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On Service Design: Pain Medication

Service design is another branch of interaction design, like user experience, that focuses on a holistic view of systems that may or may not involve technology. In simple terms, service design seeks to improve how humans interact with a service or provider.

While many of us have encountered narcotic painkillers like Vicodin or Percocet (hello, spambots) for use after minor injuries or procedures like wisdom tooth removal, it’s a whole new ballgame if you’ve had the misfortune of needing a serious procedure due to illness or injury. Based on my personal experience and the experience of close friends, it feels like there’s a major hole in the service offerings of most medical providers when it comes to ending the use of this sort of medication.

I have a variety of delightful hereditary conditions that have required various, sometimes serious, treatments and procedures. But last year (while fighting crime on the moon) I managed to shatter my kneecap in a fall. It’s an incredibly painful injury, despite my acquired high pain tolerance. I don’t recommend the injury – there’s a reason gangsters used it as an injury of choice. The best way I can describe it to others is the image that floated through my head while lying on the ground: it’s as if all the planets in the solar system became magnetically attracted to my kneecap and collided with it in one simultaneous explosion.

Anyway, 2 screws were placed in my kneecap to rebuild it, and I was placed on 2 Percocet every 3.5 hours for over 2 weeks. That’s a long time to be on such high doses of Percocet. At first, you actually feel quite sober since the pain keeps the medicine too “busy” to interfere with your behavior, but as the pain gradually lessens, you start to fall under the influence of the sometimes-crushing lethargy, nausea and other opiate symptoms. I was worried about addiction on such a constant stream of the medication, and I eventually decided to go cold turkey. Just 2 weeks – shouldn’t be that bad, right? Wrong. I stopped taking my pills before bed in the hopes of sleeping through the worst of it, but a few hours in I began to experience insomnia and jitters like a stereotypical junkie in the movies, plus chills, sweats, and strange muscle spasms (brutal when you’re trying NOT to move your leg). Eventually I gave in and took half my normal dosage, which didn’t cure the symptoms but lessened them some. I had to come up with a more gradual withdrawal plan, and it sucked but I was eventually successful on my own.

In January, a friend of mine was the victim of a freak skiing accident (he was not at fault) that shattered his right shoulder. He now has 11 screws and a plate holding it together. The injury and resulting pain were so severe that they had him on OxyContin (hello again, spambots) for weeks before moving him DOWN to the less-intense-but-still-very-serious Percocet; 2 every 3 hours. He’s still on the Percocet. He’s now at the point where he wants to get off the drugs, but he’s getting conflicting information from his healthcare providers. His doctors and therapists encourage him to keep using the drugs so he can continue to do physical therapy, but his nurses want him off ASAP. After reading online about the real addiction risks he faces after all this time, my friend recently decided to go cold turkey and has been experiencing extended withdrawal hell – all his symptoms even more intense than mine were. And how is someone supposed to heal on days of withdrawal-induced insomnia? He, too, has been unable to kick the habit on initial attempts, having succumbed and returned to the drug, and is now trying to reduce his own dosages in a gradual, self-directed effort. I’m impressed with his fortitude through all of this.

The point I’d like to make is — why are patients being put through this on their own? We know narcotic painkillers are addictive, dangerous – and also necessary in some situations. If we send people to physical therapy, why not provide some form of drug therapy to help get patients off safely? It’s not like these are cut-rate doctors here — one of the benefits of working for Microsoft is the insane medical coverage which gives us access to excellent providers. Wouldn’t it be better to give patients support in advance rather than risk them beginning to turn to illicit procurement once a doctor arbitratily decides it’s time to stop? What of the techniques used to get traditional drug addicts on the road to independence? My friend and I are both stubborn people, but it’s easy to lose your resolve when combatting real pain, or the fear of real pain, on your own for any length of time.

It just seems strange to leave patients adrift when dealing with such powerful substances. If abuse is a growing problem, rather than crack down after the problem develops, we should be proactively helping to prevent the issue in the first place.

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