Practice Pearls from the Texas Pain Society

Edited and maintained by William B. Rogers, M.D.
Tyler, TX
www.wrogersmd.yourmd.com

Over my 30 years of psychiatric practice, I have evolved two very simple criteria for the rational use of medication.  I share these rules with my patients, and advise them to use the same approach when they have medication prescribed by other clinicians:

1. The medication should not HURT the patient.  That includes intolerable side effects and drug-drug interactions with other medications. 

2. After an appropriate period of time (that may vary with the medication chosen), the medication should be effective. 

Criterion no. 2 –Effectiveness—is evaluated by reporting the effect of the medication on a predetermined list of target symptoms that the patient and I have collaborated upon and entered into the record during the initial assessment.  (I use an Electronic Medical Record that allows customized progress note templates that list the patient’s particular target symptoms at each visit.)  An example of target symptoms listed for a patient with major depression might be:

1. Early AM awakening with subsequent daytime fatigue.

2. A feeling of sadness for most of the day.

3. Lack of interest in hobbies or activities formerly interesting to the patient (examples:  reading, golfing, an evening walk with spouse).

4. Intrusive tearful episodes.

In pain management, formal target symptom monitoring lends itself to the use of a patient-centered pain rating scale in which the painful area in the body and a scale of severity can be noted with each visit.   The patient can fill out the graph or chart while in the waiting room, or, if the physician wants  to run a very patient-oriented practice and build excellent rapport with the patient (and family),  the extra 3-5 minutes it may take to personally assist the patient in rating the symptoms during the office visit is well worth the time.

With this issue, we are inaugurating a new feature that will allow the membership to share selected “pearls” from their practices across the state.   Please send your contributions by email to the TPS office or by “snail-mail” to TPS, P.O. Box 201413, Austin, TX 78720.  We’ll review them and see that they make the next available issue of the Newsletter or post to the website.

Here is my offering for this month:

1. A practice website is a very handy tool for educating my patients and for facilitating communication with them as well.  Since I use an electronic medical record (my choice was SoapWare available for sampling at www.docs.com ), I or my staff can cut and paste the patients own words of self observation, treatment responses, and questions (along with my answers) directly into the medical record.
   
   Websites can be awfully expensive to design from scratch, so I set mine up using the services of  Medem  (at www.medem.com).  The Medem websites also allow the patients to compose and file their full medical histories on line through the iHealth.com service.   Take a look at my website at www.wrogersmd.yourmd.com.