About 13 years ago, Dr. Paul Konowitz, a physician at Massachusetts Eye and Ear, developed a painful blistering condition in his throat. He ended up with an infection in his esophagus. He was unable to eat and was in unbearable pain.
While he was hospitalized, he was prescribed opioids to lessen the pain. He took Percocet pillsand wore a Fentanyl patch. The pain persisted.
“I thought about killing myself more than a couple of times,” he said, sitting in his office in Quincy. “I wasn’t working. My professional identity was crushed. There was depression.”
When the pain finally eased, he wanted to stop taking the medication.
“It wasn’t that I was addicted. It wasn’t a craving,” he said. “But withdrawal caused symptoms, like wanting to crawl out of my skin. I couldn’t stand being in my own skin.”
Konowitz asked colleagues for advice, but no one could tell him what to do. With the help of his wife, who is also a physician, he came up with a plan to taper down on the medication. It took about a month.
He was out of work for 16 months, and when he finally got back to his practice, he was a different doctor.
“I thought I was a pretty empathetic guy before, but what I experienced made me realize what it’s like to be a patient,” he said. “You don’t understand pain until you’ve experienced it.”
The opioid epidemic has led to what Konowitz believes is a well-intentioned but misguided change in the way doctors prescribe pain medication. Or, more specifically, the way they avoid prescribing pain medication.
He thinks there has been an overreaction, an overcorrection, so that many people who really need medication for pain are not getting it. There is evidence backing his theory.
“We need to curtail illegal opioids, but there are people not getting medications that they need,” he said. “I certainly understand why we’re being scrutinized. There are some bad actors in medicine, as in any field. But there’s every reason to try to trust patients. I’ve learned to listen more, to believe the patient when they say they have pain.”
He ponders, and wants other doctors to ponder, what’s worse: giving medication to someone who is drug-seeking, or not giving medication to someone who really needs it?
Konowitz’s own experience as a patient with severe pain led him to develop a training program for other physicians called Quality, Humanism and Professionalism. He teaches it with two other physicians, Stacey Gray and Carolyn Kloek. Essentially, it teaches doctors, nurses and medical students about having greater empathy for their patients.
“We’re trying to focus on what a lot of physicians roll their eyes at: the soft stuff,” he says.
He asked one of his patients, who was dying of neck cancer, to speak to a class about what it’s like to be a patient with a terminal illness. Dr. Susan Block, the chief of palliative care at Dana-Farber Cancer Institute, interviewed his patient in front of about 100 doctors and nurses.
“Those are the kind of conversations we need to have as health care providers,” he said.
The conversations he has with patients take time. And time is the enemy of physicians, who are under pressure to see more and more patients. It takes time to check whether a patient has a history of drug-seeking or physician-shopping. It’s easier to just say no.
“The reality is a lot of physicians will not prescribe pain medication because they say they can’t take the time to check,” Konowitz said. “I’ve had patients who can’t swallow and no one was willing to give them pain medication. I’ve had some with tonsil cancer who have been told to take ibuprofen.”
In response to the opioid epidemic, the system has been recalibrated to suspect the patient, but Konowitz continues to give his patients the benefit of the doubt. His own experience has led him to realize that empathy and compassion are as powerful as any drug.