Subjective Pain Assessments are Disappearing. As a Medicare Quality Metric, that is

Quality in medicine is a moving target. I have reflected and written about this topic many times, perhaps most recently in March of this year. When I was medical Director in Bucksport, Maine, I did not allow the use of numeric pain scales for the simple reason that frame of mind influences perception, and even though opiates are often effective as anxiolytics and antidepressants, there are safer treatment options. It is ironic that it takes so long for medical evidence to be adopted into practice (17 years average), and then when it comes to quality metrics there is another delay on top of that. Well, anyway, I was just informed that pain assessments for Medicare patients’ quality scoring is about to be “retired“ with the beginning of the new year. Thank goodness.

Of course, we still need to deal with patients who have pain, but assessing pain is not straightforward, much less numeric. We need to understand the significance, the symbolism and the psychological components of what people view as pain. Narrative medicine, if you will.