The Song of Our Scars by Haider Warraich

Author:Haider Warraich
Language: eng
Format: epub
Publisher: Basic Books
Published: 2022-04-19T00:00:00+00:00

In the middle of my intense shifts in the hospital during my residency, the daily noon conference was an oasis. No screeching pages, medical emergencies, or mountains of paperwork. Just an uninterrupted hour of teaching. We medical trainees sat on chairs in a large classroom and discussed interesting cases, learned critical factoids, indulged in gallows humor, and, perhaps most importantly, put food in our restive bellies. It was a daily reminder of why I wanted to be a physician.

When I look back, those conferences blur together—except for one. Instead of diving into another medical mystery, one of our chief medical residents, John Mafi, read out a note that a recent graduate of the program had sent him. His name was Kevin Selby, and he had moved to Lausanne, Switzerland, where he was completing training as a primary care physician.

John read the email aloud to us as we continued to mow down our lunches (I want to say it was burrito day). It wasn’t really clear to anyone why John decided to share the email until he reached the very last thing Kevin wrote to him, something so outlandish and fantastical that it silenced the room. Kevin wrote to John that in his six months of clinical practice since leaving the United States, he had not prescribed a single opioid.

Like many of my colleagues, I could barely go a few hours without prescribing opioids. It was my understanding that I couldn’t actually perform my job if I couldn’t manage people’s pain. I had been trained alongside the rest of the doctors in this country that the only way to help those in pain was to offer them an opioid; yet Kevin’s account seemed to challenge that notion.

I recently asked Kevin about this when I caught up with him. “The goal was zero pain. The culture was that you hadn’t really taken anyone’s pain seriously if you hadn’t given them opioids,” he recalled about his time in Boston over the phone from Switzerland.

Kevin felt even more pressured when he was working in the emergency room rather than the clinics or wards. “We were told that we had to treat pain fast, that it was unacceptable for people to be in pain and the way to treat pain fast was to give opioids.”

This was very different from his experience in Lausanne. But he wasn’t seeing fewer people with chronic pain. Studies show that Americans are not much more likely to have chronic pain than Europeans. The difference was how European doctors were trained to respond to it.8

As a resident, it seemed as though not being able to give opioids for chronic pain was like playing baseball without a bat. As I would later learn, though, that was because I had been asked to play a losing game. In fact, almost everything I had been taught about pain and opioids was wrong.

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