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  #141  
Old Mar 08, 2008, 01:05 PM
n_g
Registered User
Join Date: Apr 2006
Re: Scope of Practice

Originally Posted by NRSKarenRN View Post
2003: Students need more pain management training: education effort ...

WASHINGTON -- Medical students aren't getting adequate training to address pain problems that afflict more than 75 million Americans.

That's what health officials and medical school representatives said at a press conference sponsored by the American Academy of Pain Medicine (AAPM), in launching a new "virtual textbook" that students can use on their own time to learn about pain diagnosis and treatment.

Only 3% of medical schools have a separate required course on pain management, and 4% require a course on end-of-life care, according to statistics from the Association of American Medical Colleges (AAMC).
Less than a third of schools offer elective courses in pain management, and only a quarter provide electives in end-of-life care.
"If we are to effectively treat a future generation of pain patients, we first must educate the next generation of doctors who will care for them," said Dr. Jordan Cohen, AAMC president.
The concept of a virtual textbook "is very appealing and has the potential for broad usage," Dr. Deborah McPherson, assistant director for medical education with the American Academy of Family Physicians, told this newspaper. But she questioned whether students would find time in their busy schedules to do this type of supplemental work. "The reason why we're not teaching appropriate pain management is because there's just not enough room in [current] curriculums," Dr. McPherson said.

Medical Education A Barrier to Pain Therapy and Palliative Care. Journal of Pain and Symptom Management, Volume 21,
Issue 5, Pages 360-362


Most state medical boards require continuing medical education (CME) for physicians to renew their license. Recently, legislatures and state regulatory boards have begun to require or encourage that CME include education on pain management or palliative care for all or some licensees to provide physicians with updated medical, scientific and clinical knowledge. Evidence that many physicians lack knowledge about pain management and received little training in medical school suggests that such policies are needed and may be a positive step toward improving pain management. Emphasis should be placed on the quality of the curriculum and teaching methods. These policy initiatives should be viewed as experiments until evaluations demonstrate their value.




Uh, we're talking about board-certified physicians who have finished their residencies, not medical students. Specifically, these are pain medicine specialists who have also completed a fellowship after residency.

Do you guys still wonder why CRNA's lost every court case involving pain and why the LA legislature refused to pass a bill allowing CRNA's to do pain? This is the best evidence and arguments you can come up with?

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  #142  
Old Mar 08, 2008, 09:39 PM
wtbcrna's Avatar
wtbcrna (Male)
Senior Member
Join Date: Jul 2005
Re: Scope of Practice

Originally Posted by n_g View Post
http://www.lasvegassun.com/blogs/new...nder-licenses/
The Nevada State Board of Nursing reports that five certified nurse anesthetists voluntarily surrendered their licenses Wednesday pending the resolution of an investigation into dangerous and irresponsible injection practices at Endoscopy Center of Nevada, which led to the largest hepatitis C scare in the nation.
People do stupid things and make mistakes no matter what their level of training. Here is just a few MDAs making stupid mistakes....

http://www.nctimes.com/articles/2004...0421_51_22.txt
Anesthesiologist charged by Medical Board
http://the.honoluluadvertiser.com/ar.../ln/ln10a.html
A Honolulu anesthesiologist charged this week with purchasing chemicals that could be used to make the "date rape drug"
Failure to diagnose results in a judgment of $4.0 million when an anesthesiologist does not recognize that a patient has a small bowel obstruction.
Failure to get informed consent results in a judgment of $1.5 million after an interscalene block, for post operative pain control from torn rotator cuff surgery, placed against the patient’s express wishes, resulted in severe neck pain, arm weakness, numbness and a drooping left eyelid. The defendant anesthesiologist claimed that the patient consented.
Failure to review a medication list results in a judgment of $700,000 when a patient taking a NSAID developed a post operative spinal cord hematoma with residual weakness in both legs and no bowel or bladder control after lumbar laminectomy surgery. The anesthesiologist’s argument that it was not a breach of the standard of care to not read the medical record prior to surgery and that the anesthesiologist had no duty to discuss the drug with the surgeon was not accepted by the jury (Barbour v. Betz, June 2004).
Failure to do a “time out,” followed by wrong sided knee surgery results in a judgment of $ 175,000 with 5% of the negligence assigned to the anesthesiologist
Failure in OR communication results in a judgment of $1.75 million when information about a change in intraoperative evoked potentials was not “heard” by the surgeon and a young women undergoing scoliosis surgery woke up partially paralyzed. The technician monitoring the evoked potentials claimed that he had informed the surgeon; the surgeon denied receiving the information. A later change in evoked potentials was ignored because it was attributed to anesthesia (Skaggs v Tupper, February 2005). It is unclear from the material available for review if the anesthesiologist was a defendant

Failure to record vital signs results in a judgment of $750,000 after cardiac arrest and anoxic brain damage to 48 year old man who had presented for elective debridement of the third finger of his left hand. Induction of general anesthesia and placement of a laryngeal mask airway were uneventful. Shortly after surgery began the patient became bradycardic and suffered a cardiac arrest. For one hour there was no recording of oxygen saturation on the anesthesia record. The anesthesia resident’s claim that, despite the lack of recorded values, the patient had been continually monitored and given the appropriate amount of oxygen apparently did not impress the court (case citation withheld from article).
http://upennanesthesiology.typepad.c...-medical-.html
Thio is an anesthesiologist and pain management physician who had offices in Murrieta and Corona, said attorney Craig Johnson, who represented the plaintiffs.
"The act of billing fraud is viewed by the medical community as one of the most reprehensible acts," Johnson said
http://www.nctimes.com/articles/2004...0422_42_47.txt

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  #143  
Old Mar 08, 2008, 09:53 PM
wtbcrna's Avatar
wtbcrna (Male)
Senior Member
Join Date: Jul 2005
Re: Scope of Practice

Originally Posted by n_g View Post
Uh, we're talking about board-certified physicians who have finished their residencies, not medical students. Specifically, these are pain medicine specialists who have also completed a fellowship after residency.

Do you guys still wonder why CRNA's lost every court case involving pain and why the LA legislature refused to pass a bill allowing CRNA's to do pain? This is the best evidence and arguments you can come up with?
Actually, we are talking about scope of practice, and the practice of pain management is not limited to board certified/residency trained physicians in pain management. It is open to any physician that wants to be a "weekend warrior" and open a pain clinic. So, if they didn't get their training in medical school...then where did these physicians get their training other than these notorious weekend courses.

The La court case is all about politics....no research has been done by either side.

AGAIN....YOUR QUALIFICATIONS ARE? (I just put it in capital letters this time since you must have a hard time seeing it all the other times it was posted on here.)

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  #144  
Old Mar 08, 2008, 10:17 PM
NRSKarenRN's Avatar
Co-Administrator
Join Date: Oct 2000
Re: Scope of Practice

Originally Posted by n_g View Post
Uh, we're talking about board-certified physicians who have finished their residencies, not medical students. Specifically, these are pain medicine specialists who have also completed a fellowship after residency.

95 % pain management is provided by family MDs and surgeons in everday practice. Prrior posts stated FP's have more education than CRNA"s in pain mgmt.... the above links from brief 5 min search prove otherwise.

Issue stated is scope of practice standards for CRNA profession INCLUDES pain managment education as part of basic education....more indepth training and education available for those that choose that role and interest.

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  #145  
Old Mar 08, 2008, 10:24 PM
n_g
Registered User
Join Date: Apr 2006
Re: Scope of Practice

Originally Posted by NRSKarenRN View Post
95 % pain management is provided by family MDs and surgeons in everday practice. Prrior posts stated FP's have more education than CRNA"s in pain mgmt.... the above links from brief 5 min search prove otherwise.

Issue stated is SCope of practice standards for this profession INCLUDES pain managment education as part of basic education....more indepth training and education availalbe for those that choose that root.
We're talking about interventional pain medicine. I guess giving someone an aspirin is pain management, but it's not interventional pain medicine.

Most interventional pain medicine is done by pain docs with a few CRNA's who do a small subset of it without trying to draw too much attention to themselves.

It'll be interesting to see if there's an court in this country who would agree that CRNA's should be allowed to do pain. They have a huge uphill climb to convince people they should. If I were a CRNA considering pain, I would wait to see how it plays out before spending $2200 for a weekend NAPE seminar. Those are the folks who are really making the killing.

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  #146  
Old Mar 09, 2008, 10:28 AM
Registered User
Join Date: Jun 2007
Re: Scope of Practice

Ng have you ever performed an ISB,femoral, sciatic, or politeal nerve block for post op pain? TA-DA acute pain managment. The skill set is any different for any block it is placing a needle near a nerve and injectin a poison. A surgical rotation all 2 months of it does not make you any better at it.
Most pain medicine is practiced by FP docs period, they get their interventional traing in weekend warrior courses just like we do, excuse me for the doctor, I am sure it is called and educational seminar to expound on already known principles of medicine that only they can no about as the information is written in doctorease and cannot be read by lowly mortals like nurses. (Damn that is a run on from hell)
The leagel issues will be worked out and in the end CRna's will do pain justr as we do regional, and peripheral and as we are independent providers.
Good luck holding back the hands of time.

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  #147  
Old Mar 09, 2008, 09:14 PM
jwk
Registered User
Join Date: May 2004
Re: Scope of Practice

Originally Posted by NRSKarenRN View Post
Somehow you are missing the message that they ARE independent providers responsible for their own actions and held legally liable for acts omission and commission.
.
And somehow you're missing the message that pain management is NOT the same as "administering anesthesia".

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  #148  
Old Mar 10, 2008, 06:01 AM
Registered User
Join Date: Jun 2007
Re: Scope of Practice



Thats enough of this, thankyou so much. Toodles

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  #149  
Old Mar 10, 2008, 08:01 AM
Senior Member
Join Date: Oct 2003
Re: Scope of Practice

Originally Posted by jwk View Post
And somehow you're missing the message that pain management is NOT the same as "administering anesthesia".
Straw Man: an argument not advanced.

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  #150  
Old Mar 10, 2008, 11:17 PM
NRSKarenRN's Avatar
Co-Administrator
Join Date: Oct 2000
Re: Scope of Practice

Since scope of practice standards answered and educational links provided, closing thread.

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