As most of you know, I am currently doing a fellowship training year in addiction medicine. After 4 years of primary care, I wanted more time to teach and research, and I was also searching for people who feel social justice should be the heart of clinical practice. I loved primary care and I felt that it was very hard to practice the way I wanted to, to find the time to connect to people and a place where mission, support, and efficiency were all aligned. Addictions treatment has always been a big part of my practice, but as the saying goes, I didn’t know how much I didn’t know and I feel so lucky that I was able to spend this time learning.
I heard Ezra Klein, the writer formerly at Vox and now the New York Times, say on his podcast once that “it is work to remember that addiction is not a choice. That getting up, going to the store, and buying a bottle of alcohol and drinking it is not an entirely voluntary act when you have a severe addiction.” I don’t think that a lot of health care providers have done the work to really understand this. The consequence of this failure is clear: a lack of meaningful treatment options when we have tried and true medications and therapeutic interventions, and an all-too-often hostile environment for patients with a history of addiction.
I wrote this piece out this week in the New England Journal of Medicine about my frustrations with this failure. I targeted other doctors, but it is a message I would love to bring to the public, and would welcome your ideas on how to do that. Thank you for reading and your support. I haven’t had as much time to write over the past year and have found it harder to maintain an independent voice in a large organization, but I know I need to keep doing it for me. I should have a period of more time after I finish fellowship in July, and welcome your ideas on what to write about.
