can the work condition be modified or improved. Emphasis is given to professionalism and ethics in work.
3. If their relationship is beyond repair and it is hampering on the progress of the program, then maybe look for other substitutes.