Wednesday, January 8, 2020

Becoming a better doctor

For the most part, I don't make New Year's resolutions. I've always thought that the beginning of a calendar year was an arbitrary time to decide to start or stop doing something, and despite being the start of a new decade, 2020 feels no different. However, for the past several months, I have been working on a few professional self-improvement projects that I hope will make me a better doctor in the long term.

Last fall, I completed a training course through the Providers Clinical Support System and obtained my DATA waiver in order to provide medication-assisted treatment with buprenorphine to patients with opioid use disorder (OUD). As I observed in a Medscape commentary last year, some patients with chronic pain will continue to need long-term opioid therapy, and a certain percentage of them will eventually progress to misuse and OUD. And that doesn't include many others who become dependent on illicit opioids. Buprenorphine is an effective and evidence-based treatment that allows many patients to attain remission of their disease and put their lives back together, and as illustrated in a recent issue of the Journal of the American Board of Family Medicine, family physicians are increasingly equipping themselves to provide it, much as primary care took on the responsibility of caring for victims of the AIDS epidemic in the 1980s.

As intravenous drug use has fueled the opioid overdose epidemic, it has also been driving up rates of chronic hepatitis C virus (HCV) infections in young adults. Since September, I have been participating in a Project ECHO program through Medstar Health that is training primary care clinicians to manage or co-manage adults with HCV in Washington, DC and Maryland. Although I have expressed skepticism in the past about widespread one-time screening for HCV (and remain uncertain that the evidence supports the U.S. Preventive Services Task Force's proposed expansion of screening to all persons age 18 to 79 years), I'm also very much aware that this disease isn't going away without treatment. As the prices of antiviral drugs come down and states come up with creative ways to finance bulk purchasing for Medicaid recipients, more family physicians should acquire the skills to treat these patients.

Finally, while serving on my medical school's Subcommittee on Faculty Diversity & Inclusion, I became interested in how implicit (unconscious) bias affects not only faculty recruitment, but student and employee recruitment, mentoring, and promotion; workplace culture; and contributes to health disparities through effects on patient care. I joined our inaugural Bias Reduction and Improvement Coaching (BRIC) train-the-trainer program in part to better understand how to mitigate negative consequences of unconscious biases on my own students and patients.