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I Don’t Feel Your Pain
When you come to me or any other physician with the very common and sometimes critical complaint of “PAIN”, we enter in to a magical medical tour in order to figure out the problem and hopefully find a solution to resolve the cause. If limb, sight or life are at stake, communication needs to be more rapid and very clear. In less critical moments we can go at a different pace and follow a procedure which includes:
1. taking a good history,
2. doing an appropriate physical examination, and
3. finally ordering specific laboratory tests and imaging studies to confirm or change our presumptive diagnosis.
We look for SIGNS which are objective, visible and measurable, such as pulse, blood pressure, a rash or lesion or a lab value.
We also need to be very clear on your subjective SYMPTOMS, which are things that you feel but we don’t and we can’t see. This is where communication becomes critical and you play a very important role. Because I can’t feel your pain, it behooves you to give me the best picture possible. Of course, the more KNOWLEDGE you have of your body the more accurate and helpful you can be. Sometimes I have to make a decision over the phone without the benefit of a physical exam or other tests.
So here are some of the important points I will need to know and descriptive examples you can give me to conjure up the best virtual image of your pain. Make it magical and accurate and specific.
ONSET of pain:
When did you first notice it (date and time)?
What activity were you doing when you first noticed it, i.e. eating food, conducting physical activity, following a new dietary supplement, sleeping, etc?
LOCATION including RADIATION:
Where it hurts and where the pain travels to.
Burning, tearing, cramping, crushing, heaviness, sharp, dull, thunderclap. (This is one where you can be creative)
Things that RELIEVE the pain:
Medication and other treatments, body position, rest, or cessation of specific activity.
Things that AGGRAVATE the pain:
Eating certain foods, body position, exertion, medication, worry.
Accompanying SYMPTOMS and SIGNS:
Nausea, vomiting, sweating, respiratory distress, change in bodily functions and activity, fever.
PRIOR HISTORY of a SIMILAR PAIN:
Did you ever have the pain before, with or without a diagnosis? What was done and what was the outcome?
A GRAPH plotting the onset, course, duration and intensity can also be most helpful.
Imagine the vertical side of a graph as the intensity of the pain (scale using 0 [no pain] at the bottom up to 10 [worst pain ever] at the top.
On the horizontal line is the time, which will show the duration and frequency of each episode of the pain. The measurement will be based on how long the pain has been there. If, for example, it started instantly and was a 10 in one second ,the line would go almost straight up. If the pain started very slowly and gradually over days went from a 3 to an 8, the line would coincide. If episodes are frequent, intense, and of short duration, the line will look like multiple spikes.
I don’t really want to feel your pain but I do want to help you diagnose and resolve it. Participate in your own healing by communicating accurate, pertinent information.
Stay tuned for the next blog covering other aspects of my Magical Medical Tour:
[tags]pain, magical medical tour, Dr. Glenn Wollman, Glenn Wollman M.D., symptoms, livingsuite, diagnose, scale your pain[/tags]