Pain Management and Disciplinary Action: How Medical Boards Can Remove Barriers to Effective Treatment

1996 ◽  
Vol 24 (4) ◽  
pp. 338-343 ◽  
Author(s):  
Chris Stern Hyman
Keyword(s):  
Pain Management ◽  
Assisted Suicide ◽  
Pain Treatment ◽  
Chronically Ill ◽  
The Elderly ◽  
Disciplinary Action ◽  
Current Debate ◽  
Physician Assisted Suicide ◽  
Patients With Cancer ◽  
State Medical Boards

The current debate about physician-assisted suicide and the question of whether patients would ask for such help if their pain were adequately controlled place in sharp focus the issue of undertreated pain. Studies have repeatedly documented the scope of the problem. A 1993 study of 897 physicians caring for cancer patients found that 86 percent of the physicians reported that most patients with cancer are undermedicated for their pain. A 1994 study found that noncancer patients receive even less adequate pain treatment than patients with cancer-related pain, and that minority patients, the elderly, and women were more likely than others to receive inadequate pain treatment. Although the problem of undertreatment of pain is multifaceted, I only address how state medical boards contribute to the problem and suggest possible remedies.The literature on palliative care describes the numerous barriers that impede effective pain management and that result in the inadequate prescribing of pain-relieving drugs for terminally and chronically ill patients.

scholarly journals Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards

2003 ◽  
Vol 31 (1) ◽  
pp. 21-40 ◽  
Author(s):  
Diane E. Hoffmann ◽  
Anita J. Tarzian
Keyword(s):  
Pain Management ◽  
Pain Treatment ◽  
Chronic Pain Patient ◽  
Disciplinary Action ◽  
Pain Patient ◽  
Disciplinary Actions ◽  
Noncancer Pain ◽  
The Right ◽  
State Medical Boards

Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids. Surveys have shown that physicians fear potential disciplinary acrion for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in some cases, disciplined physicians for such prescribing. While in virtually all of these cases the disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment.

scholarly journals Er det at blive gammel tilstrækkelig årsag til dødshjælp?

2020 ◽  
pp. 235-247
Author(s):  
Søren Holm
Keyword(s):  
Mental Illness ◽  
Elderly People ◽  
Assisted Suicide ◽  
The Elderly ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Wish To Die ◽  
The Right ◽  
The Relationship ◽  
Vulnerable Elderly

A proposal put forth in the Dutch Parliament suggests that anyone over the age of 75 should have a legally guaranteed right to physician-assisted suicide if they wish to die, unless the wish is the result of a mental illness. This chapter discusses three questions about the relationship between age and entitlement to assisted dying: 1) are there good reasons to introduce a purely age-determined criterion for a right to assisted dying; 2) would such an age criterion lead to problematic discrimination against the elderly, or alternatively to discrimination against people who are too young to meet the criterion; and 3) what is the relationship between an age criterion and a postulated duty to choose assisted dying in specific situations. The discussion of these three issues shows that there are no good reasons for introducing an age criterion for the right to die, that an age criterion is potentially discriminatory to both the elderly and the young, and that introducing an age criterion could lead to problematic pressure against vulnerable elderly people.

scholarly journals Prospective, Observational Study of Pain and Analgesic Prescribing in Medical Oncology Outpatients With Breast, Colorectal, Lung, or Prostate Cancer

2012 ◽  
Vol 30 (16) ◽  
pp. 1980-1988 ◽  
Author(s):  
Michael J. Fisch ◽  
Ju-Whei Lee ◽  
Matthias Weiss ◽  
Lynne I. Wagner ◽  
Victor T. Chang ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Treatment ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Initial Assessment ◽  
Explanatory Variables ◽  
Patients With Cancer ◽  
Pain Management Index ◽  
Treatment Adequacy

Purpose Pain is prevalent among patients with cancer, yet pain management patterns in outpatient oncology are poorly understood. Patients and Methods A total of 3,123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled onto this prospective study regardless of phase of care or stage of disease. At initial assessment and 4 to 5 weeks later, patients completed a 25-item measure of pain, functional interference, and other symptoms. Providers recorded analgesic prescribing. The pain management index was calculated to assess treatment adequacy. Results Of the 3,023 patients we identified to be at risk for pain, 2,026 (67%) reported having pain or requiring analgesics at initial assessment; of these 2,026 patients, 670 (33%) were receiving inadequate analgesic prescribing. We found no difference in treatment adequacy between the initial and follow-up visits. Multivariable analysis revealed that the odds of a non-Hispanic white patient having inadequate pain treatment were approximately half those of a minority patient after adjusting for other explanatory variables (odds ratio, 0.51; 95% CI, 0.37 to 0.70; P = .002). Other significant predictors of inadequate pain treatment were having a good performance status, being treated at a minority treatment site, and having nonadvanced disease without concurrent treatment. Conclusion Most outpatients with common solid tumors must confront issues related to pain and the use of analgesics. There is significant disparity in pain treatment adequacy, with the odds of undertreatment twice as high for minority patients. These findings persist over 1 month of follow-up, highlighting the complexity of these problems.

scholarly journals Relations between Desire for Early Death, Depressive Symptoms and Antidepressant Prescribing in Terminally Ill Patients with Cancer

2002 ◽  
Vol 95 (8) ◽  
pp. 386-390 ◽  
Author(s):  
E Tiernan ◽  
P Casey ◽  
C O'Boyle ◽  
G Birkbeck ◽  
M Mangan ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Terminal Illness ◽  
Assisted Suicide ◽  
Terminally Ill ◽  
Depression Scale ◽  
Early Death ◽  
Physician Assisted Suicide ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Treatment Of Depression

Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death. Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy. Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.

How do we die?

2016 ◽  
Vol 35 (2) ◽  
pp. 69-74 ◽  
Author(s):  
Bonnie Stabile ◽  
Aubrey Grant
Keyword(s):  
End Of Life ◽  
Assisted Suicide ◽  
Hospice Care ◽  
Good Reason ◽  
The Elderly ◽  
The United States ◽  
Medical Intervention ◽  
Current Approach ◽  
Physician Assisted Suicide ◽  
Policy And Practice

Within the next two decades, the elderly population in the United States will reach its zenith, comprising 73 million individuals, 20 percent of the nation, the baby boomers’ final surge. The process of their dying may become contentious. Should policymakers and bioethicists be satisfied with our current approach to dying, or should they begin now to reconceptualize it? We distill end-of-life discussions in the bioethics literature and popular press, paying particular attention to physician-assisted suicide and its uptake where legal. Evidence so far indicates that few of the dying opt for this alternative, suggesting that its role in assuring “death with dignity” cannot be, as may have been hoped, a leading one. The end-of-life literature on the whole lends credence to the fear that most of the dying, along with their families and physicians, will muddle through a morass of uncoordinated options, with futile medical intervention the most prominent outcome — despite more palliative strategies, such as home hospice care, being favorably described. We found no reason to recommend persistence in our current approach to dying and found good reason to urge early, conscientious, and thoroughgoing reconceptualization in policy and practice as well as in theory.

scholarly journals Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020519 ◽  
Author(s):  
Young Ho Yun ◽  
Kyoung-Nam Kim ◽  
Jin-Ah Sim ◽  
Shin Hye Yoo ◽  
Miso Kim ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Pain Control ◽  
Assisted Suicide ◽  
The Other ◽  
Active Euthanasia ◽  
Physician Assisted Suicide ◽  
Passive Euthanasia ◽  
Patients With Cancer ◽  
Attitudes Towards Death ◽  
Life Sustaining Treatment

ObjectivesThis study determined attitudes of four groups—Korean patients with cancer, their family caregivers, physicians and the general Korean population—towards five critical end-of-life (EOL) interventions—active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide.Design and settingWe enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a ‘good death’ with critical interventions at EoL care.ResultsAll participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling ‘life was meaningful’ (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing ‘freedom from pain’ negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, ‘not being a burden to the family’ was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89).ConclusionGroups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.

QIM19-116: Barriers and Trends in Cancer Patients’ referrals to Pain Management in Qatar: A Randomized Cohort Prospective Study

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-116
Author(s):  
Rehab Abdelwahab ◽  
Anas Hamad ◽  
Shereen El Azzaz ◽  
Randa Al Okka ◽  
Mohd A. Wahid ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Pain Treatment ◽  
Pain Clinic ◽  
List Type ◽  
Patients With Cancer ◽  
Referral Criteria ◽  
Management Techniques ◽  
Primary Physicians

Background: Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008), beside the challenges to accurately assess pain, which might affect drug selection and pain control (Stewart, Ulster Med J 2014). In NCCCR, the treating primary physicians (PP) may prescribe analgesics to their patients or refer them to the Pain Management Team (PMT), based on evaluation or as requested by patients. This study will address the clinical concerns of PP, which may lead to refer the patients to PMT, moreover the clinical judgement of PMT on the referred cases whether they need to be refereed or not. Objectives: To determine the efficiency of the referral pathway to the pain clinic by PMT. Methods: PMT is going to assess the referred patient to their clinics according to pain assessment methods. Patients will be evaluated whether they have been appropriately referred or not, any unnecessary referral will be documented based on the following;• If the patient was referred by hematologist or oncologist• If the patient required specialized treatment• If the patient required urgent treatment/prescription or advanced pain management techniques• If the patient required further consultation by pain management• If the patient could be managed by PP Results: 195 patients were newly referred to the pain clinic during the period from March 8, 2018 to August 31, 2018. 12% (23/195) were deemed as unnecessary referrals based on PMT assessment; 43% (10/23) of them were hematology patients, while 57% (13/23) were oncology. The majority was for breast cancer and sickle cell disease patients with 35% for each. According to the PMT assessment, 61% (14/23) patients (95% CI, 40.79%–77.84%) considered unnecessary referrals due to improper basic pain assessment and management by PP, while 30% (7/23) patients (95%CI, 15.60%–50.87%) asked for refill medications. Conclusion: There is 12% unnecessary referrals to PMT, which need further improvement in the referral pathway, via the development of a definite referral criteria to PMT. PP should be encouraged to provide basic pain treatment and to consider multidisciplinary management with appropriate coordination for better improvements in patients’ quality of life.

Introduction

2015 ◽  
Author(s):  
Stuart J. Youngner ◽  
Robert M. Arnold
Keyword(s):  
Assisted Suicide ◽  
Death And Dying ◽  
The Elderly ◽  
The United States ◽  
Cultural Issues ◽  
Physician Assisted Suicide ◽  
Persons With Disabilities ◽  
Early Twenty ◽  
Continuous Sedation ◽  
Hospice And Palliative Care

This volume explores the topic of death and dying from the late twentieth to the early twenty-first centuries, with particular emphasis on the United States. The book comprises six sections. Section I examines how the law has helped shape clinical practice, emphasizing the roles of rights and patient autonomy. Section II focuses on specific clinical issues, including death and dying in children, continuous sedation as a way to relieve suffering at the end of life, and the problem of prognostication in patients who are thought to be dying. Section III considers psychosocial and cultural issues, Section IV discusses death and dying among various vulnerable populations such as the elderly and persons with disabilities, and Section V deals with physician-assisted suicide and active euthanasia (lethal injection). Finally, Section VI looks at hospice and palliative care as a way to address the psychosocial and ethical problems of death and dying.

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