Myles Gart, MD

Myles Gart is an anesthesiologist.

Cutting opioid use in half: a hospital’s pain management breakthrough

Myles Gart, MD

Physician

March 23, 2025

I’ve witnessed what’s possible when we rethink pain management. By implementing a multimodal assessment approach at my hospital, I achieved a 50 percent reduction in inpatient opioid use, measured in morphine milligram equivalents (MMEs). The Numeric Pain Scale (NPS)—that 0-10 score we’ve leaned on too much—drives overuse when it’s the only guide, and with the U.S. consuming 80 percent of the world’s opioids as just 4.4 percent of its population, …

The burden of shadowing and volunteering in medical school admissions: a hurdle, not a measure of commitment

Myles Gart, MD

Education

February 9, 2025

In recent years, the requirements for medical school admission have expanded far beyond academic excellence and personal statements. Shadowing physicians and accumulating volunteer hours are now seen as prerequisites for demonstrating commitment to the profession. However, these requirements, while well-intentioned, have become unnecessary hurdles rather than meaningful indicators of dedication or future success as a physician.

Unnecessary compared to other professions

Medical school applicants are asked to prove their commitment in ways …

How objective pain management can save lives and prevent addiction

Myles Gart, MD

Conditions

December 17, 2024

The management of pain in clinical practice often involves navigating the critical tension between compassionate care and ensuring patient safety. While subjective self-reports of pain are essential for understanding a patient’s experience, relying solely on these assessments may risk overtreatment, leading to adverse outcomes. Incorporating objective measures can enhance safety and maintain clinical integrity without compromising compassion.

The role of objective measures in pain management

1. Promoting patient safety

Preventing overmedication: Objective …
Read more…

How objective pain management can save lives and prevent addiction

The hidden dangers of prioritizing patient happiness

Myles Gart, MD

Physician

February 7, 2024

The concept of patient-centered care has become pervasive in the health care industry over the last decade. However, as a health care provider, I often wonder if this approach is truly effective in improving patient outcomes and satisfaction. With the continuous emphasis on patient-centered care, I can’t help but question if it is actually a fallacy disguised as a solution.

In the past, patients had a strong relationship with their physicians, …

Are teenagers more vulnerable to the effects of opioids?

Myles Gart, MD

Conditions

November 24, 2019

The younger you are when you are exposed to opioids, the higher the likelihood of addiction later in life. The prefrontal cortex is not fully formed until the age of 25. This means that alterations in the “feel-good” neurotransmitters, specifically dopamine (released by opioids), can have an effect that predisposes the person towards future opioid use.

Because teenagers have an overactive impulse to seek pleasure and less ability to consider the …

When the standard of care is bad medicine

Myles Gart, MD

Physician

July 26, 2019

For the last three decades, the numeric pain score has been the go-to assessment for acute pain in the hospital setting. Since this methodology was developed for research purposes to see if drug “A” had an effect on patient “A,” its clinical utility is not just worthless but dangerous.

Let’s look at a simple example of a pain order set that is commonly used across the country. If a patient says …

Why staying ahead of your pain with opioids is the wrong advice

Myles Gart, MD

Meds

March 22, 2019

I often hear the mantra, “You must stay ahead of your pain, or else.” The president of the American Academy of Pain Medicine, states a common mistake people make, is waiting too long to take pain medication. By the time you’re in pain, you’re starting from behind the eight ball. “It takes a lot more medicine to control pain after it’s started as opposed to starting it ahead of time,” he …

The fallacy of patient-centered care

Myles Gart, MD

Physician

March 14, 2019

I often wonder what it was like before patient-centered care became a mainstream catchphrase. Was there a poor relationship between the patient and physician in the outpatient setting? Were hospitalized patients’ feelings, desires, goals, and therapy options ignored? It amazes me that we were able to care for patients more than ten years ago without using a “patient-centered” approach.

According to NEJM Catalyst, “Patient-and family-centered care encourages the …

Read more…

The fallacy of patient-centered care

A paradigm shift in acute pain assessment and management

Myles Gart, MD

Meds

March 8, 2019

We have embarked upon a unique strategy to assess and manage pain. “Opioids Rarely Help Bodily Pain” is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first …

The era of opioid-free surgery has arrived

Myles Gart, MD

Conditions

September 14, 2018

As we follow the national opioid epidemic, with its greater than five deaths per hour from opioid overdoses, the focus is shifting to methods for limiting an individual’s exposure to these drugs. For most of us, our first contact with these highly addictive medications is after surgery.

Studies now reveal that 60 percent of pills prescribed for pain after surgery go unused. These opioids often make their way to other family …

Why do we keep prescribing heroin for our patients?

Myles Gart, MD

Meds

September 27, 2017

In order to fully understand the issues surrounding opioid prescribing practices, it is important to review a brief history of how these drugs came to market.

Opium was the first opioid, derived from the sap of opium poppies whose growth and cultivation dates back to 3,400 BC. In the 18th century, physicians in the U.S. used opium for multiple ailments. Towards the end of the 18th century, the addictive qualities of …

You’re wrong. Pain is not a vital sign.

Myles Gart, MD

Conditions

May 25, 2017

After years of exaggeration, misinformation and a national epidemic of opioid and heroin abuse, the nation is finally coming to terms with the fact that pain is not the fifth vital sign. This heresy, as I understand it, has existed for close to three decades and, in my opinion, has been directly responsible for the deaths of thousands of patients and lethal drug overdoses of hundreds of thousands of American …

Read more…

You’re wrong. Pain is not a vital sign.

Myles Gart, MD

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts