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EMSWORLD.com | MAY 2016 47 Conclusion Health professionals have a tendency to underestimate the pain observed in patients. Research has also found that the degree of underestimation increases as clinical experience increases. 22 It is not clear whether this is due to a "recalibration" of the emotional response to pain due to repeated exposure to patients with severe pain. This may be a natural response that protects the provider from the psychological stress of dealing with others' pain and distress, enabling objective and dispassion- ate care. Although the reason for the underestimation is unclear, there is ample evidence that the assessment and management of patients in pain is affected by the caretaker's beliefs, values and attitudes. In paramedic practice, fear of malingering can alter the evaluation of the patient's report of pain. 39 Para- medics have reported disbelief of the patient's report of pain where the associated behavior is inconsistent with the paramedic's expectations. 42 It is important to remember that it is difficult to confirm malinger- ing without accurate knowledge of the patient's prior medical history, and this fear may adversely affect the quality of care if the patient's motives for seeking anal- gesia are incorrectly attributed to behavior associated with addiction. Paramedics play an important role in the allevia- tion of pain in patients they care for. The effective management of pain relies on a focused assessment of the patient's complaint and the measurement of pain severity using reliable and valid tools. However, the evaluation of the data may be affected by personal beliefs about pain, and paramedics must be aware of the influence that cultural norms, bias and stereotyping can have on their clinical judgments and quality of care. Improvements in the quality of care provided to patients in pain will depend on appropriate educational interventions that target knowledge of pain physiology, pharmacology and pain assessment, as well as evidence- based guidelines to support paramedic practice. References for this article are available online at EMSWorld.com/12187476. A B O U T T H E A U T H O R Bill Lord, BHlthSc, GDipCBL, MEd, PhD, was previously head of undergraduate paramedic programs at Monash University in Melbourne, and is currently associate professor and discipline lead for paramedic science at the University of the Sunshine Coast in Queensland, Australia. Bill represents the professional association (Paramedics Australasia) on the Australian Resuscitation Council and continues to practice as a paramedic with the Queensland Ambulance Service. EMS1605S For More Information Circle 25 on Reader Service Card