Thursday, September 10, 2009
All of us who practice in the hospital setting and probably those of you who practice in clinics are familiar with the 'visual analog pain scale'. I wrote a bit about it on 3/17/07 (can't get a link to work... you can search the blog under 'arithmetic' and get right to it).
I got to thinking the other day, as I wrote out another prescription for Lortab for someone with "ten out of ten" pain, that one of the unintended consequences of the 'visual analog pain scale' has been a huge overprescription of narcotics and the skyrocketing of drug abuse by people who would not otherwise do it. After all, it's from a doctor, no?
I can't pull a .jpg image off the web for you but someone got a few million dollars from the NIH to come up with this 'scale' which is a series of human face caricatures progressing from smile to frown. You then ask THE PATIENT which one represents their pain at that moment. That's it. Science?
At the same time that one of my former employers was taping the pain scale to the back of every chart (at the behest of the 'Joint Commision' or JCHAO, or whatever they call themselves these days), and dinging us for not using it on every patient, the admin-weenies who are, almost to a man, not physicians, started dinging us for 'customer service complaints'. Usually these complaints were about the treating physician's refusal to prescribe narcotic pain medicine. Getting it from both ends, most of us just shrugged and came to some reasonable middle ground. My middle ground is that I will prescribe ten Lortab, no refills, to just about anyone. Sorry... that's just the way it is.
So this little theory of mine was quickly (partially) verified by a google search. Interesting, no? Oh those unintended consequences!
There are those who will still fight this battle... but with every patient that we fight we spend more and more time and field more and more complaints, and it's a wonder some of my colleagues still have the energy.
Medicine is an art and a science, and the assessment of pain can not be reduced to a silly-ass, third-grade, completely subjective cartoon. Docs, why did we surrender to these buffoons? We surely did (in almost all areas of the practice of medicine) ... but why?