HI!!!

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Hi everybody

I will put my video off, because I can not stop to cough

Is it ok?

of course, Lou

There are a number of staff from Boston Health Care for the Homeless here this morning who are on the addictions team

If I watched MSNBC I would be more worried

Long history of racial tensions in Canarsie. Wonder if that forms a backdrop of the nurses attitudes toward the patients.

great job!!

thank you so much for this powerful presentation, Kim! i have to jump on another call but can’t wait to welcome you to the spring semester seminar.

I host a seminar in a few, so regretfully, must leave now. Thank you for this fascinating talk, Kimberly!

How do you deal with the root causes of the structurel racism every day?

Policy changes are a necessary but insufficient step towards change. What are your thoughts about how to change the culture of care - particularly the cultural perceptions of substance use - and the provision of patient centered care for all people (regardless of their substance use)

I love the presentation

I can't talk at the moment

thank you

I’m from BHCHP & have a question!

its about policies, economy, social exclusion

social suffering

great presentation

As someone who moved from CA to MA, I was struck by the attitudes here of "this is how we've always done this; why change it?". I wonder if this is as much of a problem in other parts of the country. Also, whether or not medicine and its Type A personalities make it more difficult to shift gears and think outside the box?

Strategies to run from prejudices

I wanted to comment on the former Soviet Union example: we were able to provide TB care in the community of people with SUD using mobile medical units (accompaniment with nurses). Interestingly people felt very linked to the clinic through that.

I'm wondering about our use of compliance v.s. adherance. Do the words we use to discribe medication management affect our treatment?

salmaan, the key is the ethos of accompaniment and connectedness; walking with people to determine what matters and addressing it.

To Gia's point - choice of words/language is an important reflection of our medical culture. https://www.nada.org.au/wp-content/uploads/2018/03/language_matters_-_online_-_final.pdf

I like the idea of a political project of innovation

@giwilson: This is a great point. Still I feel like, in medical settings, both terms carry a very similar valence now.

against structural racism

@Christophe: Agreed!!

Agree, wonderful

Need to think who the paciente/subjects can received that one way to be attend

@ Arlene and giwilson: I think "medication taking behavior" comes closest, and in the clinic promotes real inquiry into med use (for instance), but it always feels clunky to me.

Vice-versa

@Lesley Sharp: THanks so much for your important insight and suggestions for approaches!

people are in clinic who i need to work with now, i’m so sorry to bomb in and out but Kim grateful for you and your work and looking forward to seeing what you do w your observations

we need to assess the structural racism in both sides patients and health care providers

Related to Dr. Bullon’s comment, I think the label “frequent flier” and the attitudes associated with it can be a form of violence in the medical system.

(Which relates to the earlier conversation about terminology)

policies , economic decisions , social inclusion(food , housing, school for kids etc..) should be seen in both sides

It would be interesting to hear the extent to which these negative attitudes toward patients with substance abuse disorder vary distinctively with the ethnicity/race of the patient. Or if the behavioral category (addict, etc) and the valence it carries applies widely across all patients.

Many of the accounts and observations around the culture of care that have been brought up I see as applying significantly toward marginal language speakers as well .

Yes seth

@Emma Seevak; I was just thinking about Grove's article on "The Hateful Patient" (mid 1960s I think). Terms like frequent flyer or the now archaic "crock" definitely lead to a form of dismissive abuse. Grove's points out the counter-transferential underpinnings (mostly a sense of nihilism in the providers) and recommends solutions for improving empathy. We need that kind of approach (as well as political and social change processes) to shift that kind of discourse without simply creating punitive politically correct behavior change.

good leadership is also an important factor to address structural racism

I think we need to think economic neo-liberalismo , who blaime the pacients

Unfortunately, NPs and PAs are required to complete significantly more waiver training hours than MDs

@ Lou: Abolutely!!

Coming from a place of extreme ignorance, my understanding is that nurses also get drug-tested and that leads them to use opioids for pain rather than other treatments (even if they get injured on the job)... is there an opportunity to build better anti-stigma networks through/with/around nurses who end up with addiction?

^

The paciente is subjects to choose what they want

Perhaps because I'm a clinician, but I'm finding today's presentation and discussion incredibly interesting and germane. Thank you all!

Medicare and Medicaid make 2.5 reduction in reimbursement for hospitals who's patients' evaluations show that their pain is not well managed, and nurses do not respond to calls for paon medication promptly... As a result, you "stay on top of pain" by giving it on schedule, even if patient doesn't ask for it, in anticipation!!!!

2.5%

Also, so avoid a situation where patient asks for pain med when nurses are busy with other tasks.....

@Iman: I don't argue that standing pain meds may be a convenience for staff, but there is also good research data that supports scheduled over as needed pain med administration especially in hospital, depending on the nature of the pain.

Great to have so much time for discussion

It actually reduces overall pain med use.

Agreed! I do it often to my patients. But it gets MISUSED AND EXPLOITED BY MANY NURSES!

Thank you SO MUCH, Kim, and everyone. I wish I could stay longer.

Great Seminar!

Thank you so much for the talk! It was really helpful for thinking through some of these issues.

this was really amazing, thank you so much

wonderful talk

Thank you very much for this presentation, Dr. Sue! I have a meeting, but your presentation to Prof. Good’s undergraduate seminar was formative in my decision to pursue a phd in Med. Anthropology, and it is very inspiring to hear you speak again!

Thank you….

Thank You for such a wonderful lecture!

thanks so much! i have to head to lunch soon. appreciate it again

thank you so much Sue

Bye everyone!

Thanks so much, Sue! Fabulous conversation.

yes