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Pain communication is key

Does everything have to be a short interaction? I can understand the need to be efficient and make sure information gets exchanged, but, I feel like society really has gotten reduced to numbers rather than discussions.

This even happens for some of the most important and vital interactions in our society: doctor-patient interactions. Pain is something that happens to virtually everyone. And yet, how we feel it and describe it can really be cut short.

One of the most common ways that people have to report to doctors about their pain is on a 0-10 (or sometimes 1-10) scale. We say a number, and that means…something. If I say “5” and another person says “5” does this mean that we both mean the same thing?

No. Probably not.

For example, let’s compare someone with no chronic pain to someone with chronic pain. Their baselines and also their maximums are likely different. A 1 for someone with no pain likely just

means nothing, but a 1 for someone with chronic pain may be how well they have gotten used to their pain condition; it’s just a part of life at this point; however, a person with chronic pain could also say that they are just always at 4 and any additional pain (even though it is separate from the chronic pain) just adds to that number rather than getting its own number. And then, what does a 3 mean? Or a 7?

These same sorts of issues would apply to happiness, or sadness, or emotions in general. A 5 might seem low, but maybe that actually means I am doing better than normal.

Instead, why don’t we focus on words? Actual words. The things that were literally created to describe things.

There are many ways this could be of major assistance to the doctor-patient interaction, but I’ll focus on 2 below.

1. More detailed information

I am not saying anything groundbreaking here. Just stating the obvious, but I think the obvious needs to be stated because, for whatever reason, we aren’t doing this currently. Perhaps it would take too much time to…talk to patients. Potentially doctors could get this information beforehand so it doesn’t cut into the visit time which are maximized for profit rather than ensuring the patient is actually well taken care of. All the rants aside, words would give more detailed information.

But, Alex, wait. Words are also imperfect and subjective. Hey, you know what, you’re right. And yet, I still think this is necessary. Let’s compare 3 people this time. 1 person says they are feeling a pain of 5 on a 10-point scale for their hand. 1 person says I am a 5 with throbbing pain and the agony in my fractured hand. Another person says I am a 5 with stabbing pain that keeps beating with every breath in my arthritic hand.

Which of the patients gave the least amount of information? Which patient(s) can you help better having talked to them?

That’s what I thought. But, yes, the point is heard that maybe patients also aren’t ready to explain in more detail and also that doctors may not readily take in the information. Is it so bad to want better for our medical system and to teach patients how to better disclose pain and to teach doctors how to be more interpersonally savvy?

Some medical teams already are implementing this already. At least to some degree. Some doctors and nurses will ask patients to describe their pain. Some will read a checklist of symptoms and let the patient say yes or no to the list. Yet, there is no universal and systematic way that this is done. Or if there is, I have somehow always managed to be accidentally skipped over in this process. This leads me to the next point.

2. More empathy and support

Given my posts about discrimination in the medical field, having actual conversations would likely lessen the discrimination either in frequency or severity. As insane as it is to even have to be saying this, it’s where we are at in society.

So how would this work? People like others that are similar to them. This can be on the basis of skin color. However, it isn’t practical (or humane) to ask people to have people change their skin color. Then there are other things like profession to find similarity on. And again, this option wouldn’t work because doctor visits are hierarchical—there is a doctor and there is a patient.

This means it can’t be surface-level similarities. Instead, we need to dive a little deeper. Forced interaction and working toward common goals can absolutely create a more trusting bond between people. Patients and doctors are forced to interact and they are working toward a common goal of relieving the pain. Now, within the interaction, the more talking there is, the more the doctor can understand this is a human and not just a condition to be treated. The description of their aches and pains can be understood not just at a diagnostic and utilitarian level, but at a human level.

This leads to empathy and takes care of some of the things people notice, in particular, POC, about their doctors—they just don’t care. Empathy makes for some level of care, validation, and being

understood. What people do with that is of course different. But these are doctors and they are paid to help you and also have the expertise in order to help.

This leads to support. You may or may not get the emotional support you need from your doctor, but you can at least get the instrumental/practical help needed by more fluidly evoking empathy. The doctor could potentially mirror the ways you are talking which will allow for better translation to the eventual treatment (as also seen in our write-up for this week).

Without a doubt, there are potential negatives of this approach, but that is why research is needed here to see if the positives outweigh those negatives. Then, more work could be done to improve this process rather than just letting patients and doctors do more or less whatever they want when it comes to pain communication. If nothing else, this should be an option for patients as well because everyone is allowed to have preferences for communication and if the patient doesn’t feel comfortable, then they will be less likely to come to the doctor’s office and receive the help they need.


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