It surprises many people that the most commonly performed medical procedure is not the eye exam, blood pressure reading or reflex tap. It’s the simple patient interview . As a procedure, a productive conversation between doctor and patient can tell us more than any scan or biopsy, more than any tap, culture or exam. Yet, as doctors, we often sense apprehension and discomfort during these all important talks, especially when the topic is pain.
Pain cannot be seen or quantified, making an interview the most accurate and timely way of monitoring our patients’ comfort. Pain, though, continually proves to be a difficult topic of discussion, and the issue of prescription opioid abuse has only compounded the difficulty. As doctors, we never want to imply that our patients are anything less than honest, upstanding and sincere in their desire for treatment, and we never want to sound presumptuous or accusatory. These concerns make speaking about opioid abuse challenging.
Conversely, it is our understanding that many patients assume that we suspect them of abuse, and so they underreport their pain. This is the worst thing they could do. Without an accurate picture of a patient’s pain we are helpless to provide them with the appropriate care.
The solution to this multifaceted issue is not a simple one, but it begins by strengthening the relationships between the patients and the doctors. This will require work from both parties. Doctors must take an active interest in their patient’s life outside of the exam room. They should be a trusted advisor instead of a cold authority. Patients must surrender, more fully, their privacy. Complete and utter honesty will be the fastest route to exceptional care. The relationship between doctor and patient is ideally full of trust, compassion, and respect. From this foundation we can start to have more productive conversations about pain.
PainMatters.com provides information and resources for physicians and people affected by pain to help mitigate the risk of abuse and misuse and support ongoing dialogue. Practical discussion guides and a variety of downloadable resources are available for healthcare professionals in addition to a resource section specifically designed to support People Affected by Pain.
XXX serves as a paid consultant for Teva Pharmaceuticals.