Background: Hospitalizations related to injection drug use (IDU) are often complicated by complex psychosocial circumstances and behavioral health needs. Despite growing hospitalizations amongst this patient population, little is known about physician experience caring for these patients. Our study aims to explore physician perspectives in caring for patients with IDU to understand the impact of these patient encounters on physicians and inform organizational efforts to improve care.

Methods: Using an interpretive phenomenological approach and semi-structured interviews, we explored the lived experiences of five hospital medicine and five infectious disease (ID) physicians caring for patients hospitalized due to complications of IDU at a tertiary academic medical center. Participants were invited through departmental listserv emails. Interview guide questions were developed using a conceptual framework for physician resilience that included internal and external variables as well as career and organizational resilience. A mixed deductive/inductive analysis was completed using a team-based iterative approach.

Results: Three themes emerged around how physicians experienced IDU-associated patient encounters: 1) system level barriers, 2) lack of training and education on caring for patients with addictions, and 3) powerlessness (Table 1). System barriers included lack of existing policies and healthcare infrastructure as well as competing clinical priorities and lack of standardized communication, all creating challenges for physicians in caring for patients with IDU. Physicians also identified a need for additional training and education for addiction management and effective communication with patients in order to support optimal and holistic patient care. The final theme described the overarching sense of powerlessness resulting from complex psychosocial and behavioral health needs compounded by system barriers and insufficient training in addiction management.

Conclusions: A multifaceted approach is required to address challenges in caring for patients with IDU. This includes a focus on efficiency of practice through addressing system level constraints, increased access to addiction medicine and rehabilitation resources to support these patients during hospitalization, and more training opportunities for physicians treating these patients. This in turn may improve the culture of wellness by alleviating feelings of powerlessness that physicians experience in caring for patients with IDU.

IMAGE 1: Table 1: Themes and subthemes with representative quotes