One thing I do a lot at work is pulling out feeding tubes. In my experience, this is a very painful procedure. It almost always really, really hurts. If it's a balloon tube, it won't hurt, but if it's not, I'm pretty sure it's really painful. Most patients look at me like they want to punch me in the face when it's over. One patient said to me, "I can't believe someone so small could cause me so much pain."
So I do now warn patients before I do it that it will hurt.
There was an NP who used to pull out all the tubes before I worked here (she left), and a therapist was telling me today while I was pulling one out, "She used to be really good. She didn't even tell them what she was doing then she'd just yank it out."
So I said, "Is it really better not to warn them?"
I mean, I don't want to freak a patient out and scare them, but I also don't want to lie and say that it won't hurt when I know it does. A few patients have told me it's one of the most painful things they'd ever experienced.
I don't know. Is it better to lie about it or to be honest and scare them?
If you want them to ever trust you again, warn them..."this will hurt, but I will make it as quick as possible". If you lie to me, not only will I not trust you, I may not trust your colleagues either!
ReplyDeleteAs a long term patient: Please, please tell us if it is going to hurt! I have had so many bad experiences at hospitals where staff either don't tell me things are going to hurt, or they tell me it's not going to hurt - and then it does anyway. All you are doing is creating a patient who don't trust the carers anymore, and who is afraid of every procedure because you don't know what's coming. I can take a lot of pain when I'm prepared for it, being lied to about it makes me a very difficult patient.
ReplyDeleteI'd definitely tell them. I remember when I was 5 I had to get my tonsils out, and some nurse had to give me a shot so that I would get drowsy. I even asked her, "Are you going to give me a shot," and she LIED, and then 1 minute later jabbed this huge needle into my thigh. I was so angry, and thereafter cried any time I saw a nurse. I cried really hard after that shot because I was so angry at her for lying to me.
ReplyDeleteI'm sure she justified it in her head that I would probably cry and struggle if she told me the truth, but I was the kind of kid who always made an effort to be good for medical professionals, and she basically ruined that for the next couple of years.
I think if you don't say that it will hurt, when it does they will assume you did it incorrectly
ReplyDeletewow! never thought of that! Thanks!
DeleteDuring my neuro block we had a pain management anesthesiologist give us some talks. He said a lot of doctors make the mistake of not telling their patients something is going to hurt. Not telling the patients gives them expectation that everything is going to be fine, and when it hurts they feel betrayed. Telling a patient it is going to hurt makes them expect the worst. I guess we're really good at imagining the worst, and we are especially good at imagining how something will hurt a lot. Almost always, however, it doesn't hurt as bad as we imagined, and the patient ends up thinking the doctor did a great job.
ReplyDeleteIt's like going to a lunchtime meeting that usually has free lunch but unexpectedly doesn't have it. It's not a big deal, except that you were expecting free lunch. If you knew ahead of time, you could have brought your own and been a happy camper. It's all about our expectations
As a nurse, patient, and mother of a daughter who had 13 surgeries before the age of 25, I am well-qualified to say: Yes! Tell the patient! I have never seen a feeding tube pulled (and am curious as to what causes the severe pain), but I have seen many a chest tube pulled. I remember one cardiac surgeon who would tell the patient, "Yes, it will hurt like hell, but it will be over in a minute. Feel free to yell." At the end of the procedure, most patients would say, "Well, he was right. It hurt like hell." But, it was over and done with, much like the G-tube removal. I cannot understand sneaking up on a patient and doing something painful without fair warning. It will not make it hurt any less. Do these people think the patient won't notice?
ReplyDeleteThen again, there are the confused male patients who pull out their foleys with the 30-cc bag inflated and never say a word about pain. Never understood that one.
I once had a procedure I was told would not hurt. And it did. A lot. And I felt like a baby for crying, and then wondered if the doctors did it incorrectly, since it wasn't SUPPOSED to hurt. Then talked to others who had it done and it WAS a painful procedure. I was so angry about the whole thing I switched docs in the practice. I would've loved to have been told the truth---and I love the line above about the cardiac surgeon "feel free to yell"---it validates the whole thing, and if you end up not needing to yell, you can pat yourself on the back for being so brave & praise the doc for being so good that it didn't hurt! win win.
ReplyDeleteI'm much more scared of a clinician that would perform a procedure without warning me than one that's honest about what she's doing and how it will impact me. That would be the last time I'd see the clinician.
ReplyDeleteTell them. Better to be prepared than think they're doing it wrong, if they didn't know it was supposed to hurt. My doctor told me my steroid shots (in my wrists) were going to hurt like hell and that I was going to want to punch him afterwards, but I'm glad he told me because I needed to prepare myself.
ReplyDeleteYou are doing the right thing by warning your patients. I'm always surprised that the "don't warn them" theory is still believed, especially in pediatrics. I have this fight with nurses fairly often on behalf of my 6 year old with Asperger's (we are allowed to see our doctor's M.A. now for shots instead of the designated clinic shot nurse, because I told the doctor I would consider it assault and defend my child accordingly if she pounced on my son with no warning again after I clearly told her not to). He will scream, cry, thrash, and fear medical personal for months after being pounced on, but was perfectly fine and didn't shed a tear having his blood drawn at age 4 after a clear explanation and a chance to get a coping mechanism in place (he counted to 40). He even thanked the phlebotomist. I think adults have the same emotions involved, just without the crying and thrashing (usually).
ReplyDeleteIf it hurts so much to remove regular feeding tubes, why don't they use the balloon tubes more often?
ReplyDeleteLove all the comments here! I definitely feel much safer knowing when things WON'T be painful, and I'd be really scared that something was wrong if it was more painful than I was led to expect, so I say you should definitely keep telling your patients that it'll hurt.
I think the balloon is used less because it's more likely to fall out.
DeleteReally helpful to hear this, everyone. I totally agree! But this other person made me doubt myself, praising the person who didn't warn patients.
ReplyDeleteI agree! Always tell them it will hurt. It's the same thing we do with kids. I tell my daughter her shots will hurt, but only for a minute. The result is she actually trusts me, and doesn't even cry getting shots or blood drawn (she's 5)
ReplyDeleteTell them. I went in for an IUD last year (I've never given birth) and the doctor had told me that I didn't need to worry too much about pain, and that she could give me a prescription for painkillers but I wouldn't really need one. I assumed that with my solid pain tolerance I would be fine, and felt so betrayed afterwards. It was one of the most bizarre forms of pain I have ever experienced, and nearly passed out on the table. She told me that my reaction was "Uncommon and must be from my own tension." I don't know that there is enough meditation in the world for me to relax through that.
ReplyDeleteI would rather think it is going to hurt like fire and I will wish I were dead than think it is fine and feel unexpected pain. If I can anticipate the pain, I can relax through it. The shock makes me tense.
Tell them!
ReplyDeleteTell them. That's barbaric to just go in and yank it out with no warning.
ReplyDeleteOnce upon a time I went to an oral surgeon who was very very careful about not only what he did but about warning me what he was going to do ahead of time. When i commented on it, he said, "I once sat in an oral surgeon's chair and he did everything I hear patients complain about: He didn't warn me when something would hurt, he didnt' care if I swallowed the anaesthetic gel, he was rude, and impatient, and I thought to myself, I never ever want my patients to be as pissed off as I am right now!"
ReplyDeleteRecently I was talking with a nurse at the practice I go to and for some reason mentioned that insulin shots hurt less than the damned pokes from testing lancets. She was surprised and said that shots always hurt, even when she gave them to herself. I described a few tips on how to make sure that BOTH don't hurt as much, and she was amazed. If you don't have procedures done on yourself, you can't always know what kind of discomfort there is (or isn't).
Better to say "this will hurt" and not have it hurt than the other way around.
That's true. A couple of time I've had a tube slip out easily and the patient said it didn't hurt at all... and they didn't seem angry that I was wrong, but rather pleased that it didn't hurt.
DeleteI guess the question is, if you tell someone that something will hurt, will that make it hurt more?
Echoing the above, tell them the truth. Doctors appreciate honest/open patients because they are trustworthy. Same goes for an honest doc in the eyes of a patient.
ReplyDeleteI had a phlebotomist draw blood 4 times over the course of a two hour period and I really appreciated each time she stuck me with the needle she always warned me ahead of time. "Now you will feel a little pinch". I liked knowing when it will happen since I don't look. I let out a slow breath and focus on one of the pictures on the walls so I can more easily ignore what is happening to me. When she lost the vein and was trying to find it again she told me and let me know it might hurt while she moved the needle. I didn't feel a thing and felt really good about it. I wasn't sure what the response was going to be to this question but after reading just a few, I now know myself and agree completely. It is way better to warn them.
ReplyDeleteMaybe I missed a memo, but don't patients still have to consent to everything we do to them? Of course they aren't signing paper consent forms for every assessment or minor procedure, but they do have to be informed about what's going on before we go manhandling them.
ReplyDeleteIf you tell someone "this won't hurt" when you know it will, then of course you're lying, but that's not the worst part. You are misinforming the patient about the effects of the procedure you're about to do. Without correct information, they are not able to give you informed consent. That's a bad thing.
Doing any procedure without the patient's informed consent would not only be unethical, but probably illegal to boot. Technically it may constitute battery.
Even though legal issues about small stuff may never arise-- perhaps nobody has ever been arrested for saying "This shot of Bicillin won't hurt"-- the principle is the same as for the big stuff. Always tell patients the truth.
Daniel Ariely in his book Predictably Irrational discusses a similar topic. He was badly burned when he was younger and spent months on a burn unit, and the nurses and medical staff would often wonder whether to pull the bandages off suddenly or whether to pull them off slowly. I'm not sure what the results were, but it's a fascinating discussion about whether or not to involve the patient in the discussion about painful procedures. You might find the book interesting?
ReplyDeleteHere's the amazon link in case: http://www.amazon.com/Predictably-Irrational-Hidden-Forces-Decisions/dp/006135323X
Relevant! Maybe give them something to do while you do it?
ReplyDeletehttp://commonhealth.wbur.org/2012/09/doctor-says-it-wont-hurt
In a past life, I was a search and rescue volunteer, and we were often the first ones on scene if someone was injured out in the woods. Ordinarily we wouldn't attempt something like reducing a dislocated shoulder on the scene, but a couple of times we had to when distal circulation was compromised. The first time I did one of those, I warned the patient that it would hurt. He tensed up and made it a lot harder than it needed to be. I got some advice after that: Don't tell them that it's going to hurt, say something more like "this will feel a lot better when we're done." It's true, and it keeps people from working against you in that situation.
ReplyDeleteThese sounds like a cliche but a virtue to follow for all the time. To lie may be good if its means to the end is for the betterment of everyone.
ReplyDelete