FEATURE
PROBLEM Solving
James Patrick Murphy, MD
A
6
s a physician, one of my greatest
joys is when I meet a new pa-
tient. To become so trusted by
someone that they would share
their most intimate thoughts
and fears is a profound privilege. My routine
is that I welcome, ask questions, listen, ex-
amine, review data, assess, and then engage
in problem solving. But, sometimes my patients’ problems are too
difficult for me to solve. Last week, my new patient broke down in
front of me, because I had unmasked his vulnerability and, in doing
so, I had unmasked my own. He had chronic pain from a serious injury 15 years ago. He also had
a secret. He went to a methadone clinic.
I’m an experienced pain medicine specialist. I pride myself on
being open to a wide array of multimodal therapies. I am also an
addiction medicine specialist, so I strive to be adept at assessing
patients and prescribing medications including opioids, rationally,
appropriately and safely. My new patient, “John” (not his real name,
and the details have been edited to preserve privacy), was in his 40s,
married with children, and had a full-time factory job with benefits. In desperation, John started going to a methadone clinic, think-
ing it would be temporary until he could find another doctor to
take over prescribing his pain medicine. But something happened.
Due to the hype surrounding the “opioid crisis,” the legal pendulum
began to swing away from the legitimacy of chronic opioid therapy
for pain. Laws were passed. Doctors were arrested. Clinics were
LOUISVILLE MEDICINE
Understandably, this made me think John was in treatment for an
opioid addiction. But that was not the case. John had chronic severe
pain that was treated, somewhat, by his daily dose of methadone.
About 10 years ago, John had stormed out of his doctor’s office
because he felt the endless drug screens, prescribing contracts and
pill counts required by his doctor were insulting. After all, John had
never abused drugs. All he did was get himself injured on the job
and then sought legitimate medical care. But by cutting ties with
his doctor, John had also cut off his supply of the medication that
allowed him to function.