Friday, April 14, 2006

Imponderables

Thoughts at 2AM:

In the hospital, we're always being encouraged to document the "fifth vital sign", pain. Patients are asked to quantify their level of pain on a zero to 10 scale. To help, they are typically offered an illustrative graphic such as this one:


Note that at level two, Mr Smiley Face still has an insipid grin. I have a fairly high pain tolerance but is it just me or shouldn't zero out of ten be the only level of pain worth smiling over?

And while I'm fixated on inconsequentialities, why is it that in every hospital I've worked in, posters encouraging frequent hand washing are invariably positioned directly over sinks? Could Infection Control come up with a more superfluous location?

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2 Comments:

Blogger shrinkette said...

Excellent, excellent post. And why doesn't Mr. Smiley cringe or scream? Why aren't fear and anxiety represented (that's so much of a pain response!)? We need better choices here.

April 14, 2006 12:20 PM  
Anonymous William Mangino II,M.D. said...

The pain scale was never intended to be 100% precise. There are two pain pathways-lateral and medial. The medial system is related to the "emotive" aspects of pain.These cannot be measured so easily.
It must be remembered that even once the initial pain stimulus has long passed-often times the pain "memory" remains.This may be due to central nervous system "Sensitization," where the whole "Thermometer" of that patients ability to channel new stimuli is "Reset." This is a biochemical and anatomic phenomenon.
The bottom line, for patients, is that the physician needs to learn to treat the "Suffering" as well as the pain.
William Mangino II, M.D.

April 16, 2006 8:58 AM  

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