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Editorial: Patient survey on pain management may may drive overuse of painkillers

The questions asking hospital patients how well their pain was managed were intended to show where improvement was needed. But those probing queries may have helped create administrative pressure for doctors to overprescribe pain medications in order to generate positive reviews.

The fact that the survey results are tied to hospital funding for Medicare and Medicaid patients raises the possibility that facilities have a financial reason for prescribing powerful painkillers.

With the nation in the grip of an opioid epidemic, any such unintended consequences of that linkage call for immediate adjustments, including eliminating or revising the questions about pain.

A recent Buffalo News article detailed the survey section on pain:

• During this hospital stay, did you need medicine for pain?

• How often was your pain well controlled?

• How often did the hospital staff do everything they could to help you with your pain?

As part of a survey routinely given to patients on Medicare or Medicaid, the answers to these questions are used to determine how much medical facilities are paid by the federal government.

This forces health care professionals into the undesirable position of balancing financial pressures against what is best for the patient. And all of this as record numbers of people are abusing painkillers. And when the prescriptions or the money to buy illicit pills run out, people turn to heroin.

The idea of a pill for every problem has its price, one that is too high for some people. Dr. Timothy Gabryel said that the call for pain to be treated as “the fifth vital sign” has consequences. It “set an expectation that there should be a pill for every problem and there should be no discomfort at all.” Gabryel is president of the Medical Society of Erie County and medical director of Mercy Hospital.

If the survey is contributing in any way to pressure on doctors, as a national coalition of medical and addiction professionals has indicated, then it needs to be adjusted. The same goes for the pain management standards of the Joint Commission on Accreditation of Healthcare Organizations, one of the major accrediting organizations in the country.

Curing this epidemic of opioid abuse will involve many steps. But changing the language on a survey of patients has to be among the easier fixes to what is a monumental crisis for victims and their families.

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