Wednesday, March 25, 2009

Realistic levels of pain relief

Realistic Levels of Pain Relief
From Medscape Neurology & Neurosurgery, March 13 2009

Question: Is it possible to achieve 100% pain relief in all people all of the time?
Response from Bill H. McCarberg, MD
"...Knowing that complete relief from the pain is rarely possible and understanding that most patients recognize this dilemma, the provider should not promise this outcome. When discussing the continuing treatment of a patient who has been examined, has failed multiple therapies, and returns to the provider with pain levels of 7 or 8 out of 10, the discussion should focus on other aspects of treatment. Statements from a pain provider such as "There is nothing more I can do," "You will need to learn to live with this pain," or "The doctor who deals with this type of pain is a psychiatrist," are all dreaded phrases to the patient with persistent pain. The provider should instead promise continued support and, despite lack of treatment efficacy, should not give up on the patient or stop being creative in providing help. Appropriate statements include "Even though we have not found anything to stop your pain, I am still here for you," and "You and I are going to continue to work on this pain problem to improve your function." For the patient with persistent pain, promise what you can deliver: comfort, compassion, creativity, teamwork, a caring environment, and most of all, yourself.

Patients seek help and wish for a cure but are comforted by our style and manner. We can always deliver compassion and continuity of care, which may not seem like much, but it is greatly valued by our patients."

M: Yes... this is exactly the respect for which I am looking.

Sunday, March 8, 2009


RICHARD ASHER AND THE SEVEN SINS OF MEDICINE (reposted from Dr. Dr Aniruddha Malpani's blog: The Patient's Doctor)

From the article:
This paper was written to introduce the student and recent graduate to Richard Asher - a colleague well worth knowing. His essays are refreshing and thought provoking - they will reward both student and seasoned practitioner.
Richard Asher, who was born in 1912, qualified in medicine in 1934. He spent the most important part of his career at the Central Middlesex Hospital in London. Although Asher's specific clinical interests were endocrinology and clinical hematology, they ranged more widely than these subspecialties. In his capacity as Chief of the Mental Observation Ward at the Central Middlesex Hospital, he described several new syndromes including myxedema madness, and Munchausen's syndrome.
Describing the modern hematologist in 1959, Asher refers to him in a somewhat Chestersonian statement as an individual who "instead of describing in English what he can see, prefers to describe in Greek what he can't." (5)
His terse, crisp language and his humour are seen not only in clinical writing but in special articles dealing with general medical and philosophical issues. Papers such as "Why are medical journals so dull?" (4), "Straight and crooked thinking in medicine" (2), "Talk, tact and treatment" (3), "Clinical sense: the use of the five senses" (7), "The dangers of going to bed" (1), "Six honest serving men for medical writers" (9) are examples of this exceptional talent. A decade after Asher's death, Beaven wrote that the man's "immense vitality, energy and dramatic flair made him a legend in his own lifetime" (12)...

...Many of Asher's papers have a timeless quality - and, like some of our medical classics, deserve rereading from time to time. His lecture "The Seven Sins of Medicine" is as instructive as it is entertaining. First published in The Lancet, on 27 August 1949 and re-published in a collection of his essays (10), his comments are directed to seven sins although he asserts that there are "an unlimited number." His lecture, he said, was given in the hope that "those students who wish to avoid them (the sins) may do so, and those who wish to indulge in them may enlarge their repertoire or refine their technique." The seven sins of medicine are identified as obscurity, cruelty, bad manners, over-specialization, love of the rare, common stupidity and sloth. The lecture, as topical today as it was some 35 years ago, serves as a gentle and humorous reminder of the pitfalls of medical practice.

ME: Some things don't change...

Books on Doctors as Patients and a few on the Doctor-Patient Relationship