Emergency physicians’ pain judgments: cluster analyses on scenarios of acute abdominal pain

Abstract

Physicians have been found to give lower ratings of patients' pain than do the patients themselves. We hypothesized that the physicians' rating depends not only on the patient's pain rating but also on other cues. We also hypothesized that these cues influence physicians' pain treatment and urgency level. We gave to 52 emergency room physicians in Toulouse, France, 45 scenarios describing patients with acute abdominal pain, representing all combinations of 5 levels of patient's pain rating, 3 levels of behavioral manifestations of pain, and three signs of the severity of the abdominal pathology (namely, the likelihood of appendicitis). The participants rated the patient's pain, selected the intensity of pain treatment, and judged the degree of urgency of calling in a surgeon. In rating pain, physicians took into account the patient's rating, behavioral manifestations of pain, and the signs of abdominal pathology. Clusters analyses showed two sets of individual differences. When rating pain and choosing pain treatment, physicians gave either a low or high weight to behavioral pain cues. In urgency judgments, physicians could be separated into those who gave considerable weight to the different levels of severity and those who did not.

Judging patients’ pain from external cues

“…The physicians judged patients' pain using the same kind of additive-type rule as that used by the nurses and nurse's aides. These findings are consistent with (a) suggestions by Craig et al (2011) that facial expressions provide the most sensitive information about pain level; (b) findings by Marquié et al (2008) that physicians rated pain by additively combining patient's pain rating, behavioral manifestations of pain, and signs of the severity of the pathology; and (c) findings by Chibnall et al (1997), who showed that medical students combined the reported pain intensity and the medical evidence in an additive fashion.…”

Medical Evidence Influence on Inpatients and Nurses Pain Ratings Agreement

“…Evidence supports the influence of medical evidence on symptom judgments made by both lay and medical assessors [ 3 , 12 , 15 – 17 , 27 ]. For example, among the inpatient population, the highest proportions of agreement were found in obstetrics and the lowest in surgery, oncology, and radiotherapy wards [ 3 ].…”

Categories of congruence between inpatient self‐reported pain and nurses evaluation

“…Congruence between PSRP and caregiver pain evaluation can be taken as a tool to uncover bias moderators in pain assessment (Solomon, 2001). This issue was studied at various pain conditions or settings (Iafrati, 1986; Grossman et al, 1991; Zalon, 1993; Tait and Chibnall, 1994, 1997; Todd et al, 1994; Chibnall and Tait, 1995, 2001; Chibnall et al, 1997, 2000; Bartfield et al, 1997; Marquié et al, 2003, 2007; Igier et al, 2007). In these studies most health operators were involved and lack of congruence was shown to increase with the PSRP severity.…”