How to Get What You Want from the Doctor

Stoicism Is for Wimps
Talking about pain makes doctors experience significant discomfort, to use their own dainty jargon. "They don't care to think anything is painful, especially if they've had something to do with it, like perform the surgery," says Barbara Korsch. Pain is nothing if not emotional, yet here again, "If doctors think you're exaggerating and being very emotional, they'll say, 'There, there, it can't be that bad. I've taken care of a lot of patients who have that.'"

Most of us are encouraged to be stoic about pain, which makes two people in the examining room who don't want to talk about it—the patient and the doctor. According to the American Pain Foundation, this approach is not only pointless, it is dangerous. Ignoring pain can make a condition worse, so that when you do finally treat it, the cost and disability are far greater than if you had dealt with it early on. Chronic pain (lasting six months or longer) impairs your mood, sleep, sexual appetite, friendships, energy, and overall lust for life. Both the Joint Commission on Accreditation of Healthcare Organizations and the Department of Veterans Affairs have requested that pain be treated as a fifth vital sign, to be assessed along with pulse, temperature, breathing rate, and blood pressure.

Whether your pain is chronic or not, don't be ashamed to speak up about it. Make an effort to stay calm. The doctor needs precise information about the nature of your pain, and the more specific you are, the more she will be able to help you. If she attempts to brush off your concerns by comparing you to other patients or insisting that it can't be that bad, bring the focus back to you: "I realize other patients may have reacted differently, but I have a very low tolerance for pain and I need you to take this seriously." Approach the conversation with the attitude that of course she wants to help you alleviate the pain (even if she has tried to brush you off). Do not blame the doctor for the pain. Keep it neutral. The American Pain Foundation suggests the following tips for talking about pain with your doctor:

• Tell him where it hurts and when you first noticed the pain.
• Describe what it feels like, using specific words such as stabbing, aching, radiating, throbbing, sharp, dull, burning, tingling, deep, pressing, and so forth.
• Describe how badly it hurts on a scale from 1 to 10, 10 being worst.
• Describe what makes the pain better or worse.
• Explain how the pain affects your daily life. Has it impaired your work, exercise, sleep, sexual activities, mood, ability to concentrate, state of mind?
• Tell the doctor about pain management techniques and medications you have used in the past, and explain what worked and what didn't.

Despite their best intentions, some doctors don't have much to offer in the way of pain management. Few are trained in it, and many simply don't give it much attention. If you are not getting satisfaction with your doctor, ask her to recommend a pain specialist. If she doesn't know of any, shop for one on your own. The American Pain Foundation (www. Painfoundation.org; 888-615-7246) can help.