Under My Skin

On a Scale of 1-10


When my wife was hospitalized for back surgery, I learned more about the new information revolution in health care that provides formerly unattainable precision. This investigative report includes suggestions for how we, in the outpatient world, can implement these advances.

At a 3-hour preop marathon, my wife was interviewed by several people, including two nurses. The neurosurgery nurse practitioner asked my wife how much pain she was experiencing.

"It depends on my position," my wife answered. "If I’m sitting, it’s not that painful."

"But when it does hurt?"

"Well, it isn’t that bad."

"On a scale of 1-10?"


Later on the anesthesia nurse asked her many questions. One was, "How much pain are you in, on a scale of 1-10?"

"It depends," began my wife, a slow learner.

"On a scale of 1-10?"


Things went smoothly after that until the final question, "Do you feel safe at home?"

I had kept my mouth shut until then, but at that point, I got clarification that she was, indeed, asking whether my wife feared being abused after discharge. Not an unfair question, though I did wonder whether someone who really wanted to know would ask the question while a potential abuser looked on.

On the morning of surgery a clerk asked my wife again how much pain she was in, on a scale of one 1-10. In the recovery room they asked her again, several times.

Once my wife reached the ward, each nurse asked, once per shift, how much pain she had, on a scale of 1-10. At first, she tried to explain through her opiate stupor, what she was feeling.

"On a scale of 1-10," came the polite but insistent request. I doubt whether my wife remembered 5 minutes later what number she had given, which had in any case been duly noted and entered into the computer.

Ditto the aides. Ditto the physical therapist. Ditto the occupational therapist. At each visit.

Back home the visiting nurse’s aid called to visit and set up services. Before the nurse came, I said to my wife, "Let’s practice."

"Practice what?"

"Saying ‘four’ "

"Why four?"

"Because she’s going to ask you how much pain you’re having, on a scale of 1-10."

"But it isn’t four."

"Okay, say three."

The nurse came. Her first question was, "How much pain are you having, on a scale of 1-10?"

My wife tried again to give a nuanced answer. But eventually she did say, "Four."

The nurse asked my wife whether she was depressed. "Starting last month, they’re making us ask that."

My wife laughed. "I feel wonderful!" she said. "I don’t look depressed, do I?"

"I need a ‘yes’ or ‘no,’ " said the nurse.

"No," said my wife.

"Thank you," said the nurse, wearily. "I have a 30-page form to fill out for every case."

All of the "yes" and "no" replies, and all the numbers from 1-10, will be recorded and filed in the great information repository in the sky.

We can easily apply this method to our own practices.


"Mr. Smith, how is your eczema?"

"Doing better, Doc, thanks."

"Great. How much does it itch, on a scale of 1-10?"

"Well, it’s worse at night."

"On a scale of 1-10, please."

"At night, or when I’m working?"

"On a scale of 1-10."


"Excellent. How regular have you been with the application?"

"Pretty regular."

"On a scale of 1-10."


"How happy are you with the service you received in this office?"

"Well, pretty happy, I guess."

"On a scale of 1-5, with five being ‘Very happy.’ "

"I suppose three."

"How likely are you to use our services again, or to refer a friend, on a scale of 1-6, with six being, ‘You bet!’ and one being, ‘No way, Jose!’?"

"Look, I think that’s enough."

"Just a few more questions, Mr. Smith. Mr. Smith, why are you staring at me like that? Mr. Smith, please get your hands off my neck. What? How much ... do I want ... you to stop ... throttling me? A lot! What? On a scale of 1-10? 10! 10!"

Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail him at our editorial offices at [email protected].

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