We are students at the Kansas City University of Medicine and Biosciences (KCUMB) with dual-degree status as we pursue both our D.O. and an M.A. in Bioethics. We’re busy. Yes, we want to learn everything we need to successfully pass our class and board requirements to become physicians. We are also pursuing our M.A. because we want not only to be physicians, we want to be the best physicians we can be for our future patients. We believe bioethics education is significant. While our individual paths and motivations are different, we share that common goal.
In one of our bioethics classes we had the good fortune to meet Myra Christopher. Anyone reading this blog knows of Myra and her deep commitment to the transformation of the current medical culture regarding the under treatment of pain in America.
Through her presentation, we realized how short most medical schools fall when it comes to educating students about pain management. As future physicians, we recognize that a deeper understanding of pain management, including its place as both an ethical and community issue, is necessary to offer the best possible care to our patients.
Absent this one guest lecturer in a bioethics class that is not mandatory for any of our medical school class, but for us as dual-degree students, we would have continued to wear blinders, being unaware of the significant number of people in the U.S. affected by chronic pain.
Likewise, we would be blinded to the reality that chronic pain is a disease just like any other. As future physicians we have a duty to treat our patients to the fullest extent we are able and yet, physicians all over the country undertreat chronic pain patients due to unfounded fears. Our primary ethical duty will be to do no harm. If we do not recognize the pervasiveness of untreated chronic pain, and therefore do not offer appropriate treatment, we will violate this universal, fundamental oath. Forbearance has the potential to do harm.
Without adequately addressing a patient’s pain, we could fail to address a basic need of our future patients.
In Maslow’s hierarchy, the primary need is physiologic. This refers to the need for food and water, as well as homeostasis, which refers to the internal stability of a system. Pain throws off the stability of a person and interrupts homeostasis. Therefore, physicians who do not adequately address pain fail to meet the most basic need of a patient. When someone’s most basic need is not met, the situation is often deemed unjust. As bioethics students we acknowledge the principle of justice and we consider the under-treatment of pain an ethical issue.
We can never be reminded often enough that over 100 million Americans suffer from under-treated pain and that this translates to a cost in our society of approximately $635 billion per year. At the same time we must never lose sight of the individual, the family and community in which he or she lives. As future physicians, we will be part of a community. We will live side-by-side with individuals who experience untreated pain, our children will attend school with their children, we will shop in the same stores, we will attend the same civic events. We cannot allow ourselves to forget that in addition to the inherent suffering of the patient, chronic pain also has a high cost for the patient’s community—and that will be our community as well.
As medical students we recognize that in the future we will be in positions to influence, guide and lead community-based initiatives that focus on community health development programs and will have a heightened responsibility to do so. Again, without Myra’s presentation, we would have been blind to the need and the role some of us may play in the future. We suspect it will only be through partnerships with our patients, their families and our respective communities, that we will achieve a better understanding of the needs of those in pain and improve the overall health of our communities.
While recognizing the existence of a problem is an important first step, how can we effectively treat an issue that pervades all levels of the health care system? As in all reforms, education is key. As medical students, we acknowledge that the current American medical curriculum pays insufficient attention to the diagnosis and treatment of chronic pain. In order to treat so prevalent an epidemic we must increase the number of classroom hours dedicated to this issue. As we aspire to be compassionate providers, we need an education that prepares us to ignore snap judgments and instead properly manage pain. Holistic care has no place for prejudice.
We hope that this initiative gives providers the power to change their attitudes about chronic pain patients. As for us? Now that we know better, we will try to do better.
DO/MA Candidates 2016:
DO/MA Candidates 2017: