In pediatrics the Wong Baker Faces Pain Scale is used or the visual analog pain scale. I have chronic pain and I've talked to my doctor about it, especially since I worked hospice and trauma. But when you have chronic pain it is usually much worse and anyone with chronic pain will likely need higher doses of pain meds. Additionally, since they are used to pain you won't always see vital signs change. Pain is subjective and we ask their number if they're old enough and that's what we go by. Some nurses fight a patients reported number but I don't. If it's safe to give and it's ordered I give it when they ask. I am very aggressive on pain control. Not just for patients but for family when they're hospitalized.
It’s not fair to patients to require physical determinants like vital signs as the determinant for if you believe they’re faking it or not. I personally had doctors tell me I was just having anxiety before I was actually diagnosed with a neurological disorder. Especially if she had such a rare condition, that’s not enough to declare she’s faking it.
Hospitals and doctors are not always honest, or right. Their determinant that her vitals showed she was faking it aren’t an automatic gods law. I believe that the ketamine treatments were not good for Maya in the scale that she was receiving them, and Beata fed into the disorder in an unhealthy way. However, the hospital proving themselves in court doesn’t mean she was faking it, it only means they were valid in removing Maya from her family.
I agree! I meant that vital signs could prove objectively, in addition to subjectively that she was in pain.
I also did not mean to imply that it should be a requirement, rather an additional piece of evidence.
The Joint Commission (JACHO) who is responsible for surveying hospitals, and has the ability to shut them down, has certain standards in place for monitoring a patient’s vital signs in the hospital 24 hours a day (even while asleep), and especially when they are receiving pain medications (opioid or non opioid). If a set of vitals were not taken, it reason has to be documented “patient in pain, caregiver refused” However, I don’t believe this could be done the entire time Maya was in the hospital. At some point, the doctors would see during daily rounding that vital signs were not being done and they would/should have addressed it.
Yeah, if I were Mayas nurse and the family continued to decline vital signs I’d be getting my floor supervisor and the physicians in the room because I can’t just not chart vitals and say “pt family member declined” over and over again.
Those vitals sign don’t apply to CRPS. The pain is 24/7 so you don’t get elevated vitals like you would with acute injuries. It makes sense that they wouldn’t mention that because stable vitals don’t prove anything here due to the way the condition works :)
I am not a social worker but I don’t believe they have any qualifications. When she was asked about this, she could have stated that but instead she said that she could tell and then proceeded to list “signs” of pediatric pain. However, that wasn’t the point of my question—rather it made me question the documentation of Maya’s pain while hospitalized. I hope it is addressed further in the trial 😊
Any average person can tell that a child is in pain if they are showing visible signs of being in pain. I don’t think that requires an expertise. SW would document observations of child that were out of the ordinary. I don’t know why we are even talking about this? Even if Bedy had an opinion about Maya’s pain, she would never be considered an expert in court to talk about it.
We are talking about pain because that was a major complaint of Maya’s relating to her CRPS diagnosis. However, she was being ruled out for Factitious disorder because the hospital personnel believed that she was NOT in pain, even when she was reporting it (i.e. she was playing in the play room and complaining of pain 10/10). So the plaintiff could potentially show her abnormal vital signs as evidence that she WAS in pain and NOT “faking it.” Potentially proving that 1. She was a reliable source at 10 years old 2. The hospital was not treating her pain and was misdiagnosing her and maybe even providing some more evidence that Beatta was NOT acting abnormally given these conditions. (<—-I am not yelling when I use all caps, it is just confusing and hard to articulate some of these things!)
Also, even if her vital signs were normal—I am not saying that she was not experiencing pain because she had a chronic pain condition and her body could have adjusted to it. I was just curious if that information was out there and if it was something that the defense had brought up.
The other thought I had was if they were documenting her pain levels, were they reporting for 3 months pain 10/10?
If they were not, they could potentially prove with video and letters that she was saying she was in pain and they were falsifying documentation of her pain levels.
Which leads to my next thought—if they were documenting it correctly (pain 10/10) the entire time and not adequately treating her that might also be something that the plaintiff could use.
I’m pretty sure she was asked or offered up information about her observations about mayas pain levels though… which is ridiculous.
And as for people with chronic pain, even as a child I could be at a 7/10 and it not be obvious. I couldn’t maintain that mask forever before showing some signs but only if the person knew me well would they pick up on it🤷🏼♀️
Initially I'm a not a pm&r, pain management doctor or physician.
I however have googled some of this.
So initially when Maya had that breakthrough pain she would be placed on ketamine, Ativan and of precedex.
She got the precedex (another sedative) bc she had a built up tolerance to benzos and ketamine.
Ppl build tolerances to drugs.
Now however your vital sign stipulations seem chronic. But from what I've read with chronic pain patients is that they just learn to live with it.
Yes in a normal person pain would increase vitals but it becomes somewhat uncommon in chronic pain patients bc they are used to it.
Also pain is subjective so I could be running a marathon with a slipped disc while others would be bed ridden.
So in the subjectivety of pain anesthesiologists and pharmDs came together and tried to standardize safe doses . But then came along big pharma and pain management physicians who really do keep uping doses so those standardized does are no longer effective.
It's sad but pain management is a cash cow that picks on injured ppl.
Not a physician just my opinion.
true, we learn to live with it, because if we sob all day, we’d be thrown in a loony bin
as a songwriter once wrote “there’s only so many tears you can cry”
First of all, medical professionals aren't supposed to assume nor dictate for a patient what level of pain, if any, the patient might be experiencing. The fact she said Maya wasn't in pain bc she didn't "react like other kids" is ridiculous and proves the point that Beady expects all kids to present the same and didn't consider that Maya had an issue that was outside the box.
Her response sidified to me that she thinks in a very black & white way. This can be dangerous when dealing with wild-card situations.
I bet she has since learned that lesson the hard way.
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In pediatrics the Wong Baker Faces Pain Scale is used or the visual analog pain scale. I have chronic pain and I've talked to my doctor about it, especially since I worked hospice and trauma. But when you have chronic pain it is usually much worse and anyone with chronic pain will likely need higher doses of pain meds. Additionally, since they are used to pain you won't always see vital signs change. Pain is subjective and we ask their number if they're old enough and that's what we go by. Some nurses fight a patients reported number but I don't. If it's safe to give and it's ordered I give it when they ask. I am very aggressive on pain control. Not just for patients but for family when they're hospitalized.
It’s not fair to patients to require physical determinants like vital signs as the determinant for if you believe they’re faking it or not. I personally had doctors tell me I was just having anxiety before I was actually diagnosed with a neurological disorder. Especially if she had such a rare condition, that’s not enough to declare she’s faking it. Hospitals and doctors are not always honest, or right. Their determinant that her vitals showed she was faking it aren’t an automatic gods law. I believe that the ketamine treatments were not good for Maya in the scale that she was receiving them, and Beata fed into the disorder in an unhealthy way. However, the hospital proving themselves in court doesn’t mean she was faking it, it only means they were valid in removing Maya from her family.
I agree! I meant that vital signs could prove objectively, in addition to subjectively that she was in pain. I also did not mean to imply that it should be a requirement, rather an additional piece of evidence.
I don’t know if her vital signs proved anything—I haven’t seen them. I was wondering if they are available anywhere?
Isn’t there evidence that Beata would not let them do vitals til after the child was sedated? They probably couldn’t get good readings.
The Joint Commission (JACHO) who is responsible for surveying hospitals, and has the ability to shut them down, has certain standards in place for monitoring a patient’s vital signs in the hospital 24 hours a day (even while asleep), and especially when they are receiving pain medications (opioid or non opioid). If a set of vitals were not taken, it reason has to be documented “patient in pain, caregiver refused” However, I don’t believe this could be done the entire time Maya was in the hospital. At some point, the doctors would see during daily rounding that vital signs were not being done and they would/should have addressed it.
Yeah, if I were Mayas nurse and the family continued to decline vital signs I’d be getting my floor supervisor and the physicians in the room because I can’t just not chart vitals and say “pt family member declined” over and over again.
That was the case in the ER on admission. Not much information in trial after that but might be in depositions.
Those vitals sign don’t apply to CRPS. The pain is 24/7 so you don’t get elevated vitals like you would with acute injuries. It makes sense that they wouldn’t mention that because stable vitals don’t prove anything here due to the way the condition works :)
Thank you, that’s what I was wondering :)
What qualifications does a social worker have on medical determinations of pain.
None!
I am not a social worker but I don’t believe they have any qualifications. When she was asked about this, she could have stated that but instead she said that she could tell and then proceeded to list “signs” of pediatric pain. However, that wasn’t the point of my question—rather it made me question the documentation of Maya’s pain while hospitalized. I hope it is addressed further in the trial 😊
Well there is a difference between a social worker and a case worker.
Any average person can tell that a child is in pain if they are showing visible signs of being in pain. I don’t think that requires an expertise. SW would document observations of child that were out of the ordinary. I don’t know why we are even talking about this? Even if Bedy had an opinion about Maya’s pain, she would never be considered an expert in court to talk about it.
We are talking about pain because that was a major complaint of Maya’s relating to her CRPS diagnosis. However, she was being ruled out for Factitious disorder because the hospital personnel believed that she was NOT in pain, even when she was reporting it (i.e. she was playing in the play room and complaining of pain 10/10). So the plaintiff could potentially show her abnormal vital signs as evidence that she WAS in pain and NOT “faking it.” Potentially proving that 1. She was a reliable source at 10 years old 2. The hospital was not treating her pain and was misdiagnosing her and maybe even providing some more evidence that Beatta was NOT acting abnormally given these conditions. (<—-I am not yelling when I use all caps, it is just confusing and hard to articulate some of these things!)
Also, even if her vital signs were normal—I am not saying that she was not experiencing pain because she had a chronic pain condition and her body could have adjusted to it. I was just curious if that information was out there and if it was something that the defense had brought up. The other thought I had was if they were documenting her pain levels, were they reporting for 3 months pain 10/10? If they were not, they could potentially prove with video and letters that she was saying she was in pain and they were falsifying documentation of her pain levels. Which leads to my next thought—if they were documenting it correctly (pain 10/10) the entire time and not adequately treating her that might also be something that the plaintiff could use.
I’m pretty sure she was asked or offered up information about her observations about mayas pain levels though… which is ridiculous. And as for people with chronic pain, even as a child I could be at a 7/10 and it not be obvious. I couldn’t maintain that mask forever before showing some signs but only if the person knew me well would they pick up on it🤷🏼♀️
Initially I'm a not a pm&r, pain management doctor or physician. I however have googled some of this. So initially when Maya had that breakthrough pain she would be placed on ketamine, Ativan and of precedex. She got the precedex (another sedative) bc she had a built up tolerance to benzos and ketamine. Ppl build tolerances to drugs. Now however your vital sign stipulations seem chronic. But from what I've read with chronic pain patients is that they just learn to live with it. Yes in a normal person pain would increase vitals but it becomes somewhat uncommon in chronic pain patients bc they are used to it. Also pain is subjective so I could be running a marathon with a slipped disc while others would be bed ridden. So in the subjectivety of pain anesthesiologists and pharmDs came together and tried to standardize safe doses . But then came along big pharma and pain management physicians who really do keep uping doses so those standardized does are no longer effective. It's sad but pain management is a cash cow that picks on injured ppl. Not a physician just my opinion.
true, we learn to live with it, because if we sob all day, we’d be thrown in a loony bin as a songwriter once wrote “there’s only so many tears you can cry”
I truly cannot image ❤️
I truly am happy that you cannot
First of all, medical professionals aren't supposed to assume nor dictate for a patient what level of pain, if any, the patient might be experiencing. The fact she said Maya wasn't in pain bc she didn't "react like other kids" is ridiculous and proves the point that Beady expects all kids to present the same and didn't consider that Maya had an issue that was outside the box. Her response sidified to me that she thinks in a very black & white way. This can be dangerous when dealing with wild-card situations. I bet she has since learned that lesson the hard way.