You may put the blame on me but I will still call it "ridiculous" and here is how I feel after retirement, I feel free to write it as I thought before and did not.
About five years or so before I retired there came a statement (from high above and I dunno who started it)
that a FIFTH VITAL SIGN must be recorded
There were four recognised ones since "times immemorial" (Called TPR and BP is added later)
1. Temperature in degrees as measured with thermometer
2. Pulse rate as counted in one minute by the nurse/doctor
3. Respiratory rate observed from the patient, 'times' per minute
4. Blood Pressure measured with the BP Machine
and now added 5. PAIN recorded as approximate number out of a maximum (most severe unbearable) of 'ten' and 'one' (the least pain-- AS FELT AND EXPRESSED BY THE PATIENT)
The ridiculousness is quite evident because it is NOT a sign at all to begin with because it a FEELING OF THE PATIENT which varies extremely widely in each individual and even in the same individual at various times of his/her life or day. We all clinically as physicians are fully aware of these things and yet we ere duped into thinking we are doing something clinically important
We know pain is a purely subjective phenomenon and thus is given attention according to the background of the patient, man or a woman, young or old stoic or not or hysterical or neurotic which is sort of observed by us but not necessarily written down.
However the disastrous result of prescriptions written for pain under "orders' is now coming out which was bound to happen and of course drug-addicts were happy (in those days I remember) so that population was going to increase and you did not have to be a genius to diagnose/predict that.
Now every physician will feel some degree of discomfort on writing a prescription of an opioid or similar drug for those who do require such medication genuinely and feeling comfortable only for "terminal" type of patients. Surely many of us during our practice of medicine are bugged pestered and sometimes cheated by any number of "drug-seeking" patients and we pass our "clinical lives' with some uneasy moments. So when I retired I felt relieved from this aspect of my medical life most.
(Another medication that always made me think "I-wish-there-was-some-other-medication-available" type of feeling was heparin and less feeling with other anticoagulants)
Please visit my Urdu blog at خیالات و احساسات
About five years or so before I retired there came a statement (from high above and I dunno who started it)
that a FIFTH VITAL SIGN must be recorded
There were four recognised ones since "times immemorial" (Called TPR and BP is added later)
1. Temperature in degrees as measured with thermometer
2. Pulse rate as counted in one minute by the nurse/doctor
3. Respiratory rate observed from the patient, 'times' per minute
4. Blood Pressure measured with the BP Machine
and now added 5. PAIN recorded as approximate number out of a maximum (most severe unbearable) of 'ten' and 'one' (the least pain-- AS FELT AND EXPRESSED BY THE PATIENT)
The ridiculousness is quite evident because it is NOT a sign at all to begin with because it a FEELING OF THE PATIENT which varies extremely widely in each individual and even in the same individual at various times of his/her life or day. We all clinically as physicians are fully aware of these things and yet we ere duped into thinking we are doing something clinically important
We know pain is a purely subjective phenomenon and thus is given attention according to the background of the patient, man or a woman, young or old stoic or not or hysterical or neurotic which is sort of observed by us but not necessarily written down.
However the disastrous result of prescriptions written for pain under "orders' is now coming out which was bound to happen and of course drug-addicts were happy (in those days I remember) so that population was going to increase and you did not have to be a genius to diagnose/predict that.
Now every physician will feel some degree of discomfort on writing a prescription of an opioid or similar drug for those who do require such medication genuinely and feeling comfortable only for "terminal" type of patients. Surely many of us during our practice of medicine are bugged pestered and sometimes cheated by any number of "drug-seeking" patients and we pass our "clinical lives' with some uneasy moments. So when I retired I felt relieved from this aspect of my medical life most.
(Another medication that always made me think "I-wish-there-was-some-other-medication-available" type of feeling was heparin and less feeling with other anticoagulants)
Please visit my Urdu blog at خیالات و احساسات
3 comments:
I am so with you on this post - Just found your awesome blog and I love it !!!! wish you were my teacher hahahhaa - We just think alike maybe because -- I am an old soul or you are a young one ? Whatever it is " This pain " caused me to leave the Actual practice of medicine and I decided to do contract work as a reviewer ! I didn't want to be part of this "druggie" culture in anyway !
Thanks Anon I am so glad you think like me
Yes I am an "old soul" and incidentally I have practiced in Pakistan (two years) England (about 7 years)and USA (33 years)
Now that's something - your years of practice = my years of life :)
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