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Charles Argoff, MD, hadn’t planned to go into pain medicine.

But as a medical resident in neurology in the mid-1980s, he noticed that nearly everyone he took care of experienced pain. And here was the curious thing: there didn’t seem to be satisfactory ways to deal with it. Pain was somehow overlooked by most of his professors.

One of his teachers was different, though. Howard Sachs, MD, PhD, wanted to treat the pain as well as the condition causing it. Dr. Argoff liked that approach, and Dr. Sachs became a mentor to him. The professor taught his pupil what he knew about compassionate care—not just about the science behind medicine, but about the humanity at the heart of doctoring.

argoff8But there’s another integral part of medicine, too: looking for clues and finding answers. That description is particularly true of neurologists, according to Dr. Argoff. “Neurologists like diagnoses,” he says. “We’re often criticized for only wanting to make diagnoses. I think we’re wired differently from our colleagues in other branches of medicine.

“My goal is always to get to the right diagnosis first,” he continues. The patient provides clues, but the clues that led to one diagnosis in one patient may lead somewhere else in another patient. Physicians can’t get comfortable and think that just because they’ve seen a set of symptoms before and it led to a diagnosis of X that those same symptoms mean X in another patient.

It’s not always clear-cut—which Dr. Argoff finds frustrating. And gratifying. “Pain is such a young field, when compared to cardiology and other branches of medicine,” he says. There’s still a lot to learn.

NO {SIMPLE} SOLUTIONS

“I wish it were as simple as ‘If that, then this,’” he says. “If a strep culture comes back positive, then you prescribe penicillin—as long as the patient isn’t allergic—and you know that, if the patient takes the medication as indicated, the infection will go away. It isn’t as simple with pain medicine.”

Dr. Argoff says there are four main steps in his care regimen:

{1} A solid assessment of the patient’s condition, which takes time

{2} A thorough understanding of what the patient is experiencing

{3} Appropriate testing

{4} A firm foundation for treating the total person, leading to a personalized care plan.

He’s treated patients who have been to other doctors and gotten the wrong diagnosis, but he’s careful not to point fingers at other physicians. After all, doctors are often expected to have all the answers. And that’s just impossible.

But, Dr. Argoff says, doctors need to be equipped with some solutions and an ability to fashion a plan of attack. He feels that medical schools have come some distance on dealing with pain since his own med school days—but still not far enough.

“If a person goes through medical school and then residency and never learns how to manage a patient’s pain, how do you think they feel when they’re fully trained and in practice and yet they aren’t effective at treating someone’s pain?”

argoff5“Too many doctors don’t know what to do other than to prescribe opioids,” he continues. “It’s what doctors do. It’s what dentists do. A patient is in pain. We want to fix it.”

His advice to any physician treating pain: “If your eyes are wide open and your mind is open, you will find a way to be helpful to your patient. Don’t just refexively offer treatment without thinking it through.” For too long, he says, too many physicians simply reached for the easy choice: opioids.

A {DIFFERENT} APPROACH

Prescribing opioids seemed like the easy answer, but it has led to massive problems. Opioid abuse is now a national health care concern. Dr. Argoff advocates doctors going beyond the most obvious solution.

“I think I have a reputation for trying things that are a little outside the box,” he says. “There’s no algorithm, no one answer, that can help all people.”

He has several pieces of advice for his students: Take time. Be creative and open-minded. Consider different treatments, and treatments used in combination. The ultimate answer may involve medication, physical therapy, nerve blocks, implantable devices, Botox, IV infusions—or some fusion of those. “We’ve got to find the right treatment for the right person.”

And teamwork is essential, Dr. Argoff says. “No one person has all the skills to effectively treat every patient. Doctors need to be confident enough to know when a referral to another specialist is in order. We’ve all got to work together,” he adds. “We’ve got to be good detectives.” {PP}