Sunday, March 25, 2012

Good "Communication key to treating chronic pain"

I saw this article today, "Communication key to treating chronic pain" and I about flipped my lid. Almost everything about it is wrong. But if you were to go online and Google articles on the same subject, you'd find lots of people agreeing with her. They're all wrong. Their communication styles are designed around trying to talk like a doctor so that you can then better communicate with your doctor. But we shouldn't try to do that, and it's fine if we don't. Doctor's didn't get their degrees by being foolish. They can understand us, even if we're talking dumb. What this article will set you up to look like, is not an empowered patient, but a drug-seeker.

"1. Pinpoint the pain" - Dear lord, do not try to memorize any medical charts or symptom lists! This is what people who are not sick do, when they're trying to score some drugs. You never, ever want to act like that. Instead, tell your symptoms like a story. Start at the beginning of your day, and walk your doctor through what you do, when the symptoms come on, and how you respond. Your doctor will know what clues to look for, in order to come to a diagnosis. Your doctor will also be familiar with the small, little details that a true patient knows, and no drug-seeker could. No memorization required! In fact, when it sounds like you've memorized something, it's even more suspicious. Just be you. Tell your story.*

"2. Rate the pain" - This is what every triage nurse asks and it's an absolutely worthless question. My 6 may be the worst pain you've ever experience in your life, or vice versa. There's no baseline or standard for comparison. You may as well answer the question: "Threat level orange." Rather, what you should do is try to compare your pain now to some other painful event in your past. "This is as bad as when... [insert personal story here]." That give the health official a more realistic picture of what your level of pain is, and you'll never run into the problem where you say "8", absolutely mean "8", but the nurse writes down "6" because: "everyone exaggerates their pain." Giving them full control over the number, but letting them know what it compares to, lets them know you're leaving the rating up to the professional, while still being fully informative.

"3. Give a timeline" - (This is the only bit of information I find useful, but I'd one-up it by saying, keep a journal of your symptoms if possible, including meals for possible dietary triggers.) "Let your doctor know when the pain started; whether it’s constant or off and on; what makes it flare up; and whether certain activities make it better or worse."

"4. Share personal toll" - In this the author means how it's effecting you emotionally. Great googley moogley! Unless you have a solid relationship with your doctor, do not approach them about psychological problems, especially if you're a woman! That's a quick route to being called hysterical, getting minimized both medically and personally, and stigmatized forever. The better approach is if you are feeling these things, contact a mental health professional yourself. If you have to get a referral from your doctor but don't want to tell them why, you can say that you "want to make sure you have good coping mechanism for this difficult time..." (or something to that effect). There is still very much the belief that if the pain can't be explained, the patient may be "manifesting it as a way to get attention because of their inability to cope in other areas of their life." Sad, but true. Instead, tell them how it's taking a toll on your activities and what kind of simple tasks in your life it interrupts.

"5. Chart the treatments" - If you want look like a "problem patient," then by all means bring in a huge stack of papers for him or her to read. That's also a great way of appearing like you're trying to tell the doctor how to do their job. I'm not saying it's a bad idea to keep a health diary. As I mentioned before, that's a great tool for providers. But leave the "charting" to the professionals. Don't just pile a bunch of assignments on them like they're back in school. Pull out the material only if asked.

The article mentioned: "Be your own advocate." Also, unfortunately, a bad idea. In my article, The Pros and Cons of Patient Interactions, I detail how the good intentions of patients can be seen in the worst light by medical providers.

It also goes on to mention: “If your health-care provider doesn’t understand what you’re saying or dismisses your problem, look for someone else,” Jamison said. I wholeheartedly agree. The only option we have as patients is to vote with our feet. If you ever get confronted with doctor shopping just tell this joke:

You know what the student graduating at the bottom of his class from medical school is called, right?



"6. Be specific" - "Tell your doctor or health-care provider what the pain feels like." This is similar to my point in number 1 & 2. Do not try to sound like a health professional. Instead, compare your pain to some other experience in your life. Otherwise, it has the potential to make you sound like you're running a scam or hustling.

*Tell Your Story
This can be difficult, because the "the medical exam – the most frequent point of contact between patients and the health care – was never designed to engage patients." (emphasis theirs) This is from former hospital executive Steve Wilkins, in his article Patient Engagement – Here’s The Key To Success In Case You Are Interested.(He also makes a great infographic:)

Used with permission

Your doctor may rush and interrupt you. They're very busy people. Stick to your guns. Tell your story and make sure you get it out. If they try to jump ahead, you can politely "scold" them by saying, "Hold on... I'm getting to that." The point is to make your doctor listen. We want to do that politely, and in a way that invites them to recognize what we're going through and diagnose properly. The Cliff Notes are just not enough. They need the whole story. They're probably going to be resistant. This is not the current style of doctoring. But we can teach them a better way that can give more authentic results (weeding out the fakers in the process).

It works. I retrained myself to talk this way and I have much better relationships with my doctors now, especially the new ones I have to see, where there is no prior relationship. And if they're a good doctor, they'll listen. They may get a little flustered at first, but then they relax and listen. It's not just communication. It's good communication that counts.

Good luck!


  1. This is very nice post. It is important to be specific while visiting doctor regarding pains & joint treatments. I like your points & i totally agree with you. Thanks for this sharing.

  2. Thank you for letting me know you like it! I try to do my best... :^)