How Medical Boards
Can Remove Barriers to Effective
Treatment
By Chris Stern Hyman
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.
One of the significant impediments is
physicians' fear that prescribing an adequate quantity of opioids
will result in an investigation by the state medical board,
the Drug
Enforcement Administration (DEA) , or the state agency
responsible for regulating controlled substances.
Another is the
woeful lack of knowledge of some physicians about
how to treat
intractable pain and their inaccurate perception
about what is and
is not legal.
Even members of state medical boards do not have a
clear
understanding of what is legally and medically acceptable in
using
opioids to treat pain.
The most effective antidote to the physicians' fear is
ensuring that
state medical boards are not investigating and
disciplining
physicians who
treat pain appropriately and that state
medical
boards and physicians are well informed about
effective
pain
management.
Is this best accomplished by statute,
regulations, or
guidelines, or by using experts
and education?
Statutes and
regulations can give
physicians some reassurance,
but the key to
appropriate
enforcement is the level of
knowledge about pain
management of state medical boards'
members and staffs.
In
attempting to remove barriers to effective pain
management, state
medical boards should take the following steps.
-
Objectively assess the medical board's level of
knowledge
of effective pain management
and the extent
of
the undertreatment
of pain in their state.
-
Enlist the assistance of physicians
who are experts in
pain management
to review cases under investigation and
to serve as
expert witnesses in hearings.
-
Consider how the regulatory process
can be used to
improve pain management.
- Evaluate how best to inform
and educate licensees
about pain management.
