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Climbing the Learning Curve

PAINWeek Live Virtual Conference 2020 Scholarship Winning Essay

Growing up, every individual will experience pain, commonly in a physical or emotional context. As a child, this pain is often described as being present while pointing at a location on the body. However, as the mind matures, how one describes pain also evolves. From an initial description of the pain’s onset and inciting factor, a person will delve into what worsens or alleviates the symptoms and what remedies have been attempted in the past to treat their pain. In this aspect, the word “pain” is often the tip of the iceberg for a variety of conditions that can negatively impact a patient’s livelihood and result in outpatient visits or hospitalizations.

Similar to the growth of an individual describing their pain, learning how to treat a person’s pain is an educational process that takes time and dedication. As a medical student, I learned to recognize that a person was in pain and to ask important questions regarding their concerns which focused on the acuity of the problem. I was part of a team, reporting to my residents, fellows, and attendings that came up with a proposed solution to tackle the individual’s needs. During my residency in obstetrics and gynecology, I trained to come up with solutions to the acuity of the pain, providing one or multiple treatment options to their problems. Though I learned to treat acute problems well, outpatient and chronic conditions were often referred to specialists. We learned about these conditions in our continuity clinics and specialty rotations, however, an ever-changing rotation schedule did not always allow for continuity of care with patients.

When I sought out a fellowship, I wanted to choose a facility that would deal with conditions that physicians often refer out such as chronic pelvic pain. I wanted to be the specialist that received referrals of more difficult conditions. As a gynecology fellow within the Veterans Affairs (VA) system, I have worked with complex pain patients that often require care over multiple visits and sometimes years. My fellowship has introduced me to conditions that were only briefly touched on during my residency program such as myofascial pelvic pain and bladder pain syndrome. In 2016, there were over 95,000 women veterans who were treated for chronic pelvic pain. As one of the few standalone gynecology departments in the VA system, we often get referrals for pelvic pain from neighboring facilities and our patients can drive a few hours seeking care. I work with pelvic pain specialists and started learning from day 1 a proper assessment and treatment of these individuals.

Although asking pertinent questions and performing physical exam maneuvers are important, there is an underlying theme that I have had to relearn with my patients. Listening. The patient is the individual who knows their condition the best. Often, we are rushed in a patient encounter knowing that there are patients who are waiting to be seen next. A rushed conversation can lead to missing crucial information. A patient’s primary concern can lead to a multi-factorial diagnosis of their underlying condition. Learning not to cut of a patient for the sake of time or making assumptions based on our own past experiences has been crucial to nailing a final diagnosis.

Coming up with a solution to a patient’s problems requires a foundation of knowledge. The opportunity to receive a scholarship to attend PAINWeek would deepen my understanding about pain and directly benefit my patients. Medicine is an occupation of life-long learning and I look forward to learning about both pharmacological and non-pharmacological methods of helping patients in pain. Most importantly, I look forward to collaborating with pain providers from specialties outside my own, and gaining access to resources that are available to the PAINWeek family of providers. I hope to become long-term contributor to the PAINWeek mission of education, research and excellence in clinical care.

Alexander Wang, MD
Orlando VA Medical Center
Orlando, FL