To the Doctors Who See Patients With Chronic Pain

Dear doctors who see patients with chronic pain,

This is what I’d like you to tell you.

1. Believe a patient 10 times before you disbelieve him or her.

When a patient tells you he or she is in pain, believe that person until you have objective proof to the contrary. There is nothing as validating and as calming as seeing a doctor or nurse take you seriously and feeling like you can trust them to take care of you, which is what they’ve been taught to do. I have been treated so poorly in the ER several times that sometimes I would rather stay home and cry and scream for hours, even when I know there is a way to relieve the pain, because the disrespect and indignity isn’t worth it. For a patient to feel that way about their doctors is as ludicrous as a person not calling the fire department while their home is burning to the ground because of fear of the firemen’s reaction. You would say, “They are firemen, that’s their job!” It is no different in your case.

2. Everyone has a different reaction to pain.

Not everyone cries or screams. Some people grit their teeth or hold tight onto something or just don’t show the reaction you would expect from someone with pain. It is because we are not in acute pain. Our pain is long-term, and exacerbations are just an extension of it, so we react as we’ve trained ourselves to react because if we didn’t learn not to cry and scream during severe pain, we’d be crying and screaming forever.

3. Do not mock the patient.

I have been embarrassed several times by a doctor who would come into my room and smirk and say things like, “Oh you again. What do you want now?” He has not been the only one. It is an absolute wretched feeling. If we could be anywhere in the world, including the comfort of our homes, why would we choose to deliberately come to a hospital unless we really needed to? Moreover, saying things such as “What do you want?” is taunting and seems like a trick question. Most of us know what works for us, but if we answer with a specific drug or dose, we run the risk of people assuming we’re addicts. I always answer, “I just want the pain to go away.” Many times they just give me the least potent thing, which doesn’t get through my pain, and then make me wait for ages before finally giving me something that helps.

4. Do not make chronic pain patients feel like their exacerbations are a waste of your time.

Yes, there will always be more serious patients in the wards as there will be less serious patients. But we are one of them too. We are patients too, not a nuisance. You have been trained and have worked so hard to get to where you are. You took an oath to make lives better, and that doesn’t always mean saving lives in times of crises. It can also mean easing someone’s pain for a little while or improving their quality of life.

5. Most importantly, remember what empathy truly means.

In medical school, we’re taught how to show empathy — give your full attention to the patient, nod at appropriate intervals, show the right facial expressions, express remorse or regret when necessary. But not all doctors understand what empathy really means. Empathy is putting yourself in the shoes of the other person, if only for a moment. To show true empathy to your patients, you must step back and imagine yourself in the sort of pain they describe day in and day out and then think of how you would want to be treated. That is empathy. Not a tilt of the head or a half-smile or a few practiced reassuring words — but making the patient feel like even though you can’t understand or imagine what they’re going through, you believe them and want to help them.

Some of the best words I have ever heard from a doctor (and I’ve been to more than I can count) were, “I believe you. I know your pain is real.”

That’s all we want to hear.

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