Pain No Longer a Fifth Vital Sign


The AMA has removed pain as a “fifth vital sign” and it is pissing some people off.  This from some pain website:

The AMA’s main “solution” to the opioid problem is to stop asking patients about their pain.

In fact, reading their site shows how everyone has their own perspective and how doctors are caught in the middle.  As the site goes on to say:

Pain was first recognized as the fifth vital sign in the 1990’s, giving pain equal status with blood pressure, heart rate, respiratory rate and temperature as vital signs. The policy encourages healthcare providers to ask patients about their pain.

Not exactly.  They try to elevate The Joint Commission as the gold standard of care but forgot to mention how The Joint Commission started giving out Pain Rating scales that were funded by Purdue Pharmaceuticals.  The AMA wants the fifth vital sign dropped from the physician’s lexicon and I agree.  How about dropping The Joint Commission as well?

As one reader, who pointed this article out to me, said:

Wow, the Placebo Journal was so ahead of our time.  Finally The Joint Commission creeps who pushed this crap should have a special level of Hell reserved for them.  They ruined medicine and have killed hundreds of thousands of patients. We just “do as we are told”.  I’ll never forget these smug bastards with their little clip boards coming around an we docs were blamed. If you stood up to them you were labeled “disruptive”. Disruptive physicians were those pesky doctors who actually gave a damn.On the other hand, the physicians that The Joint Commission and hospital administration loved just kept the narcs flowing.


Kill the MOC.

Kill the Joint Commission.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Pain No Longer a Fifth Vital Sign

  1. Douglas Krell MD
    July 5, 2016 at 1:57 pm

    Oh! So now we are to just stop asking about pain? Will punitive measures be applied if we document pain? Should we simply ignore presenting symptoms of pain? God no! While dropping the whole 5th Vital sign idea is fine…it should have never been started in the beginning. I believe the problem is not with the pain “campaign”, it’s with the idea if you don’t perform to some poorly constructed standard, you are to be flogged publicly, professionally, financially. And since opioids treat pain and the country has an opioid epidemic, what if your regimen of treatment fails the test of standard therapy? Might you be subject to felony arrest and conviction as well? In my opinion the adversarial system we have in place serves neither the patient nor the physician. It’s time for education, not pronouncements and punishments.

  2. Frank Rubino MD
    July 4, 2016 at 10:18 pm

    Medicine has a long history of “fads” . Pain as a vital sign was just one of many. Now we have Metrics. Patient centered medical home, Acountable Care Organizations all set by bureaucratic pseudo doctors who don’t practice medicine but manage medicine because it is so much more important to society than what we “grunts” do day to day.

  3. mamadoc
    June 29, 2016 at 10:50 pm

    5th vital sign my foot. It was a crock then and it’s still a crock. And don’t get me started on JCAHO

  4. Bill Ameen MD
    June 29, 2016 at 8:54 am

    It’s high time for an attack on the worthless Joint Commission! When I worked in ER and these pricks walked through, checking for dust on bottom bed-rails so that the hospital wouldn’t lose its Medicare reimbursement, once my anal sphincter loosened I’d think, Boy, what I wouldn’t give to be on the JCAHO when I retire so I can aggravate the crap out of working doctors and nurses too! But no, I couldn’t do that, I’m not THAT big an a**hole.

  5. Thomas Guastavino
    June 29, 2016 at 6:28 am

    Explain to me how pain, a totally subjective measure, can be treated the same as other “vital signs” that can are totally objective?

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