One of the more difficult things for patients to do is to describe pain. This is an example of a recent conversation I had with a patient. The names are changed, except mine.
Me-“Good morning, I am Dr. Froe. I see that Dr. Smith wanted you to come over to talk to me about your testicle pain. Tell me about it.”
Patient-“Well doc, I have this pain in my left side, it’s been goin’ on for a long time. It gets real bad sometimes, sometimes I can hardly walk. “
Me-“the left side of what?”
Patient-“the left side of my sack”
Me-“is it the testicle or the skin or something else that is hurting?”
Patient-“I don’t know, I just know it hurts real bad sometimes”
Me-“when did it start?”
Patient-“Oh, I don’t know, a while ago.”
Me-“how long ago is that a week, a month, a year, 5 years?”
Patient-“no not 5 years, but maybe I did have something like this that long ago, I’m not sure.”
Me-“how long have you had this pain that you are describing, a month, a week, a year.”
Patient-“probably about a couple of months”
Me-“Is it there all the time?”
Patient-“no”
Me-“when do you have this pain”
Patient-“Oh, I don’t know. It can kind of just come up anytime.”
Me-“does it ever wake you up at night”
Patient-“no”
Me-“Is it worse in the morning or at night?
Patient-“I usually don’t have it in the morning, sometimes it’s there at night.”
I don’t know about you, but I am frustrated just typing this conversation. This is real. This is probably 5 minutes into the appointment and I have no idea of what is going on with this guy. Remember, you only have a short amount of time to get your story out.
Here are the things your doctor needs to know to help you to figure out what is causing the pain.
WHERE
Where is the pain? Is it always there? Does it go anywhere else? Does it start there and go somewhere else or start somewhere else and end there?
WHEN
When did the pain start? This means when did you first have this pain. If you can’t remember, guess, five years ago, 2 months ago, figure it out before you get to your appointment. Remember, answers like “I’ve had it a while” or “a long time” are very non-specific. We do not know how long a while is to you. Have an answer. Your doctor will also want to know if it has gotten worse over time
HOW LONG
When you get the pain, how long does it last? Minutes, seconds, hours, days. It is constant, intermittent, predictable, unpredictable? Yes, people do say, “every time I push on it, it hurts.”
HOW BAD
We will usually ask, “On a scale from 0-10, how bad is it at it’s worse?” Zero means no pain, 10 means the worst pain that you have ever felt. You can only judge this by your experiences. If the worst pain that you have ever experienced is a bad headache then that is your 10 pain.
BETTER OR WORSE
What do you do that helps or makes the pain worse? It is worse when I walk, it is better when I eat, are examples of answers to this question.
CHARACTER
Describe the character of the pain. Is it sharp, stabbing, pinching, burning, dull, stinging, numbing, tender, squeezing, tight, heavy?
Let’s try that conversation again.
Me-“Good morning, I am Dr. Froe. I see that Dr. Smith wanted you to come over to talk to me about your testicle pain. Tell me about it.”
Patient-“yes, for the past 2 weeks I have been getting this pain in the left side of my sack. It comes and goes. It seems to be worse in the day when I am at work. I walk a lot a work and sometimes need to lift heavy things. Sometimes I take ibuprofen, it helps a little. When I get home and get to sit down it seems to get better. It might have started after we had a particularly hard day at work. Several people didn’t come in and I did a lot of heavy lifting just to get the work done.
So much better. He did not answer every question, but there is so much information here that we can move quickly to trying to figure out the problem.
Hopefully, this helps you the next time you need to describe a pain to your doctor.
Remember, your health is your responsibility.
