Medical science has come a long way over the centuries. We started off with trial and error to discover what would work as effective treatments. Over time, this became more systematic. Now we have the scientific method which is supposed to produce the evidence to justify the different treatment doctors now offer us. Except, somewhere along the way, we lost our way. Whose fault was this? Sad to say, we have to blame the lawyers and the lack of a rational response from the medical profession. Let's start with the law. It's a good thing we have the right to claim compensation when we are injured by someone's negligence. Everyone accepts the idea the driver at fault should pay for the damage caused. Except, when it's applied to the medical profession, we get a very aggressive response. We are not supposed to find fault with our doctors. They are like gods. We need tort reform to prevent these lawyers from even suggesting doctors can make mistakes. It's more important to maintain public confidence than to pay compensation to those who may be injured.

Fortunately, consumer protection is holding the line, but the results are interesting. Instead of practicing evidence-based medicine, doctors are continuing to be defensive. Whenever we report a set of symptoms, they immediately order every possible test to decide what might be wrong with us. Most of these tests are a complete waste of time and money. But, if this should ever come to a court, the doctors will always be able to say they took every precaution, explored every possible diagnosis (no matter how unlikely). The rest of the world has national practice standards based on the scientific method. There are trials to discover which treatments produce the best outcomes in the standard cases and that's what doctors are told to do.

What has this to do with pain management? If you go see a doctor and get treatment, you are supposed to get better. If you do not, this is calling the treatment you received into question. So the doctor who first accepts responsibility for your care guards you, keeping everyone else away who might be able to find something wrong with the treatment. In the rest of the world, we are moving toward pain management clinics that review every aspect of the care to date. If there are oversights or errors, these are corrected. The patient and not the doctor's interests come first. Naturally, this is resisted by doctors whose errors may be detected. They fight off referral to the specialist centers by simply prescribing ever more powerful painkillers. The first time you complain of continuing pain, you get one of the NSAIDs. If the pain is moderate to severe, you get Ultram. If that does not solve the problem, you get one of the opiates and, suddenly, you are a potential addict. The lawyers and the doctors should reach an agreement with the politicians. In the best countries, there are systems of no-fault insurance which pay out compensation to people who are injured, no matter who is at fault. This leads to a focus on the patient's needs which is the optimum approach. Painkillers like Ultram continue to be used, but in a more scientific way, a better way.