Being in pain is a bit of a pain

There were so many great talks and presentations at the British Renal Society’s Conference in Leeds last week that it’s taken several days of reflection for them all to sink in. My mind however keeps returning to a talk from a junior doctor from Imperial College Renal and Transplant Centre, Louis Koizia. His excellent and detailed talk had the less than catchy title of “Pain management in renal inpatients: How good are medical teams on renal wards at prescribing analgesia?”


After studying patient’s levels of pain and associated prescription patterns for pain killers the short answer to the question he posed in the talk title was “Not very!” While the hospital had a recognised pain ladder it clearly wasn’t meeting the needs of its patients. The doctors and pharmacists addressed this and within 8 weeks had redesigned the pain ladder and submitted it for approval. So where’s the problem I hear you ask.

Well, the first problem Louis reported was the delay in implementing the new pain ladder. The changes to procedure had to jump through so many hoops, be debated by a multitude of committees that seven months later the changes have yet to be introduced. The debate isn’t about what colour paint should be on the walls, we’re talking about a significant issue for the patients affected, one that will improve their lives and potentially reduce the length of time they need to stay in hospital thereby cutting costs (which, let’s face it, is the only mantra that matters in healthcare these days).

The second and in my opinion more worrying problem arose from a comment made by a member of the audience, a colleague of Dr Koizia, Professor Edwina Brown, a consultant nephrologist who was leading the study. She reported that at one of the many meetings they’d attended seeking approval for the changes one doctor claimed “kidney patients make up the fact that they’re in pain”! I’ll let that sink in for a second or two. We don’t have pain, we just say we do! To what end? Sympathy? Attention seeking?

Now I have a small problem with the increased use of the phrase “patient centred care”. To my mind it still infers patients have things done to them rather than work in collaboration with their doctor to decide what’s best for them. Leaving that aside, how on earth can we ever have patient centred care when doctors assume they know what patients are feeling? I must stress that I’ve not come across a doctor in my many years of ill health who has openly expressed such an opinion or demonstrated such a poor attitude but the fact that one doctor feels that way makes me suspect he’s not alone.

I’ll close on a lighter note with a quote I heard at the Conference from Roger Greenwood, consultant nephrologist at East & North Herts NHS Trust and former president of the British Renal Society. His quote seems appropriate for Louis’ problems gaining approval for the changes to the pain ladder.

“Don’t ask for permission, just learn how to apologise”

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