What is pain management?
- by admin
Sometimes we in the America are the best. But the rest of the world has been steadily catching up with us in areas of life that really matter. Some countries have now overtaken us. So if you look at the international league tables, we’ve dropped way down in education standards, and we’ve got one of the worst value-for-money healthcare services in the developed world. That’s what happens when you allow capitalism to take responsibility for public services. If your political system depends on not raising taxes, you can only cut services and the first to be cut is usually education. Now add the profit motive into the mix. If your doctor’s pay depends on how many patients he or she sees in a working day, how many minutes do you expect to have in your consultation? So, for example, we have an infant mortality rate of 6.4 babies dying for every thousand births. This is worse than every East and West European country – only 3.9 babies per thousand die in the Czech Republic. Our hospitals and clinics make money by testing you to find out what’s wrong. This can take a lot of tests. Then the doctors might prescribe the cheapest drugs or they might prescribe the more expensive drugs where they get incentives and kickbacks. In Europe, tests and treatments are only allowed if there’s clear evidence both that they are needed and likely to be effective. Drug prices are controlled by governments.
So how does pain management work in the countries with the best international standings? The first part of the answer might surprise you. By making the patient more important than the doctors. This flows from the practice of socialized medicine. Doctors’ pay does not depend on the profitability of the hospital or clinic where they work. Their performance is measured by the length of time patients must wait to see them, by whether their treatments have successful outcomes, and by their “death rates”. Yes, that’s right, hospitals publish the survival rates after the most common surgical procedures. We only rarely hear about the death and readmission rates in our hospitals. Our doctors are terrified of medical negligence and malpractice actions, and no one ever admits to a mistake. Yet without access to this information, we cannot make informed choices about where to get our medical care.
When it comes to pain management, the first thing the Europeans do is review the patient’s medical history. If there’s any possibility of a mistake in the treatment so far, there are tests. If further surgery or other treatments are indicated, these are put in hand. Only if there’s nothing further to be done to treat the underlying cause do they then treat the pain as a problem in its own right. This brings a big team together including psychologists, counselors, cognitive behavioral therapists, physical therapists and specialist pain management doctors. In the US, only five of our medical degree courses make pain management a mandatory subject. So most of our doctors need never learn about how to make the best decisions on pain. They prescribe Tramadol for the routine case. If you still complain, they increase the dose. If you still complain, they abandon Tramadol and give you something stronger.