Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The moment this physician realized she hated the pain scale

Cherilyn Cecchini, MD
Physician
October 6, 2017
Share
Tweet
Share

I was surprised when I felt my body stiffen as I became aware that an iPhone had just been fiercely thrown in my direction. “I’m calling security,” shouted a distant voice in the background.

“I want the 10 mg oxycodone pills! I am in 10/10 pain!” The patient shouted this to me as he abruptly got up, violently launched his phone in my direction and stomped toward the exit of the consult room.

Let’s rewind for a moment. This adolescent patient was already discharged from the hospital. I was called to the consult room to discuss the plan with his mom and to re-emphasize his pain management plan. Upon entering the room, I could tell that the parent was in distress. She looked utterly defeated. She asked me quietly if I could provide her son with the stronger dosage of medication. I calmly explained to her that we were following his documented pain plan, which clearly indicated that he should be prescribed seven 5 mg tabs of oxycodone to use as needed until seen by his pain management physician. I could see the tears forming in her eyes. I said I would speak to her son’s physician and return. I sensed that her son was growing more and more agitated by the second. I left the room and paged the pain management physician on call.

He promptly returned my page, and we had a lengthy discussion about the patient’s habit of selling drugs on the street, which is why his pain contract is binding and incredibly strict. He advised me to provide only the 5 mg tabs and explain to the patient and the parent that he would see them in the next 1 to 2 days at the pain clinic for further discussion. I thanked him for the explanation and for his time.

I returned to the consult room and told the patient that I was unable to provide higher mg tabs and that I was strictly following his pain contract. It was maybe a nanosecond later that I saw the iPhone heading straight toward my face and heard stomping out of the room. The mother glanced at me sadly, picked up the prescription, retrieved the shattered phone and slowly walked out of the room to find her son.

In this moment, I remembered a hematologist’s words to me. He told me that he was the “most fired” hematologist in all of Washington, DC because he refused to prescribe opioids to patients he knew did not need them. He instead brought to their attention factors that families often disliked acknowledging, such as co-existing anxiety or depression that often accompanies chronic pain.

It was during this moment that I realized I hated the pain scale.

“Doctor, I’m in 10/10 pain,” says a patient while he or she is sitting up in bed comfortably attached to his or her phone, sending messages or checking various forms of social media. “I can’t leave the hospital because my pain is 11/10,” says a patient while he or she devours the latest meal tray without any evidence of tachycardia or vital sign changes. And yet, we continue to ask, “what is your pain on a scale of 1 to 10” every four hours. We are feeding into the pain problem. We are disabling children by asking them to attach a numerical value to their pain. Instead, we should be asking, “What have you been able to do today?” Or perhaps, “How tolerable is the pain?” These questions would set more realistic expectations for patients and families. Chronic pain is challenging, but one of the most difficult parts of managing this is emphasizing that the pain will almost never fully go away.

Instead of allowing patients to lie in darkened rooms, we should encourage them to sit up and out of bed once their pain becomes manageable. Child life-specialists are incredibly useful in these scenarios and do a wonderful job providing techniques to distract patients from their pain. We should empower these patients to take control of the pain rather than allowing it to disable them.

Cherilyn Cecchini is a pediatric resident.

Image credit: Shutterstock.com

Prev

5 ways doctors can cope when natural disaster strikes

October 5, 2017 Kevin 0
…
Next

Anti-immigrant policies put people at risk during Harvey. And that's just the beginning.

October 6, 2017 Kevin 2
…

Tagged as: Hospital-Based Medicine, Medications, Oncology/Hematology

Post navigation

< Previous Post
5 ways doctors can cope when natural disaster strikes
Next Post >
Anti-immigrant policies put people at risk during Harvey. And that's just the beginning.

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Cherilyn Cecchini, MD

  • Time for grieving is a necessity for medical trainees

    Cherilyn Cecchini, MD
  • What is the pediatrician’s role in marijuana use?

    Cherilyn Cecchini, MD
  • The opioid crisis hits children

    Cherilyn Cecchini, MD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • The present moment as a refuge

    Toni Bernhard, JD
  • Blame the pain, not the opioids

    Angelika Byczkowski
  • Using low-dose naltrexone to treat pain

    Alex Smith
  • Why staying ahead of your pain with opioids is the wrong advice

    Myles Gart, MD
  • A paradigm shift in acute pain assessment and management

    Myles Gart, MD

More in Physician

  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • In a fractured world, Brian Wilson’s message still heals

    Arthur Lazarus, MD, MBA
  • Why being a physician mom is harder than anyone admits

    Cynthia Chen-Joea, DO, MPH
  • Removing vaccine advisers could jeopardize lives

    J. Leonard Lichtenfeld, MD
  • Why would any physician believe that the practice of medicine will become less abusive for them in the future?

    Curtis G. Graham, MD
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Why health care must adapt to meet the needs of older adults with disabilities

      Lynn A. Schaefer, PhD | Conditions
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
    • Improving patient encounters: time-saving strategies for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • How art and science fueled one woman’s path to medicine

      Amy Avakian, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • 4 traits every new attending physician needs to thrive

      Sarah Epstein | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Why health care must adapt to meet the needs of older adults with disabilities

      Lynn A. Schaefer, PhD | Conditions
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
    • Improving patient encounters: time-saving strategies for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • How art and science fueled one woman’s path to medicine

      Amy Avakian, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • 4 traits every new attending physician needs to thrive

      Sarah Epstein | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The moment this physician realized she hated the pain scale
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...