by Dr. Solomon Liao
Students and residents often ask me why I like my job so much and why I always walk around with a smile on my face when I’m on service. I respond that helping to relieve people’s pain is very rewarding. It provides instant gratification. The more challenging the case is, the more rewarding the result. Very few interventions in medicine provide as immediate an impact on patient’s function and quality of life as reducing their pain.
The volume of pain patients is huge. Over 116 million Americans have chronic pain. As my father taught me, “You go where the need is.” However, as I learned from one of my college mentors, “The need is part of the calling, but the need is not the calling itself.” As a palliative medicine hospitalist, I provide pain management as part of a larger calling of symptom relief and whole person care. My palliative care team and I therefore address not just physical pain but emotional pain and spiritual/existential pain as well as the family’s pain. My wife jokes that with the advancement of technology, someday I will be replaced by a much smarter robot (like in Star Trek or Star Wars). I quip back that no machine can ever get a patient in pain to open up about their pain story like a human physician can.
When I started as a hospitalist 16 years ago, I saw how frustrated inpatient physicians were in treating patients’ pain. Unfortunately most of us weren’t given the tools (the skills and training) needed to provide adequate pain management. The health system was also stacked against our efforts and desire to provide good pain care. The vitals, the pain scores, the documentation of how much pain medication the patient got, and the patient’s labs were all in different places. I had to spend a lot of time, energy and effort just gathering the information I needed. Now with electronic medical records, we have the opportunity to not only streamline care but track outcomes and provide real-time feedback. The electronic ordering system can help physicians to “do the right thing” and reduce errors, such as opioid conversions and provide alerts (e.g. drug interactions).
I am excited that the Society of Hospital Medicine has released its Pain Management Implementation Guide. If you are passionate about improving your patients’ pain like I am, then I hope these new guidelines will help your hospital to improve the system of care for pain patients. I think the most useful points in the guidelines are:
- An interdisciplinary team approach that addresses whole person care
- Placing pain management in the context of quality of life and function rather than reducing a severity score
- An emphasis on multi-modal care, especially for challenging or high risk patients
- Taking advantage of electronic medical records and electronic prescription drug monitoring programs
You can view the full guide online here: www.hospitalmedicine.org/painmanagement
Dr. Solomon Liao is a Clinical Professor of Medicine and Director of the Palliative Care Service at the University of California, Irvine. Dr. Liao completed his medical school training at the University of California, Irvine, his Internal Medicine residency training at Northwestern University Medical Center, and his Geriatric Medicine fellowship at UCLA. He is board certified in Geriatric Medicine and Hospice and Palliative Medicine and has practiced Palliative Medicine for over 18 years. Dr. Liao has served as the treasurer of the American Academy of Hospice and Palliative Medicine (AAHPM). He has been a member of the AAHPM board and is currently a member of the editorial board of the Journal of Pain and Symptom Management. Dr. Liao has served as an editor of several publications and has served on the USMLE Step 2 Test Writing committee and the National Quality Forum’s Palliative Care Steering committee. He has numerous publications in peer-reviewed palliative medicine and geriatrics journals and has spoken widely at national conferences.
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