May 8, 2023

On a Scale of One to 10, How Annoyed Are You at Having to Rate Your Pain?

Has modern medicine turned to counting as a diagnosis?

By Ed Goldman

When did pain and discomfort become Olympic events? 

When (and why) do doctors, nurses and hospital volunteers ask us to rate our physical distress “on a scale of one to 10, with 10 being the worst”?

Edgy Cartoon

Malpractice makes perfect

Why do I think that if I tell the doctor, nurse or hospital volunteer that my pain is weighing in at about eight, unseen judges—watching my exam on Zoom—are going to hold up cards with various numbers on them to indicate they disagree with my self-assessment and what they think my level really is?

We’re not talking about figure skating, high-diving or gymnastics. My stomach flu, joint aches or fever don’t include, respectively axels, gainers or parallel bars.

When I was the hapless passenger in a car accident 15 years ago, an EMT, who was otherwise pretty great, nevertheless asked me in the ambulance to rate my suffering on that scale of one to 10. 

Since I could barely breathe—it later turned out I had at least 12 rib fractures (I say “at least” because an emergency room doc said she’d “stopped counting at 12”)—I managed to mutter “14.” I misread the look on the EMT’s face. He frowned at me and I thought it was an expression of sympathy. But no. “This is not time for comedy, Mister Goldman,” he scolded.

Ah, but it was. His question had struck me as being on a par with asking someone who’d just fallen out of a sixth-story window, “Did you just get here?” A good follow-up question might be, “And what did you do to upset Putin?”

I continued to make jokes at the hospital, sorry to say. I’d heard that President Reagan did this when he was shot, expressing his hope that the surgeons about to save his life were Republicans. One of the doctors allegedly replied, “I think we’re all Republicans today, Mister President.”  

See? Banter. Rapport. Who says you can’t have that in the midst of a medical crisis? (There are limits, of course. Like the old joke, “Other than that, Mrs. Lincoln, how’d you enjoy the play?”)

While the one-to-10 inquiry probably has holistic merit—because you’re asking patients to be active participants in resolving their dilemma—if you’ve ever spent a few days in a hospital, you know that the repetition of it can prove to be not only annoying but also can cause misleading responses. 

For example, when I underwent seven surgeries over a three-year period—from 2009 to 2012, if you’re archiving this, and you really should be—I’d be asked to self-rate my pain when the nurse woke me at 3 a.m. (to make sure I was sleeping okay—I wish I were making this up); when the anesthesiologist prepped me for the operation(s);  when I came to the OR nurse insisted on knowing if I was hurting. In those moments I was so groggy I could barely discern whether I was even alive, much less achy. I found it curious that as the drugs wore off I wasn’t asked then to appraise my agony. 

Well, I might as well get used to this brave new world of counting.

In fact, why not apply the same system to things other than personal pain, like: 

  • the psychic scars we suffer after a romantic breakup (“On a scale of one to 10, how badly do you feel about my dumping you for someone I met online? And how about if the website was eBay?”);
  • the humiliation we feel when a restaurant host says there’s no record of our having made a reservation and the place is completely booked (“On a scale of one to 10, how do you feel about having polished your shoes, dry-cleaned your suit, washed your hair, driven eight miles to get here and having your date say in front of the host, ‘I bet you forgot to call, didn’t you?'”) ; and
  • the intense pulse throbbing we experience when a cop pulls us over for speeding through a yellow light while we were transporting a frail and elderly parishioner to a spaghetti feed the Catholic church was raising to offset the multi-billion-dollar lawsuits filed against the Diocese for past sex crimes (“On a scale of one to 10, did you think you were rushing to get in good with the Lord?”).

No, Officer. I was afraid of being late to the Olympics skating competition.

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Ed Goldman's column appears almost every Monday, Wednesday and Friday. A former daily columnist for the Sacramento Business Journal, as well as monthly columnist for Sacramento Magazine and Comstock’s Business Magazine, he’s the author of five books, two plays and one musical (so far).