Editor’s Note: When Dr. Richard Radnovich wrote a provocative column for The National Pain Report entitled “10 Things Never To Say To Your Doctor”, it engendered interesting and passionate response. It prompted Kurt W.G. Matthies to write a response. Both of these men made great points. The idea of the original column was to help patients understand what the doctor might be thinking. Dr. Radnovich explains in this follow-up commentary:
Thanks for posting the thoughtful and reasoned commentary on “10 things never to say to your pain doctor”.
It is obvious that I have simultaneously over-estimated my ability to write on this topic, while underestimating the frustration chronic pain patients have with their care.
I do not want to belabor this, but sadly the point of the article has beenOK grossly misunderstood. And the point of the piece is VERY IMPORTANT; misunderstanding the point of “10 things” is detrimental to all pain patients. So, let me clear it up.
Unfortunately, Mr. Matthias, your response perpetuates and expands the misunderstanding. Here are just a few examples: “we’re missing an entire group of patients when we follow the thought process of Dr. Radnovich” and “Let’s look at Dr. Radnovich’s ideas” and “Dr. Radnovich, please consider the fact that some pain patients who present in your office may know a hell of a lot about medicine”.
You, and others, have made this about me.
Let me be abundantly clear: the items on the ‘10 things’ list are not a valid basis for formulating an opinion about a pain patient, much less a treatment plan. They are not treatment guidelines. They are not suggestions that pain docs ought to follow in evaluating patients.
And they are certainly not “my ideas” nor how I treat my pain patients.
The ‘top 10’ list reflects the assumptions, biases, stereotypes, short cuts, categories, pigeon holes, first impressions, presumptions, and pre-judgements that just about every physician may make during an office visit. These impressions color how they feel about you and how they treat you.
Again, this is not my idea. I did not create this process. I am not to blame for its existence. Research has been done and books have been written on this phenomenon. Probably the most popular is “How Doctors Think” by Jerome Groopman, I would encourage all pain patients to read it.
Here is another way to look this. Patients talk about doctors, right? Well, doctors are human and we talk about patients. Or more accurately, types of patients. Docs share the things that patients say and do that rankles them; the things that trigger their pre-judgements. That ‘top 10’ list is based on the things that I hear repeatedly mentioned from other doctors.
Again, I did not make those up. THEY ARE VERY LIKELY WHAT YOUR DOCTOR ALREADY THINKS when you say the things on the list. Let me repeat that: I did not create that list; those are the things that your doctor already thinks. More importantly, your doctor is likely basing decisions on those assumptions, whether or not they are valid. Mr. Matthies, you provided an example of this from your own experience: “My pain doctor asked me during my first visit – who’s your lawyer? Is this a work-comp case? When I replied I had no lawyer, he was surprised.” Your doctor had already made a judgment and assumptions about you.
The point of the article was not to marginalize patients nor justify poor treatment; it was not to make the pain patient even more depressed about the state of pain management.
The point was to empower pain patients by making them aware of theses biases. And if they choose to, use the biases in their favor by adjusting how they present to the doctor.
Of course, you can choose to ignore all of the ‘top 10’, and you can pillory me in the process for bringing them up. The plain facts are that 1) these biases exist and 2) the relationship with your physician is a 2 -way street. You will not be able to change the doctors’ biases, but you do have complete control over how you present. If you are repeatedly unhappy with how you are treated, you might consider the latter.
I wish you, and all pain patients, good fortune in finding a pain doctor that really listens and cares. They may be hard to find, but we are out there.
Editor’s Note #2: I’m happy to report that both Dr. Radnovich and Kurt W.G. Matthies are going to continue writing for the National Pain Report.
Follow Us on Twitter