Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1163
Narratives 89 N

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"The proper use of pain scales"


Dr Studin: I am here with Dr. Michael Schoenfeld. So you write narratives for doctors who want to retain you to do that, so this way they don't have to spend three, four hours per narrative. And you're their easy button.

Guest Dr: I am. Yes.

Dr Studin: And Michael, how long have you been doing this to them and how many narratives have written and done so far for doctors?

Guest Dr: I think I've done them for about five years and I've probably done a couple of thousand. I'm not sure.

Dr Studin: So Michael, one of the things you talked about that's hugely problematic is doctors reporting pain scales, my issue is doctors are putting VAS and not knowing what vas stands. And I said, doctor, what does VAS is? they all say, well, I'm not sure. But then they say, well, maybe... So I say let me refresh your memory doctor, is it a visual analog scale? And they say yes. And I said, doctor, did you show them a picture of like smiley faces or did you just ask them? Well, I asked them, well, that's a verbal analog scale and they purge of themselves. If that's their testimony on court, they've got to be careful. That's my issue. But what is your issue?

Guest Doctor: you're absolutely right. And I actually have that little chart in my office right in my little hand now, what was it called? The one baker faces pain scale rating?

Dr Studin: Yes. And it was done by pediatric nurses working with a toddlers who couldn't verbalize pain. That was what really originated from.

Guest Dr: Well, my issue is really easy. I mean, doctors very often use the pain scale of one to 10. And my question always is what if the patient had no pain? What, what would one mean? So obviously 10 means the most of your pain. And most of our patients that have a 10 pain scale In my opinion and what I've learned. And perhaps you would agree, that's almost like an emergency room type of pain and also if they have a one pain scale, how could they, how could it be one this, they have no pain, so ideally it's best to use zero to 10 and I do see a narratives all the time where the patient reports no pain and then their right the pain was sharp. So there's another issue besides the pain scale description of the pain.

Dr Studin: Doctors have to pay attention basically.

Guest Dr: They have to pay attention and they have to not get tripped up and they have to be honest.

Dr Studin: Well, I don't think that doctors are some dishonest. I think doctors just get lazy, And not paying and not paying attention to what they're writing and/or saying. Because every single word, especially in our world of personal injury, some lawyers is going to be look defense or plaintiff going to be looking at every word, every phrase. It has to be accurate. It has to be consistent and it has to be demonstrable or colorful. And that's why you use the visual analog scales with those smiley faces. And you hit the nail on the head up front when you said take a picture of those smiley faces, you can get it right on Google. It's free. Yep. Laminate it, put it in your examination room and every treatment room, everywhere.

Guest Dr: And also pain scale is often done in a range, right? Some people wake up a 10 or an eight or a seven, and by the afternoon they might be a four. So there's nothing wrong with giving a range of pain scales either.

Dr Studin: I would say the pain scale was four with exacerbation up to six or seven. That usually occurs in the afternoon or upon exertion. And that would resolve that issue. 

PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.