I recently read this article by David J. Schimp, DC, DACNB, DAAPM. Dr. Schimp is an Associate Professor and Attending Clinician at Texas Chiropractic College. He describes his own personal journey with validating patients pain – here is a portion of his article….
Validation was a term and concept that had been completely foreign to me. Through difficult lessons, I learned that validation is something every doctor needs to understand and practice. Validation, though can be a two-edged sword and must be wielded with caution.
It is a basic human response to want others to appreciate our suffering when we are in pain. We feel validated when someone acknowledges our struggle. Simply said, we know “they understand.” For a doctor, validation can be difficult, particularly when our mechanistic minds cannot explain why someone is suffering. Too often we use the term malingering as a substitute for our own clinical deficiencies, and the patient suffers twice. First, they experience suffering from the disease itself. Then they undergo emotional suffering from the lack of validation. Until a patient feels that they are taken seriously, the focus is not on getting better, but rather on proving how sick they really are. Perhaps, in part, the lack of validation drives the suffering of some patients who shop from one doctor to the next. But the solution is not always found in the simple act of validation.
A woman in her late 30’s was experiencing pain in her forefoot that developed after returning to aerobic activity following childbirth. Initially she complained of a minor pain that was marked by a slight limp and had little effect on her normal routine. Stress fracture was a likely explanation, but x-rays were negative. The woman was instructed to rest, ice and protect the injured area. After several weeks, however, she continued to complain of pain. Advanced imaging (MRI) was negative. With no clear explanation for these complaints, my recommendation was to continue to to walk on the foot and return to normal activities – to walk through the pain. Within months, she became resigned to using crutches or crawling and finally a wheelchair for the next 6 years. Why? Perhaps because I had never validated her suffering.
In this case, my ego did not allow me to accept the fact that I was not able to help. And rather than comforting by simply stating, “I don’t know how to explain what is going on, but I can see that you are really struggling,” I was cold and lacked compassion. Years passed and the woman visited several specialists until she found a doctor who validated her pain. Unfortunately, at this late stage, there was a double-edge to the sword of validation.
The art of validation is not something that can be mastered by attending a psychology workshop. That might help, but the art of validation rests in genuine compassion for the patients who have been entrusted to our care – the health of those that we have been given the privilege of protecting. The Pain Practitioner Summer 2014