[Guest Post by Dr. Paul Rosen]
Almost a decade ago I was in a crowded conference room of doctors. There was a heated conversation about what to do about a particular patient complaint.
Parents were complaining that the doctors were not giving any numbing medicine or pain control before doing a spinal tap on their babies. The doctor argument was that a spinal tap was an emergency procedure that needed to be done without delay.
The parent argument was “don’t come near my baby with a needle without some form of pain control.” At the time, the parents were refusing the procedure without some sort of comfort measure.
I recalled my residency days in the late 1990s. As a pediatric resident, we did many spinal taps on babies who presented with fever. We were trying to make sure they did not have meningitis, a potentially fatal condition in infants.
On one occasion, I remember one of my attending doctors demonstrated how he could inject a small dose of lidocaine under the skin to numb the area before inserting the needle to extract the spinal fluid. It seemed to make perfect sense at the time, but after that, I rarely observed any babies getting numbing medication prior to a spinal tap.
Fifteen years later, views towards using comfort measures have become more liberal, but widespread change has not fully taken root.
We currently have an array of distraction techniques, pharmaceuticals and technology to decrease the pain and anxiety associated with procedures. Our hospital has been aggressive in employing comfort measures to decrease pain around procedures.
Our nurses are using a device called a J-tip, which propels lidocaine under the skin painlessly and without a needle before inserting an IV.
Staff members in our clinics are putting topical numbing cream on the children before sending them to the outpatient lab for blood work.
Child Life program staff employ distraction, guided imagery, deep breathing and music therapy to help children with procedures.
Our staff members who do bladder catheterizations are administering nitrous oxide to children to make the experience less painful and less traumatic.
You could argue that, we in medicine have been a little slow in this area. Dentists have been using nitrous oxide for their patients for several decades. We have come a long way in pediatrics, but we still have a long way to go. Comfort measures are still not employed as much as they could be in pediatrics. And why would we only want procedures to be less painful for children? Why not adults too?
Unnecessary Pain and Patient Experience
It is estimated that at least 10 percent of the adult population suffers from needle phobia; an intense fear of needles that often starts in childhood and persists into adulthood. This fear can be so intense that many adults avoid going to the doctor and avoid routine health maintenance. This is a problem that endangers the health of many.
You could argue that decreasing pain for procedures is a good marketing play and will help build consumer trust and market share. But the fact is that if we can prevent avoidable pain and suffering, then it is the right thing to do for our patients. And not just for kids. I don’t want my wife or my mom to have any unnecessary pain that could be prevented.
The patients at our health system have told the IV nurses and the phlebotomists that they won’t go anywhere else for care. They tell us that the distraction, pain control and comfort measures we use means they don’t have to hold their child down and they don’t have to see their child cry with a needle stick.
Let’s hope the days of arguing about spinal taps are gone and we can look for opportunities to relieve suffering every chance we get. In healthcare, those opportunities are all too frequent.
Pediatric Rheumatologist Paul Rosen, MD is Clinical Director of Service and Operational Excellence at Nemours. He received a Masters of Public Health degree from Harvard University and a Masters of Medical Management degree from Carnegie Mellon University. Dr. Rosen’s interests include patient-physician communication, family-centered care, and the patient experience. He teaches medical students about improving the patient experience, and he serves as the faculty mentor for the physician executive leadership program for medical students at Sidney Kimmel Medical College at Thomas Jefferson University.
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