OTHER PEOPLE’S PAIN: THE PROFESSIONALS OF MEDICAL SCHOOLS
Posted: under Pain Relief-Muscle Relaxers.
Medical, dental and veterinary schools were set up to purvey the principles of their profession. The cause of disease and fundamental cures were the main target. Symptoms such as pain were mere signposts on the road to the main aim. Symptom control was historically not worthy of the attention of serious men so this task was assigned to denizens of the depths of the hierarchy, such as nurses and physiotherapists. Even dying was not a worthy subject because, by general medical agreement, there was nothing more to be done.In the past twenty-five years, pain has regained a status worth consideration in these professions. However, there are new powerful, justified claims on the strictly limited time available for medical education. The hugely tempting developments of molecular biology, biochemistry and genetics have considerable new claims on the time of the students and on the interests of the faculty. To make time, traditional subjects such as gross anatomy have been condensed to a wizened nugget of the former two-year absorption of medical students in the dissecting room. Despite the obvious fact that pain is the most common complaint and the reason why patients visit their doctors, the subject as such has made little progress in capturing jealously guarded class time. In the preclinical years, pain can be ‘explained’ in fifteen minutes by mouthing the hundred-year-old myths that there are pain fibres in the peripheral nerves and a pain tract in the spinal cord with a pain centre in the thalamus. A few hours of lecture have been inserted to cover the whole of psychology. The pharmacologist may give a one-hour lecture on analgesics. In the clinical years there may be just a single session on pain. This means that the fully qualified doctor usually emerges with only three to four hours of tuition on pain.Deans and professors ritualistically regret the lack of time devoted to pain, but there has been little progress. It is true that elective courses on pain appear and are attended with enthusiasm by psychologists and pharmacologists as well as medical students. If the table is so bare in the medical school, it is not surprising that nurses, physiotherapists, occupational therapists and psychologists fare little better in their need to understand the subject which will take up so much of their working life.*82\219\2*
