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#5288 - 04/16/03 12:01 PM
"subjective" complaints of pain
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pele
Member
Registered: 06/11/02
Posts: 136
Loc: Honolulu
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I work for a ortho surgeon who uses "subjective" regarding pain in his impressions, i.e. "subjective complaints of pain left forearm healing fracture" or "subjective complaints of low back pain". A patient called last week incensed because to him (and me) calling his pain subjective meant that it was not real. The nurse told me about this and asked why subjective was used. I would like anyone's opinion on this. I can speak to the doc, but he is stuck in his ways and even when he agrees to change, he goes back to his old habits. Thanks in advance for your input.
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#5289 - 04/16/03 12:10 PM
Re: "subjective" complaints of pain
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Mrs Blue
Member
Registered: 06/12/02
Posts: 142
Loc: Advance, MO
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The way I understand it is that "subjective" is what the patient tells you they are experiencing. "Objective" on the other hand, is what is demonstrated on exam and physical findings in the office by the physician.
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#5290 - 04/16/03 12:11 PM
Re: "subjective" complaints of pain
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Mrs Blue
Member
Registered: 06/12/02
Posts: 142
Loc: Advance, MO
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The way I understand it is that "subjective" is what the patient tells you they are experiencing. "Objective" on the other hand, is what is demonstrated on exam and physical findings in the office by the physician.
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#5291 - 04/16/03 12:14 PM
Re: "subjective" complaints of pain
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AnnR
Member
Registered: 12/31/69
Posts: 18414
Loc: Ocean Park WA
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It seems to me that any pain complaint is subjective, because it is not possible to objectively measure or quantify pain. Subjective--what the patient says--is the first section of a SOAP note, and it is pretty much a standard term. I know what you mean, though, that it does have a little bit of a negative feel to it, but that's because of mis-usage and not actual meaning. I wonder if explaining a SOAP note format would help the patient understand the medical use of the term??? That's one reason why docs ask patients to quantify their pain on a 1-10 scale. (I was a little insulted recently when a rheumatologist showed me a little card with pictures from a smiley face "0" to a screaming face "10" and asked me to quantify my knee pain). Rambling a little but hope it helps.
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#5292 - 04/16/03 12:21 PM
Re: "subjective" complaints of pain
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pele
Member
Registered: 06/11/02
Posts: 136
Loc: Honolulu
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Yes, but in the impression, it is the MD's objective opinion, and he is stating the pt has subjective pain. In the dictionary, among many other definitions of subjective, it states, "arising from conditions within the brain or sense organs and not directly caused by external stimuli", "lacking in reality or substance": illusory.
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#5293 - 04/16/03 12:23 PM
Re: "subjective" complaints of pain
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pattyB
Member
Registered: 05/28/99
Posts: 2628
Loc: Rhode Island
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Subjective complaint of pain is perfectly appropriate. As Ann explains above, the subjective portion of an office note is what the patient states. The objective portion is that which is proven by physical exam and/or testing. I hear this term used often, and I don't think there is any need to ask the doc to change his ways. His dictation is right on the mark. If you need to, just explain to the patient the meaning of subjective in this context and that it does not mean that the patient is imagining the pain. Patty
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#5294 - 04/16/03 12:27 PM
Re: "subjective" complaints of pain
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pattyB
Member
Registered: 05/28/99
Posts: 2628
Loc: Rhode Island
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In that case, Pele, maybe the patient should take the issue up with the doc. There must be a reason that the doc sees the pain as "subjective". Maybe he cannot find a clinical cause for the pain. Maybe x-rays and/or other tests do not bear out the patient's pain. I really don't think this is an issue for you to get involved with as it seems to be a clinical issue between the doctor and patient. Who are you to tell the doc which words to choose to describe a patient's condition. Patty
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#5295 - 04/16/03 12:29 PM
Re: "subjective" complaints of pain
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mtag
Member
Registered: 07/09/01
Posts: 1072
Loc: North AL
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You are right about the literal definition of the word "subjective" and I can see how some patients would react negatively to its use in the Impression portion of a note. However, to give your doc the benefit of the doubt, I think he is just assigning ownership to the pain. It's the patient's pain, and like Ann said it is hard for him to quantify. He can't "see" it and measure it, he has to take the subject's word for it.
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#5296 - 04/16/03 12:40 PM
Re: "subjective" complaints of pain
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Deborah
Member
Registered: 12/31/69
Posts: 3596
Loc: Mobile, AL
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I have subjective tinnitus, meaning only I can hear it, not the doctor and not anyone else -- just me!! At my visit yesterday with the neuro-otologist, he dictated a note while I was in the room and stated "Impression: Subjective tinnitus." [ 04-16-2003: Message edited by: Deborah ]
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#5297 - 04/16/03 12:40 PM
Re: "subjective" complaints of pain
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pele
Member
Registered: 06/11/02
Posts: 136
Loc: Honolulu
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Thanks for all your replies. I think everyone is right and there are no right or wrong answers to this. My doc is not the greatest dictator and there are many things I have to bring to his attention. His grammar skills are nonexistent and there are many times when he is medically wrong because of his sentence structure, which makes what he wants to say sound like something else. He tells me to type what he means, not what he says, but still, there are things sometimes even I can't understand and I bring it to his attention. I have been transcribing for him for five years now and it is never dull. Thanks for all your help.
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#5298 - 04/16/03 02:16 PM
Re: "subjective" complaints of pain
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pele
Member
Registered: 06/11/02
Posts: 136
Loc: Honolulu
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Here's one I just transcribed! Decreased subjective findings of torn medial meniscus.
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#5299 - 04/16/03 07:33 PM
Re: "subjective" complaints of pain
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Anonymous
Anonymous
Unregistered
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Per Taber's Cyclopedic Medical Dictionary: quote:
subjective. Arising from or concerned with the individual; not perceptible to an observer. Opposite of objective.subjective sensation. A sensation occurring when stimuli due to internal causes excite the nervous system; one not of objective origin. subjective symptoms. Symptoms of internal origin, evident only to the patient.
But...I have not a clue what "decreased subjective findings..." might mean! 
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#5300 - 04/16/03 08:28 PM
Re: "subjective" complaints of pain
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mtag
Member
Registered: 07/09/01
Posts: 1072
Loc: North AL
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Methinks the doc just likes to say "subjective!" They all have their little catch words or phrases...maybe we're reading way too much into this! I think subjectively his brain is stuck  [ 04-16-2003: Message edited by: mtag ]
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