Tuesday, September 27, 2016

Function makes a lot more sense than pain

For instance, during the Sept. 19 hearing, the reference committee heard testimony on a resolution put forth by the Georgia and Massachusetts chapters that drew applause at its introduction. The resolution centered on eliminating the subjective measure of a patient's pain as the "fifth vital sign."

Matthew Burke, M.D., of Arlington, Va., a new physician constituency delegate, spoke in favor of the resolution. "Pain is not an objective measurement of human physiology," he said. "While we should all strive to control pain, this is an inappropriate distraction."

Alternate delegate Douglas Martin, M.D., of Sioux City, Iowa, noted his work in the area of occupational medicine and his experience with workers compensation claims. A patient will say his pain level is a nine out of 10, said Martin, even though the patient is able to carry on a normal conversation. "Function makes a lot more sense than pain" as a measure of illness or disability, he said. 

District of Columbia delegate Kandie Tate, M.D., of Laurel, Md., expressed her concerns with total elimination of the pain score, however. "I'm worried we're moving the pendulum so far that we're not treating pain adequately. What would you replace it with, and how would you address pain?" she asked.

Connecticut alternate delegate Robert Carr, M.D., of Southbury, said the pain measures "sound good and feel good" but are not evidence-based and have unintended outcomes.

The Congress agreed and adopted a substitute resolution asking the AAFP to work to eliminate the classification of pain as a determinant of quality patient care.


Courtesy of Doximity

1 comment:

  1. On March 10, 2010, I wrote in another forum:

    Not infrequently, I see an adolescent with chronic headaches who has missed innumerable days of school with a headache that is always there and, seemingly, always has been. The head pain is diffuse and difficult for the patient to characterize. It is an "8" or a "9" (whatever that may mean) at the time of the visit. The headache by report interferes with the patient's concentration and makes it difficult for the patient to do schoolwork. The patient seems somewhat sullen and taciturn, but is in no way obviously incapacitated. I usually wonder, "If this patient can sit in my office, why not in the classroom?" I also wonder, "Does this patient have a headache?" On certain days, the patient seems overall to feel better than I do. I also muse that patients with childhood cancer have better school attendance records than this.

    Fortunately requests to write a letter excusing such truancy come to me relatively infrequently. I may on occasion write a letter stating, "John (or Jane) is a patient with Chronic Daily Headaches. We are working on medical approaches to the pain..." I have added, "I am hopeful that John or Jane's absenteeism can be addressed quickly." My most recent essay of this sort concluded, "Depression could be a factor in John or Jane's disability. In situations like these, school avoidance also remains a possibility."