An ER doc talks about the ridiculousness of the pain scale:
“Oh at least a 10. Can I put 11? Or 12? It’s way off the scale.” Vicki wrote 10 in the box. This meant she was supposed to give strong pain medicine, quickly. Another quick look from Vicki; she had only been in the room for two minutes with this patient yet she already had the same feeling, one that I was quite sure about: that there wasn’t really that much pain here and that the VAS protocol (a hospital policy at that point) was wrong for this patient too.
{ 4 comments… read them below or add one }
I question the timing.
SUBJECTIVE
Waaaah! My colon hurts… give me drugs. A semiquantitative scale on a purely subjective metric… Tell me again about the “science” of clinical medicine.
Another arrogant doctor who thinks he knows better than his patients what their pain is. It is possible his doctor is worng about both patients, and perhaps “Jakob” really isn’t in all that much pain while the woman in question really was in excruciating pain.
I know from personal experience that it is quite possible to suffer a severe injury and feel little or no pain, yet have excruciating pain from a problem with no objective evidence of its existence. In my case I recall ripping my inner arm open as a kid when I got hung up on a chain link fence, an injury that left five parallel scars from the cuts the longest of which is over 8 inches. I felt almost no pain from this other than with the initial injury, and even washing and changing dressings on the wound was relatively painless. Contrast with the pain I sometimes experience in my arms which has no known or discernable cause, yet can be absolutely excruciating, with the pain sometimes so extreme I can’t lift a teacup without agony. As a chronic pain advocate, I imagine my language is peppered with “plaintiffese,” whatever the hell that is, as well as an “inappropriate” knowledge of pain meds, proper dosages, etc.
So it is quite possible Jakob really was feeling very little pain, and the woman in question was also in very severe pain from undetectable soft tissue injuries which often take a day or two to start hurting in earnest. She sealed her fate with the ruse about Percocet, but that may well have been the result of previous experience with doctors and denial of treatment, where perhaps she she had expressed knowledge of a drug and got burned for that.
All in all another good article demonstrating the utter inability of doctors to determine a patient’s pain based on visual cues and thus their lack of qualifications to serve as gatekeepers over who does and does not get pain meds.
Long ago, in a place far, far away I worked as a paramedic. We had very defined protocols for pain management, but also the leeway to think for ourselves. On more than one occasion I found examples of both types of patients. Some would be screaming even before you started an IV, while others denying an obviously painful situation. You can not turn off your brain and treat these people according to their complaints. To do so would place them at risk for other problems.
You can tell the people that are truly in pain, and the ones possibly exaggerating it, trying to game the system. Both patients must be treated, but you must temper what you do with the entire picture and not just what the patient chief complaint is. This includes subjective and objective evaluations. Many times in this “Consumer Society” we think that what the patient demands is what they need, and thus should get. Unfortunately many times this is exactly what happens, and it is the patient that end up suffering.