This past week, I was speaking with a patient; let’s call her Marcy, during her regular appointment. “You’re just not like other doctors,” she said. “How is that?” I asked.
This seems like a good place to discuss the reason Marcy comes to see me. Marcy has a history of opioid use disorder. She has been on medication-assisted therapy (MAT) for many years. For those unaware, opioid use can alter people’s brains. Some patients can taper off MAT, but others require MAT for life. In fact, they need the medication much like a diabetic needs insulin to function and be productive members of society. Contrary to popular opinion, the majority of MAT patients don’t use their medication to get high. Instead, it’s the opposite: they take their medication to treat a brain that functions differently from one not addicted to opioids.
At this point, I must interject that not one MAT patient I know of chose to become “an addict.” Instead, something occurred (often many things) in their lives that made medicating their pain more tolerable than enduring it. To return to the diabetes analogy, this is similar to a person’s body becoming unable to produce or react to insulin. The vital difference, however, is society’s view of MAT patients versus how they perceive a person with diabetes. The former is often seen as a judgment issue, while the latter is viewed as bad biological luck. Perhaps the stigma has been alleviated, just a bit, by the recent fervor surrounding the mini-series Dopesick.
Marcy went on to tell me that over her many years on MAT, she had experience with several physicians. According to her, most MAT doctors write prescriptions but don’t truly engage with their patients. And when they do, the questions seem superficial. To be honest, I’ve heard this sentiment from many MAT patients. More often than not, patients end up feeling like numbers, not people.
This is even worse in certain MAT clinics. Patients are often given no specific appointment time and end up waiting for hours to be seen. In many such clinics, patients are required to endure this daily, making things that the rest of us take for granted (like holding down a job) very difficult.
I told Marcy that I view my role as a MAT doctor as a privilege. I have the unique opportunity to help someone reclaim their life. I’m trusted with holding space for someone as they recall deeply painful memories. Often, these memories have been “factified,” with feelings and emotions erased from them for the sake of survival.
“No one has ever said that being my doctor was a privilege,” Marcy said. “It’s been quite the opposite.” “Then they’re missing the essence of doctoring,” I replied. And she emphasized, “You’re just not like other doctors.”
That poignant statement was meant as a compliment, as Marcy recognized someone who genuinely cares, setting me apart from what she has unfortunately come to consider the norm.