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Communication in Healthcare: The Value of Patient Use of PQRST in Describing Pain

"The single biggest problem with communication is the illusion that it has taken place" - George B. Shaw
By: Victor E. Battles, M.D.

PQRST, a mnemonic used by doctors and nurses for evaluating pain, can also be used by patients to improve communication in healthcare. The potential benefits of the improved communication include making doctor visits and other physician encounters more productive, improving the quality of healthcare and lowering the cost of health care.  

P in the mnemonic stands for provocation and palliation which stated more simply means, what brings the pain on and what eases it. Q represents quality and calls for a description of the pain with an adjective or adjectives such as cramping, dull, sharp, electrical-like, or burning. R refers to the region of the body where the pain begins and where it radiates if it moves from that position to another. S stands for severity and should generally be rated on a scale of 1+ – 10+, with 1+ meaning the pain is barely noticeable or just above 0 and 10+ meaning that it is virtually unbearable. T represents the relationship of the pain to time. That temporal description should include when the pain first started, how long it lasts, how often it occurs, how long it takes to be relieved by whatever relieves it, when the severity changed (if applicable) and whether other associated symptoms precede, follow, or occur together with the pain. 

Since studies have shown that in most cases information provided by patients is more important than diagnostic tests or physical findings for accurate diagnosis, a complete and accurate description of pain is very important. During many doctor-patient encounters however, patients are not prepared to give that all-important information in an accurate, succinct and organized manner, thus resulting in suboptimal productivity. That in turn often times results in increased reliance on diagnostic testing and a delay in diagnosis.  In addition to the increased costs resulting from overreliance on diagnostic testing, there is a cost factor associated with the need for additional office visits because of suboptimal productivity during prior visits. 

In order for patients to make the best use of PQRST communication in healthcare, it is necessary to track and document the various PQRST elements of pain and to have the documentation available at the time of doctor visits or other physician encounters. Recording PQRST information about pain immediately as the information becomes available and well prior to seeing the doctor increases the likelihood that it will be accurate, organized and useful for a doctor to make a diagnosis and provide appropriate treatment.  

The improved communication in healthcare resulting from patients’ use of the PQRST system in describing pain can be of benefit to patients with respect to it promoting more timely diagnoses, better healthcare, and reduced healthcare costs. 

Source: Proactive Health Outlet
Victor E Battles, M.D. is a board-certified internist with more than 30 years of patient contact. He has served on hospital quality assurance committees and in October 1986 was certified by the American board of quality assurance and utilization review.  

Virtual Doctor Pain Description Blueprint is a pain assessment and documentation resource based on the PQRS concept, which is designed to improve communication in healthcare. To learn more about it and to obtain a free download click here.

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