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Stories from doctors of patients with pain. A qualitative research on the physicians’ perspective

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Abstract

Goal of work

.The aim of this study was to explore the physicians’ internal representation of the doctor–patient relationship in the dramatic field of the patient with pain.

Methods

Using an open narrative format, 151 physicians were asked to “Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain”. The narrations were examined in accordance with a clinical-interpretive method.

Main results

Three “perspectives of observation” were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the “depersonalization” of pain. In the professional perspective, the narrative concerns the patient as a “person” and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives.

Conclusions

The professional perspective seemed to be the only place in which physicians could “stop”, a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.

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Acknowledgements

We would like to acknowledge the physicians who kindly gave their contributions for this study and participated in the training course on doctor–patient communication from January to May 2003.

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Authors and Affiliations

  1. Chair Department of Medical Psychology, School of Medicine, University of Milan, Milan, Italy

    E. Vegni, E. Mauri & E. A. Moja

  2. Department of Medicine, Surgery and Dentistry, San Paolo Hospital, via Di Rudinì 8, 20142, Milan, Italy

    E. Mauri

Authors
  1. E. Vegni
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  2. E. Mauri
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  3. E. A. Moja
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Corresponding author

Correspondence to E. Mauri.

Appendix

Appendix

The following story exemplifies the three doctors perspectives with patients in pain. The “biological” perspective is clearly evident at the very beginning of the story. The meeting with the other as a person as described in the “professional” perspective is unequivocal, for example, with the use of the patient’s first name. The last sentence exemplifies the personal perspective, that of the “hurt healer”. This story is also an example of the continuous journey of the doctor within the three perspectives. The original layout characteristics of the text have been maintained.

50 years ♂ ALS

Disease’s (very fast) progression with acute respiratory failure—hypercapnia—admission to the emergency unit—ETI—mechanical ventilation, tracheostomy and then discharged to his home with ventilatory support.

NB tetraplegic patient

He is sent to our unit (the patient had been treated at another intensive care unit) and I am appointed to provide specialist support at the patient’s home (reanimative support to ventilation and analgesia for associated pain). He is not my first patient; on the contrary all these patients are of my competence.

SURROUNDING—at the beginning opposed; the intensive care in which at first he was treated was “perfect”; it’s a pity that they refused some informations to the patient on the course of the disease, prognosis and progress; we are seen as incompetent but (?) “I’m quite young. How could my time be up?”.

The patient is going bad and bad ...

He refuses the PEG or a nasogastric tube for feeding and prefers feeding by OS (patient with dysphagia) with consequent inhalations ... and then, the pain ... piercing, dull, unceasing, shooting.

He’s not exactly happy.

(Who knows why?!)

After a week ... all of a sudden, the correct feeling is established; a relationship of trust is born; I am able to understand what Lucio is looking for.

We examine the pain, we calm the anxiety together and the drugs slowly begin to work ... .

Where is the problem?

Are we becoming too ... friendly?

I have recently suffered the loss of my mother. For obvious reasons I treat the patient at his home; I identify myself with him; I see his children, his family; I become almost a distant cousin.

When he died (of pneumonia) at 5 a.m., they called me at home; I went; I lost ... the distance.

His death is a loss, not a sad observation

[MD136]

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Vegni, E., Mauri, E. & Moja, E.A. Stories from doctors of patients with pain. A qualitative research on the physicians’ perspective. Support Care Cancer 13, 18–25 (2005). https://doi.org/10.1007/s00520-004-0714-2

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  • DOI: https://doi.org/10.1007/s00520-004-0714-2

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