Relationship of Patients' Pain Reports to Their Requests in Two Medical Settings

Abstract

Do patients' uncertainties about what their pain sensations mean influence their reports of pain? To study this question, patients' pain reports were examined within two hospital-based medical practices, a walk-in unit and a general medical practice, practices to which patients bring different uncertainties about their diagnosis and treatment. Patients' requests for medical help are a measure of such uncertainties. Within each practice requests of patients reporting pain were compared with those of nonreporters. In the walk-in unit, where new patients face diagnostic uncertainties, pain reporters compared to nonreporters were more likely to make requests that focused on diagnosis and that had a cognitive form (explanation). In the general medical practice, where returning patients face treatment uncertainties, pain reporters and nonreporters were equally likely to make requests that focused on treatment and that had a somatic form (medication). This result was not predicted since pain reporters were expected to exceed (not equal) nonreporters in this normative pattern. The relationship of pain reports to the intensity of medical uncertainty and the continuity of the doctor-patient relationship is discussed.