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| Stuart Isett for The New York Times |
"Here it was again: the dreaded pain conundrum. A patient requests a strong pain medication and the doctor has to figure out whether the request is legitimate. This is an aggravating situation on many levels. On the individual level, there are the immediate issues of trust — do I trust Mr. W.’s story, and, conversely, how will my decision affect Mr. W.’s trust in me?"
"Then there is the larger issue of how we
doctors treat pain in general. A 2011
report from the Institute of Medicine highlighted how poorly the
medical field handles pain. Undertreating pain, we are admonished, violates the basic ethical
principles of medicine. On the other hand, we are lambasted for
overprescribing pain
medications, enabling addicts and creating an epidemic of overdose deaths."
"What are doctors to do? Pain is a
subjective symptom. There is no instrument to indicate its severity. All that a
doctor has is the patient’s word."
"For patients with chronic pain,
especially those with syndromes that don’t fit into neat clinical boxes, being
judged by doctors to see if they “merit” medication is humiliating and
dispiriting. It’s equally dispiriting for doctors. This type of judgment, with
its moral overtones and suspicions, is at odds with the doctor-patient
relationship we work to develop."
