News From the End of Life
News From the End of Life
Failure to ease pain brings large jury award
CA doctor hit with $1.5 million judgment
A jury in California awarded $1.5 million to a family of a deceased cancer patient who died while experiencing severe pain. The jury agreed that Wing Chin, MD, failed to address the patient’s pain adequately, but it did not rule that he acted with malice or had intentionally caused emotional distress, so there was no award of punitive damages.
In a trial that became a forum for the debate over how pain is treated in American medicine, an Alameda County jury on June 14 found that Chin, an internist, committed elder abuse and reckless negligence by not giving enough pain medication to William Bergman, who died in 1998.
The case is a major victory for patients’ rights advocates who argue that many doctors don’t treat pain adequately, said Barbara Coombs Lee, president of Compassion in Dying, a Portland, OR, advocacy group that provided legal assistance for the lawsuit.
"It’s a good day for us," Lee stated after the decision was handed down. "This case was against all odds. . . . This is a precedent-setting case because, to our knowledge, never before has undertreating pain been defined as elder abuse."
The suit was brought by Beverly Bergman, 45, the daughter of the retired railroad detective.
Certified palliative medicine docs on the rise
835 now are credentialed
The American Board of Hospice and Palliative Medicine (ABHPM) granted certification to an additional 56 physicians as of July 1, bringing the total number of physicians certified in the specialty of hospice and palliative medicine to 835 worldwide.
The medical specialty of palliative medicine is devoted to achieving the best possible quality of life for patients and their families faced with a life-threatening or terminal illness. Physicians who achieve certification from ABHPM are recognized as experts in the practice of palliative medicine.
"The art and science of care for patients who are not likely to be cured has always been an important part of the physician’s role," observes Ronald Schonwetter, MD, chairman of the ABHPM. "Unfortunately, for the last generation of physicians, training in palliative care was not considered important. Physicians had to keep up with
all of the technological advances in curative medicine. But all patients die eventually. And unless the physician is skilled in providing pain control and symptom relief, and in working with
a palliative care or hospice team, patients generally will not have the opportunities for comfort, dignity, and closure that they deserve. ABHPM diplomates are the physicians helping medicine realize the importance of high quality end-of-life care."
Eligibility requirements for certification from ABHPM are significant. Applicants for certification must have received prior major specialty certification, practiced at least two years following residency, worked as a member of an interdisciplinary team for at least two years, and directly participated in the active care of at least 50 terminally ill patients in the preceding three years.
Applicants who meet these requirements are then permitted to sit for the annual certifying examination, which covers pain in cancer and noncancer patients, management of non-pain symptoms, hospice and palliative approach to care, ethical and legal decision making at the end of life, death and dying, and communication and teamwork.
ABHPM will offer the certifying examination next on Oct. 13. Applications to sit for the examination must be received by Aug. 31.
[Editor’s note: A handbook for examination applicants as well as other information on the American Board of Hospice and Palliative Medicine may be obtained from the organization’s web site at www.ABHPM.org or by calling (301) 439-8001.]
1 in 4 in the U.S. suffer from chronic pain
Pain perception a diagnostic problem
Chronic pain affects 86 million Americans, causing the brain to constantly and mercilessly fire pain signals to the nervous system for weeks, months, even years. This condition, which is associated with several other conditions, is difficult for medical personnel to detect. It can be surprisingly resistant to modern medical treatments. Amazingly, chronic pain has only recently been classified as a disorder by health care organizations.
"Pain is the No. 1 reason people go to see their physician," says R. Norman Harden, MD, a neurologist and medical director of the Rehabilitation Institute of Chicago’s Chronic Pain Care Center. "The prevalence of chronic pain and the range of diseases that are associated with it have forced the medical community to finally acknowledge the fact that chronic pain is a serious problem, one that requires a unique set of treatments."
Until recently, health care organizations have treated pain as a symptom of a larger problem. In many cases, pain was considered to be the result of an injury or disease and merely a part of the healing process. Due to the subjective nature of pain, the medical community faced several challenges in both evaluating the disorder and pinpointing its causes.
"The biggest obstacle we have to overcome is assessing a patient’s pain, because each person’s perception of pain is different," says Harden. "The only way to measure’ someone’s pain is by measuring their improved functions and decreased disability, depression, and anxiety. That’s why we tailor pain management therapy for each individual patient, as opposed to a one-size-fits-all approach.
"Another huge obstacle to overcome is gaining the patient’s trust," Harden adds. "Many come to the Chronic Pain Care Center after going through multiple tests, doctors, and treatments with no clear answer to the cause of their pain. Most important, they are still in serious discomfort and feel that it is something they will have to live with."
Part of the confusion regarding chronic pain is the fact that it is tied to several other disorders such as fibromyalgia, lower back pain, migraines, and arthritis. Some of these disorders are a direct result of another disease the patient is suffering. However, fibromyalgia, for instance, has no known cause, which makes it difficult to diagnose. Many patients see several doctors and try several treatments before they are correctly diagnosed and treated.
Breaking the vicious cycle
In addition to affecting the patient physically, chronic pain may cause mental anguish. Many researchers have found a connection between mind and body in which misery leads to stress, and stress leads to pain. This cycle can be repeated over and over again unless the patient breaks through the cycle by using appropriate pain management methods.
"Many chronic pain patients have been suffering for so long, they’ll try almost anything to relieve their pain," notes Harden. "Therefore, most of my patients are receptive to what might be considered unconventional pain management treatments, including occupational therapy, exercises that focus on the mind-body connection, and social setting therapy."
Today, medical professionals are required to assess and treat a patient’s pain. Just last January, the Joint Commission on Accreditation of Healthcare Organizations, a national accrediting board, defined pain as the "fifth vital sign" along with heart rate, pulse, body temperature, and blood pressure.
The center has adopted an interdisciplinary approach to treating chronic pain that teams physicians specializing in neurology, physical medicine, and rehabilitation; physical therapists; occupational therapists; and psychologists. The team customizes programs for each individual that focus on a combination of exercises, physical therapy, medication, and patient education.
"Doctors no longer believe that treatment for pain comes exclusively in the form of a pill or injection," says Harden. "We are not trying to mask the pain or give instant gratification with medication. We teach techniques that our patients can do at home, are affordable, and promote self-management of the disorder. Patient education is our most valuable resource and one of the reasons why so many of our patients are able to live normal lives."
The center designs programs for each patient that could include nontraditional methods such as yoga and psychological techniques for how to deal with pain at work and home. Because of the center’s interdisciplinary approach and the simplicity of its techniques, more than 90% of the center’s patients have said they would recommend the center to others, and 60% report a significant decrease in their pain, according to Harden.
"The goal of the Chronic Pain Care Center is
to bring the best quality of life to our patients by teaching them how to manage their pain at home," says. Harden. "They no longer have to feel isolated from their family and are able to enjoy their lives again."
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