Telling Your Doctor Your 'Subjective' Symptoms

This post will be a crossover between the medical field, and the patient in pain. I chose Pain because it is the one (out of many symptoms, yet pain is strictly subjective--only what the patient says it is.) Pain is a symptom (and a disease of it's own also), that can not be given a "simple" answer to the infamous question, "How have you been, and how has your pain felt?"

We, the patient, are giving a *****Subjective View, (***can only be given by the patient themselves.) No one else can be involved in the subjective question, unless you need someone to help speak or communicate for you. But these are questions, and your answers, that tell the doctor what YOU are feeling.

To let you in on exactly how the doctor or nurse asks you questions; if you ever remember your 98 second visit, (J/K) see someday if you can see this pattern in how the doc asked you questions during the visit. In Pain Management, the FIRST question is THE question that will let h/her base your plan of care on. Docs need to have a plan. And the first bunch of questions we patients answer supplies most of the information they will use in that plan.


I don't know exactly when things began to change-- the order in which nurses and docs ask a patient during their visit. Whatever acronyms Healthcare Professionals use, it evokes the same responses they are looking for. In the late 80's to early 90's, we used the acronym: SOAPIE, FOR:

S ubjective
O bjective
A ssesment
P lan
I Implentation
E valuation

Ok, so we know what order these words are in. Yet what are the providers attempting to elicit from you by using this acronym?

"Subjective"-- (Remember we are in our DOCTOR'S VISIT). This becomes OUR observation(s) of our symptoms and how to communicate them to our doc.

Doc: So, Shauna, how have you been feeling? How is your pain? (OH---Loaded Questions, right??) This is where I answer about the pain; telling doc that it is "Deep in my spine", "It is as if there is a hand squeezing the cord", "it is like when I had labor, my back was in such pain", and here is where I have finally found a way to explain to women whose back hurt during labor----**(THAT IS MY PAIN!! THAT ONE-TIME, QUICK PAIN DURING BIRTH. MY PAIN JUST KEEPS ON GIVING BIRTH.) SOUNDS quite 'ODD', BUT NOT TO A PAIN SPECIALIST WHO IS SEARCHING FOR THESE TYPES OF DESCRIPTIVE ANSWER TO THE QUESTION: "HOW HAS YOUR PAIN BEEN?"


"Objective"--What the doctor observes as h/she listens to you as you rattle off the Subjective part...trying, searching for words, any words, that will explain to the doc just how you feel in pain. They will observe how you appear emotionally, compare your rating on the pain scale to what they expect to see, although Chronic Pain patients have lived with pain for so long, that they can seriously be in an 8 out of 10 on the pain scale, and be just kind of starting into space. We have learned to cope with our pain in different ways, and unlike those with acute pain, we don't always have the screaming and crying when our pain is rated high that day. Crying, for me, is one thing that I show when it is high, go outside and stare at the mountains, but the chair won't let me sit there more than 3 minutes....you get the picture.


"Assessment"-- this is what the doctor/nurse sees, hears, feels, and smells, and they make notes according to THEIR observation of you, through the steps of assessment, taking your vital signs, palpating different areas, checking parts of the body; and the trained eye of a professional will allow them to find out where you are at in their eyes.


"Plan"-- which is when the doctor/nurse has to devise a plan of treatment for you, write any orders for needed blood tests, X-rays, MRI's CT Scans, etc. These are the plans of the doctor for your treatment.


"Implementation"--This is the action phase, when the doctor's plan is carried out. Tests are taken, and the reports sent back to the doctor. If physical Therapy was ordered, that is attended, and the Progress Notes are sent to the doctor. If medication was ordered, you will be taking it.


"Evaluation"--Time to see how your patient is doing. How did the blood work come out? The MRI's, etc.? Physical Therapy--did it help? You will both decide for the most part if the medication ordered is working or not, and I am still talking mainly about a pain patient visit.


These are the steps some docs follow--they are old school, some just use SOAP, and there are many other new acronyms that have come up since the years I spoke about. We had no computers at that time, nurses used SOAPIE, or SOAP, so did docs.


Just try and remember the SUBJECTIVE part of your visit. What you tell the doctor. Sometimes I'll have a friend that knows my life very well go with me to a doctor's appointment. And I go with them. As support, and also to help remember certain things that they had forgotten. Yet we can not speak for them. ***PAIN JOURNAL, remember!!!


I'll talk soon about some great words to use when you may be grabbing for anything that will describe your pain.

Gentle Hugs.... <3