An Important Insight into How Patients Think about Pain

Have you ever performed a difficult procedure—one where the patient was in obvious discomfort for most of the time—only to have them report afterwards that “it wasn’t so bad”? Conversely, have you ever had a patient who is anxious because of the discomfort they remember from their last procedure, even though you know most of it went quite smoothly? The reason for that may not be just about differing levels of pain tolerance.

Noted doctor and writer Atul Gawande, in his recent book Being Mortal, writes about an interesting study, conducted by the Nobel Prize-winning researcher Daniel Kahneman, which looked into how patients experience pain or discomfort in real time versus how they remember it afterwards. The results provide an insight that every health care provider should know about. He writes:

We believe that having a longer duration of pain is worse than a shorter duration and that having a larger average level of pain is worse than having a lower average level. But this isn’t what the patients reported at all. Instead, the ratings were best predicted by what Kahneman termed the “Peak-End Rule”: an average of the pain experienced at just two moments—the single worst moment of the procedure and the very end.

He goes on to say that “Just a few minutes without pain at the end of their medical procedure dramatically reduced patients’ overall pain ratings even after they experienced more than half an hour of a high level of pain.”

I’m not a clinician, of course, but I think these findings point to a pretty obvious strategy for minimizing patient distress. You probably can’t do much about that “peak” moment during the procedure where the patient feels the most uncomfortable, but you can always do something about how the appointment ends.

If you know the patient was having a challenging time throughout the procedure, take a few minutes at the end to ease them out of the chair on a good note. Do something that is dramatically less intense than what came before, something easy and gentle. Take a few moments to simply chat with them—a few moments where they can loosen their grip on the armrests and just relax for a bit. Offer a hot towel. Give them a tour of their newly-restored mouth with an intra-oral camera. Bring team members in for a celebration of the patient’s results.

If the findings of this study are any indication, those last few minutes will go a long way toward how that patient will remember the entire experience—which means it will greatly influence how they think about you and how they talk about you to others.