Interview with Dr. Steven Passik – Question #1
Question #1: What do you see as the principal obstacles for people in pain to be treated with dignity?
Dr. Lynn Webster [Dr. Webster]: Hello, this is Dr. Lynn Webster, and I thank you for listening to this inaugural Q&A series on LynnWebsterMD.com. Today I am with Dr. Steve Passik, a clinical psychologist and a pioneer in assessing and managing people in pain. He is currently the vice president of clinical research and advocacy at Millennium Health. I want to thank Dr. Passik for joining me today.
Steve, my first question for you is, what do you see as the principal obstacles for people in pain to be treated with dignity?
Dr. Steve Passik [Dr. Passik]: Well, it’s interesting because some of this is crystallized in my mind even since I started reading your book and I read the first 100 pages or so of it. You’re calling, the need for love and connection and all those things in the book, I’ve been – what’s largely lacking is outright, at times animosity towards people with pain and I think there’s a lot of projections sometimes because the therapy – the stigmatized disease – treated in stigmatized people with stigmatized drugs and interventions and so, it’s like a hat trick of stigma. I’ve been to my share of pain conferences lately that people are really talking about, “Okay, well there’s come a realization that opioid-only, drug-only therapy, is really not going to work to the best majority of this population. It doesn’t that opioids should be ignored and we’ll get into that later, but that they’re going to work in isolation and should never been expected to. And then they start advocating things that are a lot like supportive and cognitive behavioral therapy and to be practiced basically by the primary care physician or the pain doctor. And the idea that, to me that’s in a way comical because as a psychologist myself, we’re dealing with the system wherein cognitive behavioral therapists can’t even get paid to do cognitive behavioral therapy. And so, I think something’s got to give, and I think one of the main obstacle is that – and this really gets into the next question as well but I’ll come back to that more specifically – but when people have a set of whatever chronic condition that involves psychiatric motivational, lifestyle, spiritual as well as nociceptive elements, and we put a premium only on what you do to people, prescribed to people, put in people, take out of people, and then that’s only going to relegate the other kinds of treatment or the other kinds of ways in which a caring physician and treatment team would spend time with the patient to the very poorly reimbursed category. You’ll always going to have a problem with people being treated with the kind of respect that should go along with treating that kind of an illness and it’s not unique even to chronic pain. I’ve seen treatment scenarios with people who are taking care of people with pancreatic cancer, have an afternoon clinic that has 45 people in it. I mean how you – something’s got to give in our healthcare systems and I do think that patients are going to have to stand up and say, “I don’t want to be on a conveyor belt. I want to spend some time and make a connection with the people that are taking care of me and it’s not just about the piece paper in my hands, for a prescription or that I walk out the door with.”
Pain clinicians, you know Pat Murphy, has got a movement afoot to put to have a pain caregivers day and recognized what pain caregivers are doing, putting themselves at risk, taking care of everybody’s cast-off patient and all of that. I think I’ve seen this in the addiction field as well. I think when you take care of stigmatized people with stigmatized problems and deal with stigmatized problems and deal with stigmatized intervention, that tends to rub off on the practitioners also. And I think if we have a huge cadre of burned out demoralized clinicians; that is not, in turn, going to translate to the patients themselves getting the respect and being with respect and dignity that they deserve.
Dr. Webster: What would you say is the number one barrier that must be overcome?
Dr. Passik: I think it’s the philosophical underpinnings of the way in which healthcare is reimbursed.
Dr. Webster: Thanks again for listening to this inaugural Q&A series on LynnWebsterMD.com. Please come back tomorrow for question #2 with Dr. Passik.
If you aren’t already, please follow me on Twitter @LynnRWebsterMD. Also, stay tuned to my blog for more information about my upcoming book and documentary titled The Painful Truth, to be released sometime this fall. Thanks again, have a great day.
Steven D. Passik, Ph.D.
Vice President of Clinical Research and Advocacy, Millennium Health
Steven D. Passik, PhD, is vice president of clinical research and advocacy at Millennium Health. Before coming to Millennium, Dr. Passik was professor of psychiatry and anesthesiology at Vanderbilt University Medical Center in Nashville, Tenn. He was section co-editor for the opioid pain and addiction section of Pain Medicine, served on the editorial board of the Journal of Pain and Symptom Management and has been a reviewer for many peer reviewed journals, including The Clinical Journal of Pain. Dr. Passik was editor in chief of the National Cancer Institute’s PDQ Supportive Care Editorial Board. He was named a fellow of Division 28 of the American Psychological Association (Psychopharmacology & Substance Abuse) and awarded a Mayday Fund Fellowship in Pain and Society. An author of more than 200 journal articles, 60 book chapters, and 59 abstracts, he speaks nationally and internationally on pain, addiction and the pain/addiction interface. Dr. Passik received his doctorate in clinical psychology from the New School for Social Research, New York, and was a chief fellow, Psychiatry Service at Memorial Sloan-Kettering Cancer Center in New York.
Thank you for the thoughtful responses to the 2 questions posed. There are continued multiple barriers for those who suffer with pain, regardless of the many activities provided in support of quality care. We must all continue to support those in pain and the care givers who interact with them. I wholeheartedly agree with Dr. Passik and his assessment of the largest barrier, being the philosophical issues related to pain care. There continues to be the perception that all those with pain are drug seeking, which we clearly know is incorrect. There is no doubt more education for clinicians, legislators and the broader communities is essential.