Anesthesiologists

Spent my day at the chronic pain center where patients with debilitating, chronic pain are treated. Many of these patients are clearly suffering - they arrive at the clinic only after "failing" standard medical therapy for the most part. There are always the sob stories of patients who get bounced from doc to doc with their pain complaints ignored or untrusted, only to finally get vindication when the doctors at the pain clinic find something, diagnose them, and treat them with pain medications.

The problem is, pain is not visible, palpable, nor detectable by any person other than the one feeling pain. The feeling/perception of pain itself is not really all that well understood. Yet, the pain medications do work at blocking pain reception/perception. So it's not really all that surprising to find a story of a patient who suffers from intractable pain that nobody can really confirm, find some sort of radiological or physical exam abnormality that appears to explain the source of the pain, and then treat them with pain medications with relief. Truth be told - the findings could be completely incidental and not the true cause of pain. By now my attitude on chronic pain clinic is probably apparent - I'm not a believer.

The experience in the clinic did not change my opinion on chronic pain management but did alter my perception of anesthesiologists. I know that the statistics show that they are frequently abusing drugs, especially narcotics. It has often been blamed on their knowledge of medications, side-effects, and what I'm going to call hubris in believing that they themselves know how to administer the medication safely to avoid addiction/withdrawal. My observation of their behavior, however, suggests another far more human reason why they are more likely to become drug seekers/abusers.

As anesthesiologists in chronic pain management, they encounter people suffering from tremendous pain all day long - pain that again is invisible. It's hard to imagine someone else's pain, and more often than not we tend to over- or under-estimate the severity. The gratitude that comes with relief when a patient receives a pain-blocking medication is rather clear and obvious, however, despite again a lack of objective measurement. I believe these encounters result in the development of extremely low tolerance of pain/discomfort for these anesthesiologists. While on one hand this is extremely beneficial for the patients, and these doctors will appear compassionate and caring, it's a disaster for the physician himself. The low pain/discomfort threshold makes these doctors turn to pain-blocking procedures/medications and often perform it on themselves also with relief. It's then only a matter of time before they become psychologically, if not physically, addicted to pain-blocking medications as the most human instinct takes over - avoid pain.

I don't think this will ever change - and I believe this to be an occupational hazard, not a self-selection of drug-seeking/abusing people into the field/specialty of anesthesiology.