Medico-legal aspects of pain

Abstract

The pattern of clinical practice is changing in the UK in line with trends in Europe and America. The introduction of ‘clinical governance' has set a new agenda for assessing quality, performance and accountability. Britain has enjoyed a privileged position with a relatively low level of medical litigation. However, patients are more readily going to court to settle grievances or seek financial compensation. It is recognized that within the surgical disciplines, obstetrics and anaesthesia carry greater risk. Pain management is also becoming an area of concern. It is acknowledged that the establishment of a complaint procedure is a healthy sign. It encourages openness in practice, exposes shortcomings and highlights failure in service. Learning from errors can lead to improvements, if positive changes in practice are adopted. Not all complaints are valid and the majority never results in litigation. Addressing issues early and expressing honest responses will defuse most situations. Quality in medicine is a difficult measure to define and probably involves a number of key points: •best practice •critical incident reporting •analysis from confidential enquiry into perioperative death (CEPOD) •understanding of negligence •managing and learning from complaints •taking effective action. Clinical governance has a broader remit, but one core element, is that of ‘best practice'. It is within this context that one should seek to look at the medico-legal issues involved in pain management. The introduction of acute pain services and pain teams has increased awareness of what can be achieved and what should be expected in the perioperative period. Although the failure to deliver such a service has still to be tested by the courts. Chronic pain management, by contrast, has been practised for many years and there are well-developed pathways involving litigation. Consequently, claims for damage may arise out of acute or chronic pain management.