American Society of Anesthesiologists Newsletter, January 2000, Volume 64, Number 1

PATHETIC ETHICS REGARDING PAIN PRACTICES

AUTHOR: Judson J. Somerville, M.D., 
The Pain Management Clinic of Laredo

      I recently read the article, "Controversies in Pain Management:  Ethics in Business Practice" by James P. Rathmell, M.D., and Rebecca J. Patchin, M.D., Committee on Pain Management in the October 1999 NEWSLETTER.  I found it to be a misrepresentation and a display of ethical ignorance.  The last statement, "if the patient has worsened after a single injection, the patient may be better served by foregoing further injections," is a broad generalization and basically makes no sense, as no reference is made to the patient's diagnosis.
      Concerning encoding and billing for your services, the question was asked:  "Are all patients who are referred to a pain management clinic in need of a full consultation prior to procedure?"  I think this is one of the most frightening questions that I have ever come across in a professional journal.  Would a surgeon operate on a patient without evaluating him or her?  I think it is dangerous to do any procedure on a patient that one has not evaluated.  What if the referring physician sent a patient over for a procedure that was neither appropriate nor in the best interest of the patient?  Would one just blindly do the procedure?
      Moreover, the authors question whether to use fluoroscopy based on the extra cost.  There are studies which show that a significant percentage of "blind epidural injections" are not in the epidural space at all.  Why would a physician put someone at risk by performing a suboptimal procedure when, at a small additional cost, one can be almost certain of the correct position, in addition to information gained by doing an epidurogram?  This is a dangerous question which, in fact, should not even be asked.
      I resent the final statement, "As with all new medical practices, we must put the patient's needs first and place sound clinical judgment before economic consideration."  Perhaps these two professors have the misconception that private pain practitioners just stick needles in patients for money.  Not only is this implication not true, but a significant amount of chronic pain research is done by private practice physicians.  I would appreciate if future articles refrain from making rash, unsubstantiated and false statements.
      Unfortunately, misconceptions such as described display how out of touch with current private practice the "leaders" of the pain management section of ASA have become.