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.
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
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
Source: Proactive Health
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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