Sharing the pain.

Abstract

It finally happened. I finally had a chart audit that inspired me to tell others about it. Most clinicians are accustomed to having their outpatient charts reviewed by a variety of representatives from managed care organizations, hospitals, and peer review organizations. When the medical records of patients with diabetes are reviewed, most surveys focus on several key quality measures. These usually include, as a minimum, the frequency of dilated eye exams and foot inspections, as well as HbA1c results. Our office is accustomed to these chart reviews, and our marks are usually very high. A recent chart review found that I was providing good clinical care for my patients with diabetes based on these quality measures. In one area, however, I received a score of zero. It seems that I had not assessed any of my patients for pain. This was the first time that our charts had been reviewed for this specific feature, as well as the first time, in my personal experience, that pain assessment had been given equal importance to the standard benchmarks of diabetes care. It is never exactly clear which charts are used for random review, but I examined the chart of one patient that I believe had been included in the chart review. In the history section I found the following notation: “Neuropathy - present for 3 years, bilateral lower extremities, epicritic > protopathic, worse at night.” I felt that this was a reasonable assessment of the patient’s neuropathic discomfort, but it didn’t …