The Fifth Vital Sign: Fetish or A Functional Parameter?
I would like to extend the discussion of the December 23, 2006 thread on pain and the relief of pain.
As many of my visitors might know, in the United States there has been an addition to the list of physical examination “vital signs”, which formerly only included the patient’s temperature, the respiratory rate, the heart or pulse rate and the patient’s blood pressure. Because of the concern that patients were not being initially asked about nor monitored for pain, within the past decade, pain was included as a necessary requirement to be included in the list of vital signs. Patients were to be asked about the intensity of any pain at the time of the examination which was to be expressed as numbers from 0 to 10, where 0 was no pain, 1 was the most minimal pain and 10 was the most severe pain that the patient could imagine.
It had been hoped that by physicians and nurses alerted by the patient’s numerical expression of their current pain, the information would encourage appropriate physician initiation of treatment to reduce the pain or if treatment was already in progress to evaluate the efficacy of the treatment and make adjustments in therapy if not adequately effective, the goal being the professional duty to attempt to relieve the patient’s pain and suffering.
So, we teach our medical students, nursing students, physicians and nurses about the “fifth vital sign” and to never forget to take it. The question is how consistently has this requirement been followed by the healthcare providers and also whether the inclusion of pain in the vital signs has made any difference in the quality of pain management. I can’t find much in the way of studies on this topic beyond a 2006 publication of a study at a Veteran’s Affairs medical center which showed that “the routine documentation of pain levels, even with system-wide support and broad-based provider education, was ineffective in improving the quality-of-care.”
The question is whether requiring the asking about and quantifying pain to be included as the fifth vital sign represents simply a kind of routine clinical fetish (an irrational, or abnormal, fixation or preoccupation ) or a rational and functional parameter which can and does promote benefit for the patient.
Without naming names in your commentary, I would most like to read from my visitors whether their doctors or nurses routinely ask them about whether they had any pain and, if present, instructed them to formally quantitate (1-10) their pain when the other vital signs were taken or independently at other times. And, if so, then, was there some action taken based on the information provided with the initiation of pain therapy, change of therapy or ordering of additional diagnostic testing regarding the origin of the pain? ..Maurice.