Letters to the Editor - June 26, 2006

American Academy of Pain Medicine offers guidance on proper prescribing - Better pay, liability reform will ensure the doctors needed for universal care - True hospital infection control requires clean stethoscopes

American Academy of Pain Medicine offers guidance on proper prescribing

Regarding "Negotiate with patients on treatment of pain" (Column, April 3): This article brought forward some of the complex decisions faced by physicians and their patients who suffer from chronic non-cancer pain.

It was refreshing to read an article that addressed this topic directly while providing thoughtful guidance on the prescribing of pain medications and at the same time discussing the medical and psychological management of patients with pain.

Recognizing the challenges that are inherent in managing the complexities of chronic pain patients, the American Academy of Pain Medicine has published the first Ethics Charter specifically addressing issues in pain medicine.

The AAPM Ethics Charter provides methodology to approach these difficult clinical issues. It was written, in part, to help improve the quality of patient care by encouraging physicians not to shy away from difficult cases in their treatment plans.

Physicians may find additional support through the joint recommendations of the American Academy of Pain Medicine and the American Pain Society on opioid prescribing, which represents a standard of care guiding ethical practice.

AAPM invites your readers to access online the Ethics Charter (www.painmed.org/productpub/pdfs/EthicsCharter.pdf) and the consensus statement, The Use of Opioids for the Treatment of Chronic Pain (www.painmed.org/productpub/statements/pdfs/opioids.pdf).

--Philipp M. Lippe, MD, AMA delegate, American Academy of Pain Medicine, San Jose, Calif.

Editor's note: Dr. Lippe serves as the executive medical director of the American Academy of Pain Medicine.

Better pay, liability reform will ensure the doctors needed for universal care

Regarding "Uninsured week spotlights issue; agreement on solutions elusive" (Article, May 15): While it is compassionate to want universal coverage for all members of our society, we also must ensure that there are enough doctors and providers to give this good care.

Higher salaries and "no-fault" liability coverage would make America the preferred placed to practice in the world. It would be wise to stay away from Canadian or European models of care, considering their lack of efficiency.

--Lance Gee, MD, Antioch, Calif.

True hospital infection control requires clean stethoscopes

Regarding "New push for clean hands in hospitals" (Article, May 8): Your article rightly points out that hand hygiene compliance is inexcusably low. The article also correctly points out that "neckties, white coats and computer keyboards are germ nesting grounds." But stethoscopes -- the most common contaminated object to touch patients other than the examiner's hands -- were not even mentioned.

Every study that has examined this problem has found that stethoscopes in hospitals are contaminated with antibiotic-resistant bacteria. Sanitizing one's hands and then touching a patient with a contaminated stethoscope does not make sense; nor does touching one's contaminated stethoscope after hand sanitizing and before touching the patient.

Hospitals have not taken steps to close this infection control loophole; nor has the CDC issued consistent recommendations on this matter. We need to push for clean stethoscopes -- not just clean hands -- in hospitals.

--Richard C. Weidman, MD, MPH, Washington, D.C.