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Dr Shari
Skeptic Friend
135 Posts |
 Posted - 01/23/2002 : 03:25:37
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NubiWan
Skeptic Friend
USA
424 Posts |
Posted - 01/23/2002 : 09:47:51 [Permalink]
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Have seen several studies, that would suggest that our (USA) medical community does indeed, tend to undersubscribe medication for pain, of course you would better know. It consantly amuses and frustrates, me at once, how polictical thought still seems to trump scientific knownledge, as well as common sense at times, even in this day and age. Personally think all drug issues should be treated as medical issues, not criminal ones. Not that anyone asked. Thus far, have not had to confront the issue on a first hand basis, thankfully.
BTW what is a "JACHO?" The older me gets, the less "easy answers" seem to be available for any problem. Depends how close one looks at a problem, guess so.
"If we believe absurdities, we shall commit atrocities." -Voltaire |
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Garrette
SFN Regular
USA
562 Posts |
Posted - 01/23/2002 : 12:11:15 [Permalink]
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It's actually JCAHO. The Joint Commission for the Accreditation of Healthcare Organizations. It is the private body which establishes standards for, and conducts inspections of, most hospitals, clinics, etc., in the U.S. Accreditation by this body is accepted by federal bodies such as CMMS (Centers for Medicare and Medicaid Something(?)) which used to be HCFA (HealthCare Finance Administration).
Next time you go to a U.S. hospital, ask when their last JCAHO (pronounced Jay-Ko) inspection was, what their score was, and what Type I's (Roman Numeral 1) they received. If it's a public facility, they must tell you. Type I's are deficiencies. Scores are on a 100 point scale with 92 to 95 probably being average (a guess). They used to issue "With Commendation" laurels to high scoring facilities but stopped that practice about 2 or 3 years ago.
JCAHO standards are voluminous and often contradictory, both internally and with other agencies, but they are thorough and cover everything from pain management to emergency preparedness to utilities failures to physician credentialing to records management to security to fire safety.
{Edited for completeness}
My kids still love me.
Edited by - Garrette on 01/23/2002 12:13:40 |
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Dr Shari
Skeptic Friend
135 Posts |
Posted - 01/24/2002 : 01:30:02 [Permalink]
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A new standard requires hospitals to consider pain as the fifth vital sign along with pulse, bloodpressure, respirations and temperature yet go to an Emergency Room and complain of pain such as severe migraine or back pain and they will treat you like an addict and drug seeker so fast it will make your head spin.
Post-operative patients are taken off pain medication much too soon making recovery longer because they are unable to do what it takes to heal because of the pain. And that is just Acute Pain! Chronic pain patients are lucky if given say 30 Vicodin a month. This is enough pills for one pill a day that lasts for about 3-6 hours and the rest of time they are in pain. That averages over 600 hours in pain a month and maybe 120 in less pain.
Someone you love or yourself are going to develope a chronic pain syndrome such as severe arthritis, ruptured spinal discs etc and not be able to find someone to give them the amount of medication they need to keep them even reasonably comfortable. We apply a "grin and bear it" attitude towards pain patients. For those in doubt go to www.asappain.com or www.pain.com for an eye opening look at the goverment versus the patient mentality in the America.
The number of people who needlessly commit suicide because they do not get the available pain relief they deserve numbers in the tens of thousands each year.
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Slater
SFN Regular
USA
1668 Posts |
Posted - 01/24/2002 : 10:41:56 [Permalink]
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Someone you love or yourself are going to develope a chronic pain syndrome such as severe arthritis, ruptured spinal discs etc and not be able to find someone to give them the amount of medication they need to keep them even reasonably comfortable. We apply a "grin and bear it" attitude towards pain patients…
The number of people who needlessly commit suicide because they do not get
I was never able to see the humor in the TV show M.A.S.H.. The exhausted /drunken doctors and Corps. Men performing "meatball" surgery to save the young soldiers. My lack of humor stems from the fact that I was a guest of the equivalent of a MASH unit in Vietnam. Although I've fully recovered from my wounds I have never recovered from my botched medical treatment. I have been in constant pain since the late 1960s.
I'm an advocate of the "grin & bear it" school. Not because the drugs are addictive. What does it matter if you are addicted to drugs? If the pain is going to last your entire life you wouldn't want to give up you pills even if they weren't addictive. (These days I take a daily "middle-age-cocktail" of blood pressure and cholesterol drugs; they are totally non addictive-yet I'll take them every day till I die anyway. It would actually help if they were addictive, that way I wouldn't forget them.)
The problem with the "pain pills" is that they do much more than just deaden your pain, they affect the very quality of your being. They alter the way your mind works and so color your entire life.
True, the pain does that too.
It comes down to a matter of personal choice. You are pretty much screwed whichever path you choose.
I also don't share the abhorrence that most medical doctor's feel toward suicide. A person's life is their own, they should be able to end it if they feel the need (In England, until 1898, the punishment for attempting suicide was hanging. Ya gotta love those English.) I'm not sure of your assessment that suicides over pain are "needless". When the alternative is a "half existence" with your faculties clouded by drugs -constantly, and for the rest of your life-suicide becomes a viable option. There comes a point where the quality of your life is such that it is no longer worth living. People should be allowed to decide where that point is for themselves. And it would be nice, once they had decided, if they were allowed a little dignity.
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The brain that was stolen from my laboratory was a criminal brain. Only evil will come from it. |
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Valiant Dancer
Forum Goalie
USA
4826 Posts |
Posted - 01/24/2002 : 11:35:58 [Permalink]
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quote:
It's actually JCAHO. The Joint Commission for the Accreditation of Healthcare Organizations. It is the private body which establishes standards for, and conducts inspections of, most hospitals, clinics, etc., in the U.S. Accreditation by this body is accepted by federal bodies such as CMMS (Centers for Medicare and Medicaid Something(?)) which used to be HCFA (HealthCare Finance Administration).
Next time you go to a U.S. hospital, ask when their last JCAHO (pronounced Jay-Ko) inspection was, what their score was, and what Type I's (Roman Numeral 1) they received. If it's a public facility, they must tell you. Type I's are deficiencies. Scores are on a 100 point scale with 92 to 95 probably being average (a guess). They used to issue "With Commendation" laurels to high scoring facilities but stopped that practice about 2 or 3 years ago.
JCAHO standards are voluminous and often contradictory, both internally and with other agencies, but they are thorough and cover everything from pain management to emergency preparedness to utilities failures to physician credentialing to records management to security to fire safety.
{Edited for completeness}
My kids still love me.
Edited by - Garrette on 01/23/2002 12:13:40
And in some cases, the guidelines are interpreted by inspectors into a policy which is completely unattainable.
For instance, a JCAHO inspector insisted that Info Systems should have a plan that in case of a power failure and UPS failure would make test results available to doctors immediately. (We thought he'd been self-medicating) Although loss of JCAHO accredidation is difficult for business, it does not put anyone in jail. JCAHO has no teeth when it comes to enforcement.
HCFA is it's own little darling, too. As well as driving the reimbursements of Medicare claims down. (Usually by not paying them......for 4 months. Chronic late pays, but not as bad as the states Medicaid.) In addition, HCFA has been on a real "fraud" tear. When providers call to ask questions on a specific billing issue, the interpretation of the rules by the HCFA personell are not binding. If the person you talked to "told you the wrong thing", that person doesn't get punished, the provider does. By fines, repayment, jail time, loss of Medicare billing privledges, etc.
Then on top of it, they restructure their billing and give everyone six months to rewrite all of their billing software. (Dr. Shari will understand the elimination of bundling)
There is a third regulatory body that if you want to be known as a good hospital, you need their accredidation. CAP (College of American Pathologists). For the most part, they are reasonable, but they still have no idea about Info. Systems. Instead of polling IS people on what should and should not be reasonable, (JCAHO and CAP use doctors and administrators from other hospitals to perform their inspections.) they rely on the end user who rarely knows the operational level of IS past "I call them, they fix it."
(Been in IS for healthcare for 13 years, does it show that much?)
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Garrette
SFN Regular
USA
562 Posts |
Posted - 01/24/2002 : 11:53:37 [Permalink]
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Hadn't realized your affiliation with healthcare, Val. You are correct about JCAHO and the whim of the surveyors. Actually, in security and safety (encompassing also emergency preparedness, medical equipment, utilities management, infection control, hazardous materials, and life safety), my biggest obstacle are self-appointed experts in-house. While many JCAHO standards are onerous, they are better than many 'ghost standards' propagated by the rumor mill. Fighting the ghost standards takes up way too much time.
I disagree, though, about JCAHO having no teeth. While HCFA conducts its own inspections, as does L&R, they both will initiate additional inspections and suspend their own accreditations if the hospital fails to obtain JCAHO accreditation.
I'm biased, though. HCFA and L&R inspections tend more towards the clinical and record-keeping areas (such as IS) and usually only gloss over what they see as tangential issues such as security and safety. But JCAHO digs in rabidly to my areas, so I their inspections are more of an issue for me than the others.
My kids still love me. |
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Xev
Skeptic Friend
USA
329 Posts |
Posted - 01/24/2002 : 13:15:28 [Permalink]
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I say, that definitly in the case of the terminally ill, they should be allowed whatever medication helps allieviate pain.
I 'know' somone, let us call them V, who suffers from chronic migrane. Unfortunatly, V has liver problems from over-prescription of Vicodin and Acedomenephin (sp). V has taken all manner of experimental drugs, none of which work, yet V's doctors cannot/will not give V morphi, which works.
Of course there is the fear of tolerence....
Pain is a horrible thing, I inherited V's condition.
I think that doctors should have wide discretion on what amount of painkillers they prescribe. The bad of a few junkies (and lets face it, heroin is waaay easier to obtain) pestering or bribing doctors is outweighed by the good of people not suffering.
"If anyone can show me, and prove to me, that I am wrong in
thought or deed, I will gladly change. I seek the truth, which
never yet hurt anybody."- Marcus Aurelius |
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Valiant Dancer
Forum Goalie
USA
4826 Posts |
Posted - 01/24/2002 : 13:23:32 [Permalink]
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quote:
Hadn't realized your affiliation with healthcare, Val. You are correct about JCAHO and the whim of the surveyors. Actually, in security and safety (encompassing also emergency preparedness, medical equipment, utilities management, infection control, hazardous materials, and life safety), my biggest obstacle are self-appointed experts in-house. While many JCAHO standards are onerous, they are better than many 'ghost standards' propagated by the rumor mill. Fighting the ghost standards takes up way too much time.
I disagree, though, about JCAHO having no teeth. While HCFA conducts its own inspections, as does L&R, they both will initiate additional inspections and suspend their own accreditations if the hospital fails to obtain JCAHO accreditation.
I'm biased, though. HCFA and L&R inspections tend more towards the clinical and record-keeping areas (such as IS) and usually only gloss over what they see as tangential issues such as security and safety. But JCAHO digs in rabidly to my areas, so I their inspections are more of an issue for me than the others.
My kids still love me.
Granted that when JCAHO pulls their accredidation, so does HCFA, CAP and others. But they have no authority to fine or imprison chronic violaters. Which is what I meant by "having no teeth." HCFA has a mouthful in that respect.
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Tokyodreamer
SFN Regular
USA
1447 Posts |
Posted - 01/24/2002 : 14:06:02 [Permalink]
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Not sure how true this is, but I've heard that it was quite common for doctors in the 1800s to be regular users (addicts) of morphine, and lead perfectly normal lives and careers.
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Sum Ergo Cogito |
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Garrette
SFN Regular
USA
562 Posts |
Posted - 01/25/2002 : 04:44:59 [Permalink]
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quote:
Granted that when JCAHO pulls their accredidation, so does HCFA, CAP and others. But they have no authority to fine or imprison chronic violaters. Which is what I meant by "having no teeth." HCFA has a mouthful in that respect.
Conceded.
My kids still love me. |
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comradebillyboy
Skeptic Friend
USA
188 Posts |
Posted - 01/25/2002 : 20:03:44 [Permalink]
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personally, i would find that morphine addiction vastly superior to severe pain. the government's suppression of opiate use is another relic of our puritan past. its much easier for a teen ager to buy crack or heroin than it is for a sick person to recieve morphine. the doctor faces a greater penalty than the drug dealer. the public suffers.
comrade billyboy |
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PhDreamer
SFN Regular
USA
925 Posts |
Posted - 01/25/2002 : 21:36:30 [Permalink]
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Hell, we're already hardwired to receive pleasure from the neurological effects of these drugs; how bad could they possibly be for us? 
Adventure? Excitement? A Jedi craves not these things. - Silent Bob |
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Dr Shari
Skeptic Friend
135 Posts |
Posted - 01/26/2002 : 01:56:02 [Permalink]
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quote:
Not sure how true this is, but I've heard that it was quite common for doctors in the 1800s to be regular users (addicts) of morphine, and lead perfectly normal lives and careers.
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Sum Ergo Cogito
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Dr Shari
Skeptic Friend
135 Posts |
Posted - 01/26/2002 : 02:03:49 [Permalink]
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quote:
Not sure how true this is, but I've heard that it was quite common for doctors in the 1800s to be regular users (addicts) of morphine, and lead perfectly normal lives and careers.
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Sum Ergo Cogito
Unfortunately a large number of medical personel are still abusing drugs. Fentynal for anethesiologist, RNs seem to prefer Meperidine,(Demerol), but all drugs are abused. Some with little impairment but some with catastrophic results.
It has been said that President Kennedy was often on Morphine for severe back pain while in office.
Addiction is hereditary for some and others are just abusers. As I have said it is a very fine line to walk in the treatment of pain patients.
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Badger
Skeptic Friend
Canada
257 Posts |
Posted - 01/28/2002 : 14:15:33 [Permalink]
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Dr. Shari, I don't know if you posted this to get an all encompassing consensus, or if you did for discussion alone.
I don't think there is an answer to your question that could be applied globally, any more than there is one pain medication that could be applied to everyone with all types of pain. I think Slater makes the best point in that pain and its treatment should be evaluated on a patient by patient basis.
Slater can "grin and bear it", so maybe he doesn't need any pain medication prescribed. Someone else, however, may have a lower tolerance to pain and so need somethng strong. However, they may have an addictive personality, so that factor will have to be weighed. I think that the doctor should weigh all factors in the patients life and make the best choice they can so that the patient has the best OVERALL quality of life.
Just because we're hypnotized, that don't mean we can't dance. - Tonio K. |
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