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Alright going to attempt to live tweet my last session at @csam_smca : A How To Guide: Trainee Engagment
Moderated by a familiar face, my co-resident and all around rockstar Dr Ashley Warnock. Panelists include @tdbrothers @ADocNamedDani Dr Kathryn Chan and Dr Justin Koh.
Moderated by a familiar face, my co-resident and all around rockstar Dr Ashley Warnock. Panelists include @tdbrothers @ADocNamedDani Dr Kathryn Chan and Dr Justin Koh.
This is a Q&A, so I'll attempt to share both Qs and As while also trying to participate
Q1: Why is it so important to seek out opportunities to learn about addictions?
Q1: Why is it so important to seek out opportunities to learn about addictions?
A1 from @ADocNamedDani : You need to seek this out because it is not standardized education but it applies to every specialty.
A1 from @tdbrothers: Imp to seek out learning because we dont come into this work from a "neutral" stance. We have to unlearn to avoid harms
A1 from @tdbrothers: Imp to seek out learning because we dont come into this work from a "neutral" stance. We have to unlearn to avoid harms
A1 from Dr Chan: Imp to recognize that we strive to do good in medicine but there are lots of opportunities to cause harm, easy to do through language. References "vulnerable populations" (quotes included), and importance of framing that in context of oppression (YAAAAS)
Q2: How can we as trainees ensure that anti-racism and inclusivty are more than just buzzwords, but are actions?
A1 from Dr Jackson: Imp to be intentional when discussing anti racism. It is an action. Trainees need to seek education and provide education to "keep the needle moving forward" in medicine around discrimination in SUD in minoritized communities
Books recommended by Dr Brothers: Carl Hart’s book, “High Price”, and Johann Hari’s book, “Chasing the Scream, and Michelle Alexander’s book, “New Jim Crow”
A1 by Dr Jackson continued: seek out your educaiton on your own and dont depend on your institutions to provide everything you need to know about working with minoritized individuals. Hold your institutions accountable
Dr Koh: learn about the racism behind drug laws
Dr Koh: learn about the racism behind drug laws
More by Dr Jackson on this point: You cannot advocate for decriminalization or harm reduction without also advocating for social justice, investment in communities if youre seeking an equity approach
Q3: How do you address stigmatizing language from supervisors, peers as a trainee?
A3 by Dr Koh: initially approached these encounters from an angry place (HARD RELATE). This isnt effecitve and shames providers, loses opportunitiy to educate
A3 by Dr Koh: initially approached these encounters from an angry place (HARD RELATE). This isnt effecitve and shames providers, loses opportunitiy to educate
A3 Dr Koh continued: Best, most effective approach is one on one conversations to actually motivate change.
Dr Jackson: This language is rooted in addictions being based in moral failing. Gentle education, provision of resources is the best approach
Dr Jackson: This language is rooted in addictions being based in moral failing. Gentle education, provision of resources is the best approach
This approach is backed by Dr Brothers. Use foundational starting point of wanting to help people as HCPs, provide some education and context around drug policies, trauma that has resulted, people are trying the best they can.
Dr Chan: compassion and curiosity are essential to educating colleagues
Specific phrases "could you repeat that?" "Sorry I dont understand what you mean" and then "I dont think thats fair towards that patient".
Also- it is okay not to be able to dismantle oppression as a learner
Specific phrases "could you repeat that?" "Sorry I dont understand what you mean" and then "I dont think thats fair towards that patient".
Also- it is okay not to be able to dismantle oppression as a learner
Dr Brothers: seeing a change in culture at their hospital around treating pts w SUD. Comes from trainees being motivated. But also from a shift in making doctors seeing treating SUD as their job, not a moral failing
Dr Koh: Harm Reduction helps everyone. It does not "waste your time" as a healthcare provider. Patients will stay for blood work, access more services. Also seeing changes in Saskatchewan. Imp to celebrate those changes to encourage more change
Q4 from a participant: Any advice for a participant who wants to enter this field and speak up and do more in a (unnamed) province that is targeting and dismantling addictions treatment services
Dr Brothers: Has had experience in this area. Started a SIS with community that did not have provincial support and was actively targeted. Started an advocacy group to support the SIS. Recognize your career safety in being in medicine and amplify messages from the community
Suggests writing op-eds in consultation with groups who could be targeted.
Dr Jackson: Endorses above approach. THEN come back with the data around the health impacts of addictions facilities. "This is how many lives we saved"
Dr Jackson: Endorses above approach. THEN come back with the data around the health impacts of addictions facilities. "This is how many lives we saved"
Oof absolute gold from Dr Jackson: Challenge the idea that any drug use is a "use disorder". Very common idea in medicine that can be seen as advocacy when challenged.
Dr Koh: There are dif levels of advocacy. There IS advocacy that isnt flashy or public.
Dr Koh: There are dif levels of advocacy. There IS advocacy that isnt flashy or public.
contd from Dr Koh: If youre worried about being publicly targeted around advocacy, focus more on how you can advocate for the patient or client in front of you. e.g help them navigate drug coverage. Doesnt go on twitter, but is essential (love this)
Dr Chan: there is community advocacy and advocacy in your own practice.
Community advocacy can be supporting existing services. Advocacy in medical practice can look like advocatnig to colleagues around the risk of overdose after a pt is hospitalized.
Community advocacy can be supporting existing services. Advocacy in medical practice can look like advocatnig to colleagues around the risk of overdose after a pt is hospitalized.
Q5: my question! What do you think the role of HCPs is in community addiction treatment? Physicians can take away from existing supports.
Dr Jackson: HCPs definitely have a role in community advocacy but we must defer to the years of wisdom of peer based initiatives have
Dr Jackson: HCPs definitely have a role in community advocacy but we must defer to the years of wisdom of peer based initiatives have
Contd from Dr Jackson: someone in recovery from SUD is the expert in their disorder. We should collaborate but we should not get any extra recognition just because we are physicians. You are there to provide medical knowledge and educaiton
Dr Brothers: there are very different roles to be filled and its important to respect all of them. There needs to be more recognition that Peer Support workers have expertise that physicians dont have at all. HCPs have a big role in creating space for peer experts in heatlhcare
Dr Chan: It is about opening the door but leaving it open behind you to let others in.
Examples:
Invite those w lived experience/use drugs to academic experiences. Frame them as experts to be learned from. Ensure compensation as educators. (LOVE THIS)
Examples:
Invite those w lived experience/use drugs to academic experiences. Frame them as experts to be learned from. Ensure compensation as educators. (LOVE THIS)
Dr Koh: All of this also applies to research. We are not just "consulting" people with lived experience, they are making decisions, have ownership of data, and being involved from start to finish, and being paid appropriately.
Dr Brothers: Second involving PWUD in academic half days. Imp to acknowledge that many people in HC often do not have any friends who use drugs, and spending time even academically can humanize and challenge discriminatory notions about PWUD
Q6: How do you adjust your advocacy strategies to address concerns around HR and addictions support "enabling" addictions?
Dr Jackson: Data! You cannot argue with saving lives as a doctor. Needle exchange, SIS, OPS, OAT: all documented to save lives.
Dr Jackson: Data! You cannot argue with saving lives as a doctor. Needle exchange, SIS, OPS, OAT: all documented to save lives.
Dr Koh: To be a good advocate you need to know the data stone cold. People will try to dismantle your advocacy by labelling you as a "bad clinician". Knowing your data and pulling out papers whenever you can.
Know the language that opponents speak. Know data on crime, spending
Know the language that opponents speak. Know data on crime, spending
Dr Brothers: Please challenge the concept of enabling at all. What are we enabling? Helping people stay alive? It is a concept that gets passed around and it is not an empirically proven concept
Last Q before breakout groups: How can community initiatives be developed and implemented in the pandemic?
Dr Brothers: A lot of work on the ground has been happening since March. It has not stopped w the pandemic. Some groups also moved online effectively.
Dr Brothers: A lot of work on the ground has been happening since March. It has not stopped w the pandemic. Some groups also moved online effectively.
Dr Jackson: This is also where you can look to advocate via statements, contacting politicians
Dr Koh: Also watch out for people providing substandard care to PWUD just "because of COVID" e.g reducing first responder rescue breathing in ODs (damn great point)
Dr Koh: Also watch out for people providing substandard care to PWUD just "because of COVID" e.g reducing first responder rescue breathing in ODs (damn great point)
Dr Chan: Pandemic has given a lot of attention to OD crisis but imp to acknowledge that communities have been doing this work long before. We need to use this momentum
Breakout room PEARL: An emerg resident in Alberta was able to create a safe injection protocol for an inpatient to use their own supply of drugs while admitted. Protocol was based on those used in SIS, nursing expertise. Point was that it is imp to start w individual patients
Other breakout room pearls: how can we get everyone on the same side of this polarizing field? Creating platforms to get people together and humanizing these faces. Supporting ppl w LE to advocate for their own needs. Changing clinic environment to disrupt power differential
Wow another incredible session. Well worth staying online until 630 on a Saturday. The future of addictions medicine is very very bright. Thanks to all the panelists and to Dr Ashley Warnock for moderating, you did a great job!!
