The effectiveness of a brief clinical and basic science seminar on pain for 1st year medical students was examined by comparing attitudes about pain prior to the seminar to attitudes 5 months after the seminar. The 6-h course combined written materials conveying facts about behavioral, social and biological aspects of pain with clinical observations of an acute and a chronic pain treatment team. Examination of responses to a questionnaire assessing attitudes toward pain patients revealed that medical students have limited personal experience with pain and medications for pain, and limited knowledge about pain. Pre-course attitudes toward pain patients were dominated by perceived negative characteristics of pain patients and the belief that working with such patients is difficult. Attitudes measured 5 months after the course reflected increased complexity, greater emphasis that pain is real and not imaginary, and stronger belief that working with pain patients is rewarding. Five months after the seminar, students reported more accurate estimates of the frequency of problems with addiction stemming from acute pain treatment and exaggerated the prevalence of pain problems in the society. The importance of integrating clinical and basic science experiences in order to influence long-term clinical attitudes and produce lasting changes in clinically relevant knowledge is discussed.
The opening of 24-hour telephone services by suicide prevention centers has made available to the communities served by them a means to obtain help and support during times of crisis. Only a small proportion of calls to suicide prevention centers are from people who are suicidal (at the Suicide Prevention and Crisis Service of Erie County the proportion is about 2o%). The majority of calls come from people who are lonely, depressed, or in conflict with a significant other but who do not claim to be potential suicides.One group of people who do make use of 24-hour telephone services is characterized by the fact that they make numerous calls to the center. The Suicide Prevention and Crisis Service of Erie County which opened on October 3 I, -r968 , had received 3,9io calls by June 3 o, i969, from 2,I28 separate patients. In this population of callers, there were 24 individuals who had called more than lo times. The number of calls made by these 24 individuals is shown in Table I. As can be seen, the most frequent caller had called the center on I73 occasions at the time when the data were analyzed.It is frequently thought that these chronic callers are not suicidal risks and that they merely tie up the staff operating suicide prevention centers. One consequence of this point of view is the suggestion that chronic callers should be discouraged from using the center. An alternative viewpoint is that a suicide prevention center can help these individuals lead an adequate life in society by providing them with periodic help and support. To do this costs very little (both in expense and time) compared to the cost of longterm treatment and custodial care.Dr.
Pain is a frequent complaint of elderly people in hospitals and in the community, yet it is often not managed effectively. Barriers to effective management have included fear of narcotic addiction, inadequate assessment of pain, and attitudes of health professionals. Attempts have been made to improve the knowledge and attitudes of health-care professionals. This study examined the attitudes and knowledge of acute pain and pain management among well elderly people in rural and urban settings in the southeastern USA in order to identify possible barriers to effective pain management. Questionnaires on knowledge and attitudes towards pain and pain management were given to 62 rural and 63 urban well elderly people aged 65 years and older. Findings demonstrate a lack of knowledge as well as the presence of non-facilitative attitudes about pain and pain management.
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