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Difficult Choices in Medicine

By Peter Ballard

Pain management is a concept with which I’ve struggled with.  How can you tell when someone is lying to you to obtain pain medication? Is it important to identify when this is the case, or is it more important to avoid the chance of turning someone away in pain? Must I bifurcate? So far, I have not seen a single case in which pain medication was withheld by a doctor at SCVMC. I’m naturally empathetic and I suspect that people could easily take advantage of me when I become a doctor if they are capable actors. I’m not sure if this is something to be concerned about or not. I suppose that I do not care whether I’m taken advantage of…but is it in the best interest of my future patients?  Does this enable those who are addicted and prevent recovery? I’m still unsure where the balance lies. Pain is such an individual experience, how do I know when pain is real?

Though i am confounded, watching patients in pain today in the ED was more difficult than in the past and pushed me to reflect on my assumptions about pain. Twenty-five minutes after receiving pain medication, our kidney stone patient was feeling much better, and thirty minutes after she was laughing and joking. The contrast was striking and encouraging. Watching the transformation in a patients demeanor was satisfying and I could tell it was needed.  The chance to relieve suffering, even temporarily is motivating. Watching her slip back into pain a few hours later was frustrating, but inevitable. This I could tell was real pain.

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