By: Sansrita Nepal, M.D., Marisa Echaniz, M.D. and Joseph Walker Keach, M.D. 

By: Sansrita Nepal, M.D., Marisa Echaniz, M.D. and Joseph Walker Keach, M.D. 

I am a hospitalist at a safety-net hospital. Through my work I have come to understand how our daily decisions – filtered through our own biases – influence how healthcare is implemented, and I had a personal teacher in my first year as an attending. Soon after starting my job, I met Mr. K.

Editor’s note: In 2017, the New England Journal of Medicine featured a piece entitled “Letter to a Young Female Physician,” in which Dr. Suzanne Koven writes to her younger self at the point she would begin residency training, before embarking on a 30-year career in medicine. The value of this type of self-reflection is that the author is able to impart what they feel to be their most authentic wisdom.

Editor’s Note: A version of this article first appeared in the December issue of the SGIM Forum.

As a practicing hospitalist in a safety net hospital, I am on the front lines battling the opioid epidemic. In the past five years, I have seen an increase in the number of hospitalized patients with heroin-related medical complications, including abscesses, cellulitis, infective endocarditis and overdose events.

Pain management among hospitalized patients can be challenging. Patients may have unrealistic notions about how their pain should be controlled, while physicians carry their own biases and experiences that influence pain management strategies.