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Foreword
There is a current fashion that I would label “arousal of emergency physician
guilt.” Far too many articles in our literature – and far too many hidden
agendas – are addressed by declaring that the emergency physician must be
aware of some rare entity, usually in an article that declares itself the first to
report that entity in the emergency medicine literature. Moreover, there are
many groups outside of emergency medicine that wish to blame the emergency
physician for any error that is made. Such a one is the special interest
group that has decided not to pay for care should we fail to draw a blood
culture before treating a community-acquired pneumonia. The results of
such culture might be of interest for the infectious disease specialists but
cannot be shown to alter therapy, improve outcome, or lower the cost of
medical care. We all profess belief in evidence-based medicine, but only if
our own interests are served.
Nevertheless, there are areas of medicine in which our practice needs
improvement, and it is part of the intellectual honesty of emergency medicine
practitioners to obtain the evidence upon which an improved practice
can be based. Pain management is certainly one such area. For too long the
emergency physician has had a reputation for being very stoic about the
patient’s agony. That there is merit to this criticism is borne out by the reality
that we often fail to treat painful musculoskeletal conditions, that we often
underdose our analgesic therapy, and that for too long we perpetuate legends
about pain that reinforce our unnecessary failure to treat pain adequately.
For example, for years we were taught that infants did not perceive pain, and
did not require analgesia. Another example is the often-present notion that if
we give analgesia to patients with abdominal pain, we will mask their disease
and prevent timely diagnosis and surgery.
The root cause of all of this is the reality that nowhere in medicine is the
doctor as dependent upon the patient’s history as in the presence of pain. If
God had been a more helpful biomedical engineer, there would be a color
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