Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Broken Promises

There is a difference, in my opinion, between the concepts of pain treatment and pain management, and quite often when you engage in pain treatment, you are postponing the patient’s ultimate requirement that he/she learns pain management.

A patient explained to me that he initially was very fond of his surgeon. The surgeon told him `I am going to see to it that you have no more pain. I’ll do all I can do, and if that does not relieve all of your pain, I’ll refer you to
someone else and continue this until there is no more pain.’

To the patient, this simple promise was very rewarding. It also set up appreciable expectancy of recovery. In this case, as it would be in far too many, it was a promise that could not be kept.

While the patient could and did receive benefit from conservative and surgical procedures, he had painful limitations that precluded ever returning to any form of employment.

More importantly, the patient passively waited for a change in this inevitability, believing that the promise of pain relief would ultimately be kept. He remained sedentary, and his health habits (obesity, smoking, etc) further
deteriorated.

When he did not improve, he became blameful, not of the surgeon who made this unsupported promise, but of the insurance company for becoming increasingly reluctant, over the years, to authorize more tests and
procedures that had little if any chance of changing the patient’s plight.

Whether the surgeon made that promise out of compassion or merely as a marketing tool, one never knows, but the impact of the promise has been ever lasting.

Painful realities are hard to impart, and no one wants to be the bearer of bad news or negative expectations. But there is a difference between offering what a patient wants to hear, and telling a patient what he needs to hear.
Countless times, patients have told me, “I wish I had just been told the truth up front so I could begin to deal with it before I became dependent on all this medication that I hate to take but now can’t do without.”

Our patients are not small children, but sometimes health care providers treat them as such, either to protect them, give them hope or shield themselves from being seen as inadeqaute.

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