Pain is a subjective experience. Those without pain cannot understand what it is like to live in constant pain and suffering. We live in a society that values youth and vitality but when people are suffering, it seems that the system wants to turn their back on them. I regularly see patients that have surgery and are just told to live with the pain. They tell them to just go to pain management and live on pills. Many of these people want to get better and are willing to do anything to get better. I try to give these people some degree of hope when there appears to be none. It is a job that has highs and lows. The other day I had a patient write me a long letter about how I changed his life but then there are those who don’t get better or even get worse. The hard thing in the pain medicine realm is that it is easy to just give up on people. So often I see where the surgeon just writes them off and tells them to “go away” because he cured them. It reminds me of a Howard Jone’s song from the 1980’s where in the song he says, “doctor says you’re cured, but you still feel the pain”. I guess the hard thing is that we as doctors need to be more compassionate of people’s needs and to not just write them off. The system makes this difficult because it makes us in charge of their pain meds and thus we have to determine who gets them and who doesn’t. The system also encourages us to do as little as possible. One of the hardest things is to get another doctor to look over a problem that the original doctor caused. No one will touch the patient if there is an issue due to liability issues. This really makes it hard to get anything done. The system definitely is flawed and it is really flawed against those in chronic pain. I often wonder if the easy way is the right way. It would be much easier to just do really simple procedures that give temporary relief but carry no real risk. But I always go back to my Hospice training and in my mind I realize that the most important thing you can offer the patient is hope. I really try to offer solutions for people’s problems. Sometimes they help and sometimes they don’t, but when I look into the eys of a person who had no hope and I offer them just a chance, I can see some encouragement in their eyes. We as doctors are definitely not perfect and we definitely make mistakes but I think that the best we can do for our patients is to try and help them or to find someone who can. A patient the other day told me that the government would rather that he killed himself rather than be on pain meds and the sad irony is that it sometimes seems that way. The problem with drug addiction in this country is a real problem but we have to help those who are suffering. I had a recent conversation with a pharmacist who didn’t like that I was giving a patient lortab and ultram. I tried to explain that the ultram is not a controlled substance and I am trying to reduce the amount of lortab the patient was utilizing. She just couldn’t understand why they needed to be on these meds long term. She was in her twenties, just out of school and never experience pain in her personal life and thus she had no concept of human suffering. I don’t know what the answer is for this lack of compassion. As one patient told me, someday the young pharmacist will know what pain is and then she will understand. We need to do a better job of educating people about pain and suffering. We need to be the advocate for patients and their pain and most of all we need to be there for the patient and not turn our back on them (unless they are abusing their medications). All we a physicians can do is try to do no harm and to try and help people the same way that we would expect to be helped. People have to have hope or they have nothing. I have seem people end their lives because the pain was so severe and they felt that all hope was gone. Hope may not be the answer but it is a good place to start.
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micro job…
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