• Seth Resnick and R Sean Morrison.
• Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics, Mount Sinai School of Medicine, New York, New York 10029, USA.
• J Palliat Med. 2004 Oct 1;7(5):646-51.

BackgroundPrevious studies have demonstrated that patients with end-stage dementia receive a high rate of painful and uncomfortable procedures. This study was undertaken to determine whether this finding might be related to physicians' misperceptions about the burden of common hospital experiences and procedures.MethodsPhysicians were administered a survey asking them to rank on a five-point scale the pain and discomfort they perceived to be associated with 16 common hospital procedures. These ratings were compared to those previously obtained using the same instrument with cognitively intact patients who had actually undergone these procedures.ResultsOne hundred twenty-three of 123 resident physicians (100%) and 40 of 50 attending physicians (80%) to whom the questionnaire was administered responded. Overall, physicians more often rated both pain and discomfort associated with these procedures/experiences higher than did patients, and residents typically rated pain and discomfort higher than attending physicians. Resident physicians rated 7 procedures/experiences as significantly more painful and 13 as more uncomfortable than did patients. Attending physicians rated 5 procedures/experiences as significantly more painful and 8 more uncomfortable than did patients. Having a nasogastric tube inserted was the only procedure rated more painful by patients as compared to resident or attending physicians.ConclusionsPhysicians have an accurate perception of pain and discomfort associated with common hospital procedures. Further investigation should scrutinize in greater detail the ubiquity and depth of physician knowledge about the issue of procedural burden and should focus on methods and interventions that would allow physicians to consciously weigh the benefits and burdens of routine interventions in the care of persons with serious and life-threatening illness.

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