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Physician Attitudes

All patients have the same human needs for feeling well, attachment to others, and sense of self-control. Clinicians who have had difficult experiences with patients or others with addictive disorders may expect patients who have a substance use disorder to betray their trust and to manipulate them with drug-seeking behavior. These early experiences can lead to persistent negative attitudes, including cynicism and hopelessness resulting in lack of empathy and poor or inadequate screening for substance use disorders. These negative physician–patient interactions can also adversely impact patients’ willingness to discuss use and accept referrals for treatment. (17)

You can enhance your care of patients with substance use disorders by reflecting on your own attitudes and discussing them with colleagues, by increasing your knowledge about the medical nature of the disease and the effects of substance use disorders on patients’ lives, and by practicing discussions about diagnosis and treatment with patients who are fearful and discouraged.

Significant societal stigma still exists toward patients with substance use disorders despite significant advances in scientific knowledge, diagnosis, and treatment. (9,18)
Remember that addiction is a disease of the brain and comparable to other chronic medical conditions such as diabetes, asthma, or hypertension, which also need ongoing monitoring and treatment.
Lack of knowledge about clinical screening techniques and referral resources, however, increases clinician reluctance to evaluate patients for substance use disorders.

Please click the video button on the left to hear Dr. Parran's comments about the benefits of honing skills in these challenging relationships.

Anger toward patients, especially when they are noncompliant or relapsing, will only drive a wedge between the patient and physician and exacerbate noncompliance.
Negative clinician attitudes can be manifested in the way physicians ask and respond to questions about substance use, e.g., “You don’t use drugs, do you?” or in responding “Good” when a patient initially denies use.
Addressing patients’ drug-seeking behaviors respectfully and directly, in an empathic manner, while setting appropriate limits on requests for prescription drugs, will increase the possibility of engaging patients in treatment.
Patients’ behaviors may continue to be frustrating, but a positive attitude and belief in the possibility of recovery can energize patients. After all, many patients do recover, though it may be a long process and take several interventions. You can visualize frustrations as challenges to overcome, and feel compassion for patients’ struggles. Learning and using effective communication strategies and setting relationship limits in a respectful and straightforward manner create a healing relationship. Your hope and respect give your patients both hope and a new measure of dignity. If patients feel that you won’t give up on them, they may be less likely to give up on themselves.

Respond to irritability and suspicion with interventions that reflect what you hear

“Many people are concerned about these questions.” or
“I hear some concern or irritation in your voice.” or
“I’m feeling a bit confused by your responses. Help me better understand what you are saying.”

When patients express irritation with your reflections or your limit-setting, or at their own shortcomings, here are some helpful responses for you to consider.

“I hear your frustration that I will not prescribe more oxycodone for you” or
“I understand your frustration. Patients in recovery tell me that my firm limits were helpful in getting them into treatment; I hope that will be the case for you.” or
“I hear your sense of hopelessness now, and I’ve heard so many people turn that around when they get into treatment.” or
“I know you feel bad about failing to carry out the plan. But let’s look at some of the details together and see if we can learn something that will help you succeed the next time.”