Monday, February 9, 2015

A word of advice

In a recent comment on my post regarding pain scores, the indefatigable Lumpage asked, "Uhoh, I set my pain scale between 0 and 10. Am I doing it wrong?"

No, Dr Lumpage, you're not doing it wrong.  You're just doing it different.  Which is my way of saying you're doing it wrong.  Stop - collaborate and listen.

You see, I don't offer the patient the option of a pain score of zero, for the following three reasons:

  1. I have already asked them if they have any pain.  And I only ask them for a pain score if they actually have pain.  If they told me that they were in pain, and then told me that their pain score was zero, I think my brain would haemorrhage from sheer frustration. The medical history is a battle of wits.  Patients will delight in flummoxing you at every opportunity.  You must learn to close off every avenue of potential nonsense, building up your innate feel for these types of simple traps so you can conserve your energy for the real battle ahead: presenting the patient to your boss.
  2. Having a pain score of 0 to 10 is actually an 11 point scale.  This sort of thing works well for humorous effect in rock 'n' roll mockumentaries, but isn't very practical when it comes to taking medical histories from patients at 4am when neither of you can think good.  Say the person's pain score improves from 10 to 5 after 4mg of IV morphine.  In my system that is a 50% reduction in pain.  In your system that is 5/11 or a 45.4% reduction in pain.  Which is frankly absurd. Especially since if the pain drops again by another 5 points to zero, that's another 45.4% drop, for a total of 90.8%, and they are now pain free.  What the fuck? Where did the other 9.2% of their pain go?
  3. Is the patient alive? Then they are in pain.  Life is pain. Only the dead feel no pain. Or people that you've put a really good ring block in - you can just rip their nails out using haemostats and they don't feel a thing.  It's full on.  But aside from them, everyone else feels the exquisite pain of living, every waking moment, swimming in the agony of existence until they can swim no longer.
So, yeah, you're doing it wrong. 1 to 10, my friend. 1 to 10.


Anonymous said...

Bahahahhaaaa - well done PTR and Lumpage both.

I recently had an opportunity to consult my own health care professional.

They asked me a very similar question, but with one important difference. "On a scale from 1 to 10, where 10 is the worst pain you can imagine, how much pain are you in now."

I had to stop and think. The worst pain I can imagine is pretty painful. And I've watched my kids be born - so I can imagine a lot of pain. A LOT!

My healthcare professional (HCP)just laughed at me when I pointed out that I had a very vivid imagination, so setting 10 as "the worst imaginable" was going to depress my score substantially.

"I reckon, about a four or five then", I said.

"But you can hardly walk, you're half-crippled. How is that a 4?", said my HCP incredulously.

"Yes, but that's a long way short of being strapped down to a roaring BBQ plate while rats gnaw through your innards and crows tug grimly on your optic nerves"

It was an entertaining conversation, but not being a healthcare professional myself - I'm not quite sure how it advanced by diagnosis.

PTR said...


That's exactly why I don't use the phrase "the worst pain you can imagine".

Still, in your case, at least the doctor was able to determine that you pain was not due to being strapped down to a roaring BBQ plate while rats gnaw through your innards and crows tug grimly on your optic nerves.

Which is always reassuring.