This is in response to Jon Hauxwell's column of April 15 criticizing my column of April 7.
Jon Hauxwell is correct in pointing out that doctors are not always right, but that the examples I gave were not all that great. I agree, my criticism was too generalized and oversimplified, and I think he does a good job describing the complexities involved in patient intake and in pain evaluation.
I sincerely apologize for criticizing the whole medical profession for the experience I had with one doctor. Most physicians are thoughtful, caring people who work hard to give all of their patients the best possible advice and care in a timely fashion.
As Hauxwell outlined, there are indeed circumstances when "Why are you here?" is an appropriate question to ask a patient who for any reason has no file, or who has not called earlier for an appointment.
However, I maintain that in cases where there is a file, where the patient is known to the doctor, and where the appointment has been made in advance, it is patronizing, if not downright rude, to ask "Why are you here?" There are less annoying ways to solicit this information. I think, "We have a note that you called because of (for example) back pain. Is this correct?" is a perfectly good opening gambit. The next question could be, "Is anything else bothering you?"
Now for pain evaluation. Hauxwell is again correct in observing that the "On a scale of 1 (low) to 10 (high) how would you rate your pain?" should be only one small part of an ideal evaluation -- that pain is a great deal more complex. He thinks it makes sense to use it in intake as a quick indicator of where to explore further.
My own experience was less than ideal: what should have been a quick indicator was used inappropriately to determine the treatment I received. Moreover, I suspect I am not the only one who has suffered because of this kind of misunderstanding. Perhaps instead of asking the "1 to 10" question the intake assistant could probe for a range of levels by asking, "What do you do that hurts most? Least?" This should result in a more accurate assessment, and also not take more time.