Documenting Pain and Suffering
By James Beauchamp, D.C.
Science is the process of breaking an element of reality into its constituent parts for quantification and analysis. In the medical sciences we document pain and suffering (P&S) by breaking the reality of the patient’s suffering into objective documentation through the magic of office paperwork. This gives the patient the ability to relay to the doctor the facts of the injury, the experience of their pain and suffering, and how it affects his/her life. The patient’s paperwork and the physician’s documentation convert the patient’s experience into a documentable format suitable for computerized analysis. Common forms for documenting P&S include the following:
History of Injury
This is the patient’s own written description of the circumstances that resulted in his/her injury and how bad the injury feels to him or her. The physician then extracts further relevant details about the patient’s symptoms, including activity restrictions. This begins the initial baseline documentation of P&S.
The physical examination determines the functional status of the injured areas. Range of motion limitations, palpable muscle spasms, visual bruising, swelling and specific orthopedic tests constitute objective evidence of injury and supports the patient’s complaints and by extension, their P&S.
These include X-rays, MRI and CT scans, among others. This data is extremely valuable but its utility in an outpatient setting is a function of the correlation between the symptoms, the history of injury, and examination findings. When these factors are mutually consistent, they support the claim of pain and suffering. The absence of imaging findings does not imply that there is no injury or pain, since pain cannot be imaged by a musculoskeletal scan. Indeed, it is generally impossible to tell if the patient was even alive at the time it was performed. It is the physician’s clinical expertise that ties any imaging finding to a specific symptom or examination finding.
Specific Pain and Suffering Data Collection Tools
There are several specific forms that quantify elements of pain and suffering. The Oswestry Low Back Pain Disability Questionnaire, the Neck Pain Index, the Medical Outcomes Short Form 36 and the Whiplash Disability Questionnaire are written forms usually done at the time of the initial evaluation by the patients and on follow up re-evaluations. They allow the doctor to quantify P&S based on the patient answers. They are considered objective findings. While not as powerful as an actual disability rating, they are more than adequate to document the majority of injuries that don’t result in permanency.
All the data gathered during the course of the patient’s treatment are objective clinical facts which may be submitted to an insurance company for payment. On the insurance side, the data is input into a computer for analysis. This assigns a dollar value to the case including pain and suffering.
While I stand behind the scientific validity of the data collected, I have a problem with a computer derived opinion of human pain and suffering. For a patient with spinal injuries, simply walking across a room can feel like an ongoing assault. Imagine a room lined with invisible knives and razorblades. A simple shift of weight, a random movement, or just bending over to pick up a child can impale the injured individual upon these invisible restrictions which are no less painful because they cannot be seen. The P&S of a single person’s injury will spread throughout his/her social network like a contagion, infecting and harming many more people through its effects.
Only another human being can understand another’s suffering. It would be a COLLOSAL mistake to think that a computer program could ever do the same.
Dr. James Beauchamp is a Multi-Specialty HealthCare provider specializing in Chiropractic Care. He is certified in spinal trauma, manipulation under anesthesia, and as an automobile accident reconstructionist. He is also a member of the advisory board for Operation Backbone.
References available by request. Copyright James W. Beauchamp, DC