I love Kevin MD, he shoots straight.

I remember the first time I experienced the paradigm shift when it came to pain management. Sometime around the late nineties while I was on call, I received a phone call from a floor nurse stating that a patient that had their ankle operated on that day by another surgeon was having increased pain that was not controlled by the pain medication that had been ordered. As I had been doing for many years, I inquired as to what procedure was done, what pain meds were ordered, any allergies, any associated symptoms such as numbness or tingling and, most important, whether the patient had a splint on with tight bandages.

More often than not in the past, this simple inquiry revealed that there was an identifiable, correctable reason for the patient’s pain and the proper course of action would be to correct the problem — in this case to loosen the tight bandages. Just changing the pain medication was the last thing I did and for years it worked well, but this time it was different.

The nurse insisted on repeating to me that the patient’s pain was “10 out of 10.” I insisted that I understood that the patient was in pain but that it was necessary to “listen to the message not just shoot the messenger” and try to loosen the dressings first then call back if that did not work. Clearly annoyed, the nurse just hung up.

Several days later, I ran into the surgeon who was clearly upset. He told me that apparently instead of loosening the dressings the nurse called her supervisor who contacted the hospitalist who ordered stronger pain meds. The next day on rounds surgeon found the patient’s leg grossly swollen, dusky and almost developing a compartment syndrome, a very dangerous condition where the patient could have lost their leg. He then told me that what happened was that the hospital staff had been re-directed to be more aggressive in treating pain and that they were following new guidelines which included the “pain scales” and now labeling pain as a “fifth vital sign.” I thought he was kidding. How can be pain levels be considered a vital sign when there is no objective way to measure it like a heart rate or blood pressure? He just shrugged his shoulders.