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SPOTLIGHT
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Doctors don't always know best

Published on -4/7/2013, 7:15 AM

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When you go to the doctor, a nurse usually comes in and goes through a list of questions -- they call it the "vitals." I call it the "drill."

For the most part, these questions are objective: They weigh you, take your blood pressure and temperature, and ask you if anything hurts.

Two of them, though, get on my nerves. First, they ask you why you are visiting the doctor. Maybe this is not entirely unreasonable -- they want to make sure your answer is consistent with what they have in the file, or they want to see if you have any dementia.

Even so, it's annoying because you know and they know they have the information right there in your file. Far less patronizing would be, "Your file shows you are here for a regular checkup. Is this correct?"

The second question is not only annoying, it's dangerous, because it solicits only conjectural results.

"On a scale of 1 to 10, with 1 the least and 10 the most, how much pain are you feeling?"

Now, there are fairly accurate descriptions of the different levels, and they should be prominently displayed in every exam room. In fact, one seldom sees them posted anywhere. And nobody goes through the list to make sure you understand it, either.

I have two anecdotes that illustrate the dangers of this.

I was in such pain from a herniated disc that I could not sit down without excruciating pain. The pain kept me from doing much more than lie on my sitting-room couch and groan. My husband had to drive me to the doctor -- all I could do was lie down in the back seat of the car, and that hurt like the devil.

Sure enough, at the doctor's the nurse asked, "On a scale of 1 to 10 ..."

I asked her, "Do you mean right now or in general?"

She replied, "Right now."

I was standing still in the exam room, so I answered, "Oh, about a 5."

I later learned I should have said my pain was a 10, because it made me unable to serve any useful function. Worse, it resulted in delaying appropriate treatment for about five more weeks, by which time I was a total wreck.

My son told me the second anecdote. We were talking about my nightmarish experience, and he told me, "I just always say, 'Between an 8 and a 10. It's so much easier and works so much better.'"

I think the best and easiest solution to this problem is not to ask the patient anything about the "scale of 1 to 10," but to go through the descriptions of the ascending levels until the patient finds the best match. Then the nurse can note the corresponding level numerically if necessary. This should get more accurate results and keep everybody happy.

Ruth Firestone, Hays, is a frequent contributor to The Hays Daily News.

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