How many times have you been asked by a doctor; "On a scale of 1 - 10, how bad is the pain?" Unfortunately I've been asked this question too many times to count. I realise a doctor needs some indication, a clue as to what he/she is dealing with, but I wonder how helpful this unreliable approach really is. What is painful to one person, isn't necessarily the same for another. There is no "scale" by which to measure pain. Experiencing chronic pain since a young child, has resulted in me having a fairly high pain threshold, and often I make light of my situation. However, I have found this to sometimes work against me, for a doctor who has never met me before may not take my complaint seriously. I'm sure I'm not alone, as anyone who experiences serious pain on a regular basis, probably also takes it in their stride.
I was rushed to the emergency room some years ago in the middle of the night with chronic hip pain. Have you ever noticed how these things always seem to happen late at night, on a weekend or a Bank Holiday? It's Murphy's Law isn't it? Once the staff realised I suffer from Gaucher disease, I was injected with radio active material and taken to have a scan. Laying on the table beneath the scanner, I glanced towards the technician and doctor who stood behind the glass window separating us. Having the ability to lip read, has often proved very useful, and with clear vision of the doctor's mouth, I was able to decipher what he was saying. He was asking the technician how could I be laying so quietly when it was unmistakably clear, I had a very serious problem with my hip. The number written on my chart I had given upon arriving at the ER, "on a scale of 1 -10 how bad is the pain?" did not match what they could see from the images on the screen.
I was diagnosed with having an AVN (Avascular Necrosis) put into layman's terms: it means a disruption of blood supply to the affected portion of bone, in my case, the ball joint in my hip. This episode resulted in immediately being hooked up to a morphine drip to alleviate the pain and I was hospitalised for hip surgery. It was from this experience, I learnt what doctor's expect of their illusive "pain scale". On a scale of 1 - 10, 1 being the least pain and 10 being chronic unbearable pain, I now know an AVN is most definitely considered a number 10!
I'm afraid I have no time and little empathy for those who complain and make a mountain out of a molehill, or hypochondriac's who are almost happy to be ill and make a fuss when all they have is simply a cold or the flu. On a scale of 1 - 10 how would they judge the aches that accompany influenza?
So how does a doctor accurately evaluate a patient he has never met before by using this "on a scale of 1 - 10" nonsensical and imprecise method of assessing pain? If everyone has a different perception of pain, and taking into account varying ethnic backgrounds and cultures - I would have thought it's virtually impossible. This is where a patient's medical history (if one is available) would be far more reliable, and a doctor with experience, using his powers of observation, and paying attention to how the patient answers and his/her behaviour are probably far better indicators. Perhaps it's not the question that is important, but the demeanour and facial expression of the patient whilst trying to fathom what number to give as a correct response.
Maybe doctors should add a question to the list a patient is normally asked upon entering the emergency room, such as "Can you lip read?" Doctors and technicians beware! Even if there are several inches of thick glass between you and your patient be careful what you say in front of someone. On a scale of 1 - 10; 1 being a useless skill, and 10 being jolly valuable at times, I would have to say that lip reading is definitely a 10!