Picture Source (Online Marketing, 2020)
The Mayo Clinic defines Stigma as a negative view placed on a person or group of people based on the perception that a specific characteristic is negative. It leads to discrimination and shame. Stigma can be obvious or subtle. Avoiding interaction with someone is a form of stigma as is placing a label on a person because they are suffering from substance abuse disorder (2020).
The U.S. healthcare world is full of contradictions. We slap a nicotine patch on patients who are smokers as soon as they check in to a skilled-nursing facility or hospital, and yet we stigmatize the use of medicines to reduce withdrawal symptoms for substance use disorder. We promise to care and listen to our patients with compassion but judge any deviation from societal norms with harsh terms and labels. It reminds me of how children with mental disorders are often referred to in healthcare as “hard to love children”–something that struck me and pulled at my heartstrings when I started working as a therapist. In my career, I have struggled with “hard to love” patients or/and children the same as any other clinician.
I have worked all throughout the continuum of our healthcare system and I can state with confidence that healthcare professionals as a whole propagate the stigma around patients with substance use disorder. I have heard many comments over the years such as: “Ignore him, he’s a seeker.” or “That patient is a known liar.”, and “I don’t really want this patient to come in, send him to a lab instead.” When we label patients, they become that label. Pain, especially chronic, changes anyone–you, me, anyone. No one is spared. Patients can become difficult to manage. Providers struggle with managing their behaviors. And let’s face it, none of us like to feel powerless, unsuccessful, and anxious. Clinicians are human and they don’t always want to deal with what they don’t excel at. Therein lies the challenge. It’s not just clinicians, it’s their support staff as well.
Persons in recovery are often referred to as patients with behaviors. One of the basic facts you learn in occupational therapy is that all behaviors are a form of communication. Once you wrap your head around this idea, your perception of the “hard to love” patient changes drastically. It becomes a puzzle to figure out. It is no longer about the behavior itself but instead becomes about getting ahead of the anxiety, the anger, the emotion that triggered the behavior. This can be applied to any relationship: patient to clinician, colleague to colleague, and parent to child. And, it is a powerful tool in the fight against stigma in healthcare.
I strongly believe that we will not solve the Opioid Crisis until we educate our healthcare workforce in empathetic-compassionate communication, population-specific deescalation, and self-awareness of perceptions and biases. Ironically, in order to eradicate stigma in healthcare, we need to get ahead of the healthcare worker’s anxiety–same as for the patient. We need to arm them with right tools in their toolkit.
A lot of the work I do focuses on educating our team in understanding our patient population, connecting with them, and communicating in ways that foster understanding, reduce behaviors, and promote stigma-free interactions. Our staff goes through training modules designed to provide them with tools in their toolkit that help them navigate challenging situations and allow them to appreciate the patient’s struggles. Perception, customer service, and communication are learned skills, and so is stigma. We can unlearn poor service, judgment, hurtful communication, and stigma. We can coach our healthcare providers to treat this population with an open heart and mind. Education is the solution.
Sources
Mayo Clinic. (2017, May 24). Mental health: Overcoming the stigma of mental illness. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477
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