USA TODAY

							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.