Pain-management training lacking among healthcare providers

Your duty to do better, and why your veterinarian is 87 steps ahead of you

A survey of health and veterinary professional schools across Canada revealed that students don’t receive adequate pain management training (1). The survey included schools that train nurses, occupational therapists, doctors, dentists, physiotherapists, and veterinarians (1).

Only one-third of the schools could even identify set hours that were designated for pain management training (1). The average hours that pain management received by the disciplines shook out as follows: 15 for dentistry, 16 for medicine, 31 for nursing, 28 for occupational therapy, 13 for pharmacy, 41 for physical therapy and 87 for veterinarians (1). Canada’s doing better than us, though: the median hours of pain-management training received by American medical students is… 9 hours (2).  Even doctors specializing in post-surgical care are not as well prepared as veterinarians to manage and mitigate pain! (1).

Our blog has talked a lot about the experience of those in pain, building upon Erin Jackson’s work educating providers about the experience of those in pain.  Sometimes, Erin has even joked: “I swear that my veterinarian gives better care than many of the doctors I’ve seen!”  It turns out that has some merit to it: veterinarians receive about 5 times the pain management training of doctors. 

Because of the opioid epidemic that’s drawn national attention, medical schools are now grappling with the need to increase their pain management education (2). While the American Medical Association has encouraged that pain be dropped as the fifth vital sign (a “solution” that Erin’s been exploring with physical therapists while speaking at recent physical therapy conferences), elected officials are anxious for more active steps.

Governor Charlie Baker of Massachusetts was shocked to learn that the rate of opioid-related deaths has more than doubled in the past decade and claims that “physicians own part of the problem” (2). He has encouraged physicians to come up with solutions to quell opioid misuse (2).  In response, the University of Massachusetts Medical School piloted a training model for their students that includes four immersive experiences in which they evaluate and diagnose patient actors “in pain” (2). The students are evaluated on their ability to have a personal and empathetic conversation with the patients while also providing an appropriate diagnosis (2).

Our favorite model, however, is that being piloted by Michigan State University.  MSU amped up their Family Medicine pain management training by mandating periodic visits for patients with chronic pain, informed consent for opioid treatment, and depression screening for each patient (2). The depression screening recognizes that those experiencing depression are likely to feel more pain, so improved diagnoses of depression will lessen patients’ pain experiences (2).

What practices have you implemented in your clinic to ensure that you’re screening for patients in pain?  Do you perform a mental health evaluation and refer patients for psychiatric follow-up care when needed?  How do you build upon your pain management education – continuing education, trade publications, or podcasts? 

Please share! What creative mechanisms have you found most effective in serving your patient population? (aside from shadowing your veterinarian for a day)…

Sources cited:

(1)  Veterinarians receive five times more pain training than physicians, Spine Health (May 20, 2013).

(2)  Shannon Firth, Medical Schools Boost Pain Management Education, Med Page Today (Feb 4, 2016).

© 2017 Jackson LLP.

 

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