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California gets tough on pain in medical training

March 08, 2001

A hearing of the Assembly Health Committee later this year will find out whether California's medical schools, hospitals, and nursing homes are complying with new legislation and getting tough on pain.

Assembly Bill 791, which came into effect last January, compels State medical schools to include pain management and end of life care in the curriculum. Pain has also been declared a fifth vital sign, to be assessed along with all the others and duly recorded.

Co-author of the State law, and chair of the Assembly Health Committee, Helen Thomson, has written to all the State's medical schools and the Department of Health Services to find out how seriously they are taking their new obligations. The hearing, scheduled for later this year, will test levels of compliance.

Writing in the Western Journal of Medicine, Ms Thomson, herself a nurse, describes how patients suffer needlessly, because medical training fails to adequately prepare physicians to treat patients in pain and near death. Pain is the one thing dying people fear, she says. Yet it seems to be the very thing that is badly managed, even when its alleviation is perfectly possible in most cases, she adds.

Patients themselves cannot be relied on to report pain because they are frightened of becoming addicted to the drugs used to treat it, or being seen as a bad patient, she says, which is why formal recording of pain had been included in the legislation.
"If patients are asked about pain, they will be less likely to stoically grimace and bear it as an expected and unavoidable part of the disease," writes Ms Thomson.

"The intent of [the legislation] is to educate and influence the attitudes, aptitudes, and behavior of the next generation of Californian physicians..Despite breathtaking technological and scientific advances in medicine over the past 100 years, we have not adequately addressed the way we treat people in pain and at the end of life," she says.

British Medical Journal (BMJ)