We are suffering the grave consequences of a single survey question


“You’re nothing but a punk ass kid.  And you’ll die a punk ass kid!”

With that, she stormed out of the exam room, leaving me sitting on a stool, slamming the door behind her.  Apparently she walked straight up to the front desk and asked to file a complaint about me, but left prior to receiving the paperwork.

Most all physicians will immediately know what the interaction involved.  I hadn’t been mean to her.  I hadn’t called her any names.  I hadn’t even raised my voice.

I simply suggested that she was addicted to opiates.

The health care world is now suffering the consequences of a simple survey question: “Was your pain adequately treated?”

The health care administrators assume that “your pain” means the pain caused by an intense acute medical condition that the patient was being treated for.  The razor blades pain of a kidney stone.  The crushing substernal chest pain of a heart attack.  The knife-like, ripping pain of an aortic aneurysm.  These are the pains that the surveys are assumed to focus on.

But it’s not that simple.  Patients are so much more complex.  And often, they have much, much deeper pain.

The pain of an uncle that sexually molested them.  Or the pain of a husband that was physically abusive when he drank.  Or the pain of a lifetime of teachers telling them they just weren’t smart enough.  The pain of a parent not caring enough to bathe them before school.  The pain of not being able to pay the month’s electrical bill because the car broke down.  The pain of feeling like a failure.  The pain of being addicted.

Opioids dull all.  They know no bounds.  Psychological pain, physical pain, emotional pain, opioids can take it all away.

Maybe that’s why we have a society that’s addicted to them.

So maybe, just maybe, the patient care surveys should change the wording.  “Was your pain adequately treated” should become, “Was the cause of your pain adequately treated?”

And if we’re going to address the opioid crisis, maybe we need to vastly change the way we administer health care.  Maybe, just maybe, we need to appreciate social workers, counselors, mental health professionals, teachers.  Maybe, just maybe, we need to support adult education, jobs with living wages, affordable childcare, just to name a few.

Maybe we need to stop pointing fingers and placing blame.  And maybe, just maybe, we need to start trying to understand the immense complexity of pain.

Pain has gotten us here, and appropriately treating the cause of that pain is the only way out.

Justin Reno is a family physician.

Image credit: Shutterstock.com


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