What I have come to realize is that as we understand that patients are truly individuals, there are many things that the standard assessment processes are not going to capture – emotional states, emotional challenges, cultural challenges, cultural differences, different external pressures that they have in their lives. Clinicians need to think about all of the things that the patient might be keeping inside their head that they might not be sharing that would hinder the provider from truly tailoring a treatment plan to that person. Somebody who’s got to get up in the morning and go to work versus somebody who wants to get up in the morning and care for their children are two very different people. They could have the same pathophysiologic problem; they could be exactly the same gender, age, race, everything else you want to categorize them by; but they could be very different people in the context of their lives.
Like it or not, we bring precognitive judgments and thinking into the room with us every time we see a patient, probably before we even meet the patient. We judge them based on what we see. We read about them before we ever meet them. Patients will also do the same thing – patients judge themselves, patients judge us, and all of this precognitive thinking can, in many situations, corrupt the process and the treatment plan. My goal is to try and help people understand and reflect on those kinds of things and bring them into the clinical setting to try and develop trust, open candid relationships, empathy, candor, honesty, integrity. None of those things exist inside the box; they’re all outside the box – but they’re there, and they need to be taken into account. There are two ways to approach patients with chronic pain – a mechanistic approach where you literally drill down to the pathophysiology and say from a very scientific perspective, here’s what we need to treat, or humanistic level. And really, there is no such thing as a patient who is not a human. They could be a good human; they could be a bad human; they could be a challenging human – but they’re human, and you cannot treat a patient with chronic pain if you don’t take into account the human characteristics that exist around all the data we’ve been trained to capture about them.