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USA TODAY 9/7/2003 Many doctors lack training to ease patients' severe pain By Diane Meier As a physician, I often witness the suffering that can come with life-threatening illness. I have been called to the bedsides of very sick patients who are in pain, extreme discomfort or in states of serious depression. In these circumstances, I feel the responsibilities of my profession most acutely: to heal, to ease hurt and, above all, to do no harm. This is not always easy, as a host of recent studies suggest: *A majority of patients with cancer and other serious illnesses suffer from pain and discomfort, despite the fact that most such symptoms can be safely and effectively treated. *Oncologists report that two-thirds of their patients suffer from pain, and 75% of these patients categorize their pain as moderate to very severe. *Untreated pain is common. A study of 9,000 hospitalized, severely ill adults found that half of the conscious patients who died in the hospital experienced moderate to severe pain during their last 72 hours of life. If this is not troubling enough, consider the disturbing results of a recently released survey I conducted with physicians who treat seriously ill patients. Nearly 20% of them reported that they had received at least one request to help a terminally ill patient die. The major reasons for these requests were intolerable pain and physical discomfort. I can think of no clearer signal of unbearable distress than patients asking for help in hastening their own deaths. Many Americans argue that such findings support the need for physician-assisted suicides. I disagree, because I believe we doctors should help improve the quality of our patients' lives before we consider helping to end them. Palliative care Physicians want to relieve their patients' suffering, but most simply do not know how. Despite some improvements in medical education in palliative care, doctors often still are not trained to treat the pain and complex physical and mental distress of life-threatening illness. During nine years of medical education, I didn't hear a single lecture on pain management. The solution is simple. We can dramatically improve physicians' skills in relieving pain, in communicating with patients and their families and in recognizing and treating psychological symptoms such as depression and anxiety. This can best be accomplished by establishing palliative care programs in hospitals and nursing homes, where the sickest patients are treated and where doctors and nurses receive bedside training. Palliative care programs specialize in treating the pain and suffering of seriously ill patients to maximize quality of life. As the director of such a program at a large teaching hospital, I have seen thousands of patients find relief and avoid the discomfort and despair that might drive a person to want to end his or her life. Numerous studies show palliative care programs achieve similar results in a variety of health care settings. Financial disincentives Further, our health care system does not now reimburse financially pressed hospitals and overworked physicians for the enormous amounts of time required to aggressively treat the pain, complex symptoms and mental distress that destroy a patient's quality of life. Medicare, Medicaid and commercial insurers must ensure that palliative care exists in hospitals and nursing homes by building payment and quality incentives into the reimbursement system. Finally, families of the seriously ill must demand palliative care services for their loved ones who are suffering. Only then will these essential programs be readily available to those most in need. In an ironic twist, one of the most compelling arguments for these solutions comes from Oregon, the only state where physician-assisted suicide is legal. In almost half of Oregon's reported requests for assistance in dying, patients' desire for assisted suicide prompted their doctors to relieve pain more successfully or to refer them to hospice for comprehensive care of all their needs near life's end. The level of suffering that prompted the cry for help was treated, and life, once again became worth living. That's what I call good medical care. Diane Meier, M.D., a professor of geriatrics at Mount Sinai School of Medicine, directs the school's Center to Advance Palliative Care and Hertzberg Palliative Care Institute.