Get Out Your Notebooks, Doctors: It’s Time to Learn

Johns Hopkins School of Medicine prides itself on “Connecting the Best Minds in Science and Patient Care.” For several years, it has put ever more muscle behind that statement in offering a new focus of study. To this end, medical students started taking a required mini-course that addresses an intense patient care need. What’s it all about? The answer is a four-letter word that spells Pain.

As Health Shots from NPR reports, students had trepidation when they stepped into the classroom to begin this four-hour program. One said: “I initially was a bit scared and I guess a bit wary coming into this course because of the opioid crisis.” And this med student added: “That seems like that’s the only thing that people have been talking about nowadays.”

It’s no wonder. Statistics from the Center for Disease Control and Prevention (CDC) support that quote. In the U.S., 20.4% of adults live with chronic pain. On top of that, 8% have what is termed “high-impact chronic pain.”

There’s more to those numbers. As the CDC explains, the condition of chronic pain is “one of the most common reasons seek medical care.” In other words, doctors-in-training: get ready to tackle this issue with your patients, who turn to you for help managing the effects of injuries, surgeries, illnesses, and even aging.

What’s a doctor to do? Likely not the first line of defense, some end up prescribing opioids.

About that Opioid Connection

How do doctors deal with patient pain in a hospital or clinical setting? Another student interviewed for this article drew upon her own experience. She has been on a rotation doing what future doctors do, which is shadowing physicians in these environments. During this time, new patients have flowed in complaining of pain. They seek medical attention above and beyond what they have been receiving from their primary doctors. That’s because their prescriptions may not be effective. The student noted: “Sometimes those patients will ask for opioids, and then it turns into an awkward conversation.”

Why so? Of course, opioids come with risks. But there’s a more pervasive reason on yet a higher level that affects this issue as a whole. Doctors have not been trained enough formally in how to manage all the pain they see in their practices.

Time to Learn about Pain Management

The director of the pain course at Johns Hopkins understands this need. She estimated that most medical students receive about nine hours of formal learning dedicated to pain. Perhaps some courses convey information about painkillers. However, within the grand scheme and in light of how prevalent this condition is, this area gets short shrift. She explains: “I don’t remember a lot of formal pain education, certainly not any kind of course that was given to me. It was just something you kind of learned as you went along.

Johns Hopkins indeed is one of the few addressing the critical area of pain education. How do we know? Part of the answer comes from the Association of American Medical Colleges. This group surveyed their members on this topic. What were they teaching about pain? Specifically, they asked if they were educating students about four facets: what is pain, how to identify and gauge the severity, how to treat it, and how to cope with cultural and social issues related to pain management. Of the total, 87% reported that all of these categories were covered. However, the medical schools expressed wide interest in doing more – “coming up with new ways to bolster teaching about the management of pain.”

The medical field approached retrieving this information in another way. They looked at licensing testing. What kind of questions about pain did the exam pose for doctors? They found that most focused on pain assessment rather than management. However, the National Board of Medical Examiners sees a change in recent years. The volunteers who develop questions are attune to the opioid epidemic and the items they write for the exam reflect this trend.

Teaching Best Pain Management Practices

When is the best time to sensitize students to pain management? Johns Hopkins decided sooner rather than later. As such, students take this specialized mini-course at the start of their medical education. This grounds them in the subject. It covers the physical and emotional aspects of pain. And it plunges into opioids – the pluses, minuses, and challenges. In all, the instructors want students to appreciate that opioids are one of many choices. Prescribing opioids requires careful consideration and getting to know patients rather than merely writing Rx’s.

In line with this concept, the medical student featured at the opening of this article later noted: “You wouldn’t really use a chainsaw to cut a piece of paper. But you also wouldn’t use a pair of scissors to cut down a tree.” Let’s hope all Medical students learn this well.