Why It's Difficult For People With Chronic Pain To Gain Their Doctor's Trust
Many people with chronic pain find themselves interacting with clinicians who do not seem to trust them. Why is it hard to establish a trusting relationship with your doctor? And what can you do about it?
I have been on both sides of the exam table – as a physician caring for people with chronic pain and as a patient slowly coming to realize he is struggling with chronic pain. I would like to share a story I hope will help you understand why it can be difficult to gain the trust of your physicians.
It was the early 90s, and I was splitting time between two primary care clinics. One Tuesday, I took care of a man in his mid-30s who had previously sustained a serious back injury, with X-rays showing significant damage to multiple lumbar vertebrae. He told me that he experienced a flare of his lower back that morning after picking something up. The pain was now so bad that I had to help him get on the exam table. After assuring myself he had not suffered any nerve damage, I prescribed him a modest supply of oxycodone. (Remember it was the 90s—that's what we did!)
Two days later, I was working in the other clinic and saw the same man in the waiting room, scheduled to see one of my colleagues. I told the colleague that I was familiar with the patient he was about to see and asked my colleague to reach out to me after he finished examining him. The patient told my colleague that he had tweaked his back 'just that morning.' My colleague was inclined to prescribe him narcotics, but I told him about the Tuesday appointment, and we got to digging around for more information. After a few calls, we discovered that this patient was notorious for rotating across clinics seeking narcotics.
In retrospect, I can see all kinds of things I did wrong that week. I gave out narcotics too freely to a patient I barely knew. When I discovered his deception, I did not call an addiction expert to see if we could help this man overcome his need for narcotics. Instead, my colleague and I confronted him about his deceptive behavior and sent him home without further treatment.
But I am not telling you this story to reflect on my mistakes. Instead, I want to share my feelings.
I felt betrayed. I was trying to help this man, earnestly assessing his situation and prescribing a treatment I thought would alleviate his pain. I felt embarrassed that he had so easily fooled me. The dude knew all the right things to say, all the right 'pain postures' to pose in to convince me to prescribe the medications he desired. And I felt angry. I tried to help him and he showed his gratitude by lying to me.
Flooded with emotions, I lost the ability to feel compassion for whatever issues were causing this man to spend his time in medical waiting rooms seeking narcotics.
More importantly, I became more suspicious of subsequent patients who came to clinic complaining of pain. How do I know they are telling me the truth? Their x-rays look horrendous but how do I know whether they are feeling pain? That wince they display when I raise their leg in the air – how do I know that's not an act?
I am telling you this story because someday you may tell a physician about your pain and sense that the doctor does not believe you. Maybe that physician, like me, has been burned.
We physicians should not allow a handful of deceitful patients to undermine our trust in the rest of the people we care for.
We patients, on the other hand, should recognize that some physicians view us with suspicion not because of anything we said or did, but because of other patients they have encountered, patients who left them feeling angry and embarrassed. We should hope that our physicians greet us with trusting attitudes. But we should not be surprised if building such trust takes time.
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