美国国家公共电台 NPR How To Teach Future Doctors About Pain In The Midst Of The Opioid Crisis

 

STEVE INSKEEP, HOST:

A medical school is trying to face an underlying¹ problem of the opioid epidemic². Addictive³ though they are, opioids are manufactured to address a real problem - pain. That's where the medical school comes in. It's teaching future doctors to think in new ways about pain management. NPR's Nell Greenfieldboyce went to class.

(CROSSTALK)

NELL GREENFIELDBOYCE, BYLINE⁴: Over a hundred would-be doctors are gathering⁵ in a lecture hall in Baltimore. This is Johns Hopkins University, home to one of the top medical schools in the country. Its first-year medical students have gathered for a mandatory⁶ part of their education.

SHRAVANI DURBHAKULA: OK, good morning. Welcome to the pain course.

GREENFIELDBOYCE: The pain course - four whole days on nothing but pain. Annie Cho is one of the students.

ANNIE CHO: I initially⁷ was a bit scared and I guess a bit wary⁸ coming into this course because of the opioid crisis. And that seems like that's the only thing people have been talking about nowadays.

GREENFIELDBOYCE: She's about to become a doctor at a time when physicians are under pressure to limit prescriptions⁹ for opioid painkillers¹⁰. Yet every day, they face patients who are hurting, from injuries, surgical¹¹ procedures, diseases. Around 20% of adults in the U.S. live with chronic¹² pain. The students seem well aware of the challenges they'll face. Jenny Franke says she's been shadowing doctors in a clinic and has already seen new patients come in with pain.

JENNY FRANKE: And it seems that the therapy that they're on hasn't been working. And a lot of the times, their past primary care providers have just kept prescribing the same thing over and over. And sometimes, those patients will ask for opioids, and then it turns into kind of an awkward conversation.

GREENFIELDBOYCE: This kind of clinical experience is the traditional way that doctors have learned to deal with this. Shravani Durbhakula is assistant professor in the division of pain management at Johns Hopkins. She's directing the course this year.

DURBHAKULA: Most medical schools get about nine hours of formalized pain education. If I was to think back to my training, it probably is somewhere about that much time.

GREENFIELDBOYCE: She recalls lectures on a few types of painkillers.

DURBHAKULA: But I don't remember a lot of formal pain education, certainly not any kind of course that was given to me. And it was something you just kind of learned as you went along.

GREENFIELDBOYCE: Here, the students learn what pain is, how it's a physical and emotional experience, how doctors tend to underestimate pain, how it can be affected¹³ by people's moods or cultural expectations or individual sensitivity. They discuss problems with the usual way of asking patients to rate their pain on a scale of one to 10. They learn to instead ask if and how pain limits people's daily activities. And, of course, they talk about opioids. Beth Hogans is a neurologist and pain specialist at Johns Hopkins who helped create this course. About a decade ago as the crisis was taking off, she looked to see what medical schools were teaching.

BETH HOGANS: U.S. medical students were getting less than one hour on average of opioid-related instruction in medical school. That's not enough.

GREENFIELDBOYCE: This course explores not just the nuts and bolts about prescribing opioids but also how these students feel about them. A doctor named Ryan Graddy asked the students to pull out their cellphones. He says they should text him a few words in response to this question.

RYAN GRADDY: What comes to mind when I say chronic opioid therapy?

GREENFIELDBOYCE: Their answers start to appear on a big screen behind him. The first word is bad.

GRADDY: OK.

GREENFIELDBOYCE: Other words pop up - addiction¹⁴, drug abuse.

GRADDY: So interesting - right? - so a lot of negative connotations that people have with chronic opioid therapy.

GREENFIELDBOYCE: Yet he says some of his patients have successfully been on opioids long term. Opioids can be a useful tool in the toolbox. Though, these painkillers have to be used thoughtfully and carefully. One speaker told a harrowing account of how he was prescribed opioids by about a dozen different caregivers after having an accident in surgery. When he became physically¹⁵ dependent and wanted to stop taking opioids, he couldn't find a doctor willing to help him get through his agonizing¹⁶ withdrawal¹⁷.

DAVID BOTROS: Ended up in a very, very difficult situation where he was handling withdrawal all on his own.

GREENFIELDBOYCE: David Botros is one of the medical students. He says the story surprised him.

BOTROS: I really didn't expect that to be - I don't want to say possible but even a factor in the health care world I guess.

GREENFIELDBOYCE: He and the other students heard about other possible medications to try, and they learned that pain control goes way beyond just prescribing drugs. Patients could benefit from physical therapy, cognitive¹⁸ behavioral therapy and all kinds of exercise like yoga. Graddy thinks the medical profession overall has done a disservice to patients when it comes to chronic pain.

GRADDY: I see that certainly in my own practice, a lot of patients who have bounced around from place to place and not really been treated with respect or dignity or empathy that they deserve.

GREENFIELDBOYCE: That's why this medical school invited patients and their families to this lecture hall. They movingly spoke¹⁹ about how pain impacts their entire lives. And these students definitely get the message. Tony Wang took this course two years ago. He just finished his third year of medical school.

TONY WANG: The message that I distinctly remember leaving with was pain management is extremely complicated. It's not just give this medication and they'll feel better.

GREENFIELDBOYCE: He's now doing his clinical rotations²⁰ in the hospital and says most of the patients he sees there have some kind of pain. Nell Greenfieldboyce, NPR News.

(SOUNDBITE OF PENSEES' "FACELESS ARTIST")

1 underlying   

adj.在下面的，含蓄的，潜在的

参考例句：

• The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
• This word has its underlying meaning.这个单词有它潜在的含义。

2 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。

3 addictive   

adj.(吸毒等)使成瘾的，成为习惯的

参考例句：

• The problem with video game is that they're addictive.电子游戏机的问题在于它们会使人上瘾。
• Cigarettes are highly addictive.香烟很容易使人上瘾。

4 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

5 gathering   

n.集会，聚会，聚集

参考例句：

• He called on Mr. White to speak at the gathering.他请怀特先生在集会上讲话。
• He is on the wing gathering material for his novels.他正忙于为他的小说收集资料。

6 mandatory   

adj.命令的；强制的；义务的；n.受托者

参考例句：

• It's mandatory to pay taxes.缴税是义务性的。
• There is no mandatory paid annual leave in the U.S.美国没有强制带薪年假。

7 initially   

adv.最初，开始

参考例句：

• The ban was initially opposed by the US.这一禁令首先遭到美国的反对。
• Feathers initially developed from insect scales.羽毛最初由昆虫的翅瓣演化而来。

8 wary   

adj.谨慎的，机警的，小心的

参考例句：

• He is wary of telling secrets to others.他谨防向他人泄露秘密。
• Paula frowned,suddenly wary.宝拉皱了皱眉头，突然警惕起来。

9 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

10 painkillers   

n.止痛药( painkiller的名词复数 )

参考例句：

• The doctor gave him some painkillers to ease the pain. 医生给了他一些止疼片以减缓疼痛。 来自辞典例句
• The primary painkillers - opiates, like OxyContin - are widely feared, misunderstood and underused. 人们对主要的镇痛药——如鸦片剂奥施康定——存在广泛的恐惧、误解，因此没有充分利用。 来自时文部分

11 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

12 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

13 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

14 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

15 physically   

adj.物质上，体格上，身体上，按自然规律

参考例句：

• He was out of sorts physically,as well as disordered mentally.他浑身不舒服，心绪也很乱。
• Every time I think about it I feel physically sick.一想起那件事我就感到极恶心。

16 agonizing   

adj.痛苦难忍的；使人苦恼的v.使极度痛苦；折磨(agonize的ing形式)

参考例句：

• I spent days agonizing over whether to take the job or not. 我用了好些天苦苦思考是否接受这个工作。
• his father's agonizing death 他父亲极度痛苦的死

17 withdrawal   

n.取回，提款；撤退，撤军；收回，撤销

参考例句：

• The police were forced to make a tactical withdrawal.警方被迫进行战术撤退。
• They insisted upon a withdrawal of the statement and a public apology.他们坚持要收回那些话并公开道歉。

18 cognitive   

adj.认知的，认识的，有感知的

参考例句：

• As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
• The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。

19 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

20 rotations   

旋转( rotation的名词复数 )； 转动； 轮流； 轮换

参考例句：

• Farmers traditionally used long-term rotations of hay, pasture, and corn. 农民以往长期实行干草、牧草和玉米轮作。
• The crankshaft makes three rotations for each rotation of the rotor. 转子每转一周，曲轴转3周。