Louise Haynes, MSW
Medical University of South Carolina
Have you ever heard the term "Goomer?" It's the acronym for "Get out of my emergency room" and was the 1970s term for a person who would be later called a "frequent flyer"--someone who was seen repeatedly in hospital emergency departments. The person often had a mental illness, substance use disorder, or both. "Goomers" were reviled by medical residents working in emergency rooms because they required lots of time and attention, and visit after visit, they never seemed to get any better. For many physicians, exposure and training in the treatment of addiction has consisted of caring for the down-and-out emergency room patient who barely survived from crisis to crisis. Physicians-in-training rarely, if ever, saw substance abusing patients get better, and their knowledge of what we know as recovery was non-existent.
Is that still true today?
Probably.
Could it change?
Perhaps.
What if medical education included an immersion experience through which physicians' training required them to participate in a treatment program that included interactions with patients, families, and staff in a recovery-oriented culture? Could this experience balance out the necessary grind of medical training often found by working in the emergency department?
Such programs already exist.
One of them, the Betty Ford Institute's Summer Institute for Medical Students , gives students a one-week experiential opportunity to learn about addiction and recovery through integration into the daily life of the patients and participation in the Center's family program.
"In the area of addictive disease, awareness and sensitivity to the issues surrounding it begins with an adjustment in attitude. It has long been said the best way to help those not addicted understand the recovery process is to let them see it happen. This concept is equally try in the Summer Institute for Medical Students, where students learn side-by-side with alcoholics/addicts or with recovering family members working their own recovery...Being a part of a process that fosters change strongly reinforces the belief that both the alcoholics/addicts and their families can and do recover."
According to Joseph Skrajewski, Director of Medical Education for the Betty Ford Center, 112 medical students are chosen annually from a much larger group of applicants from all over the world. Since 1985, more than 2,000 medical students from many of the nation's leading universities have participated in the Center's week long immersion program to learn about addiction, treatment, and recovery. Although there is not currently an evaluation component to measure the long-term impact of this initiative, there is a 10-item pre/post questionnaire that is used to assess attitudinal changes among the participants relative to the Center's rather traditional treatment philosophy, the results of which are presented below:
Survey
Statement
|
%“true”
before
|
%“true”
after
|
|
1
|
I feel
comfortable assessing a patient for addiction
|
15%
|
87%
|
2
|
Addiction
in NOT due to a lack of willpower or choice
|
95%
|
98%
|
3
|
As a
physician, I am comfortable talking to addicts about their addiction/behavior
|
35%
|
95%
|
4
|
I am
comfortable talking to family members about problems they have due to a loved
one’s addiction
|
43%
|
92%
|
5
|
I
understand that addiction is a brain disease
|
48%
|
100%
|
6
|
I know
the 12-Steps and how they are used in treatment and for long-term recovery
|
4%
|
90%
|
7
|
I
understand the roles of a Sponsor in a patient recovery program
|
27%
|
94%
|
8
|
Patients
who are mandated to go to treatment do as well as those who choose to enter a
program
|
55%
|
75%
|
9
|
I
recognize what medications are most likely to “trigger” a relapse for
recovering adults
|
9%
|
73%
|
10
|
I know
what community resources are available for patient referral, regarding
treatment and 12-Step programs
|
15%
|
93%
|
While the survey results demonstrate significant changes in the desired direction, it could be argued that medical students who enroll in the immersion program are likely to have some knowledge or life experience that motivates them to seek a greater understanding of addiction. So, the Betty Ford Center experience builds on an existing openness to greater understanding of recovery.
It would be interesting to conduct follow-up interviews with medical students who had participated in the program to understand how this training experience influenced their career paths, future professional decisions, and patient care. Did the positive attitude changes toward addiction and recovery persist, or did later experiences erase the lessons learned during the one-week immersion program at Betty Ford?
The Betty Ford Center's sister organization, Hazelden, has a similar program that focuses on medical residents, and there are likely similar medical education programs in other treatment programs across the country.
These include the Scaife Advanced Medical Student Program, offered by IRETA since 1999. Read about Scaife fellows' experiences in these posts from the IRETA blog:
Lessons Learned from IRETA's Scaife Advanced Medical Student Fellowship Program
Update Your Image of a Person with a Substance Use Disorder.
So, what if more of the nation's best treatment programs offered scholarship to support a training program for medical students or residents and those programs used the best science available to provide evidence-based treatment to support recovery?
And what if we evaluated those medical education experiences and continued to refine and enhance the most salient aspects of the experience? Could a positive experience that allowed physicians-in-training to interact with patients, families, and staff make a significant impact in breaking down the barriers that impede the integration of physicians into holistic medical care of those affected by addiction?
What do you think?
Share your thoughts in the comment section below.
A version of this article originally appeared in the Spring 2014 issue of The Bridge, Increasing Physician Involvement in SBIRT. The Bridge is a quarterly e-publication from the ATTC Network Coordinating Office.
Louise Haynes is an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina and is the Director of Research for the Lexington Richland Alcohol and Drug Abuse Council in Columbia, SC. She has worked with the NIDA Clinical Trials Network for more than 12 years. In addition to her research experience, Ms Haynes has worked in both clinical and administrative roles in South Carolina. She was Director of Women’s Services at the state’s single state authority (DAODAS) and Director of Morris Village, a publicly funded 150 bed inpatient treatment program. Early in her career she was a social worker at the Ralph H. Johnson VA Medical Center in Charleston.
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