You Are Not Allowed To Be Negative!!!

I had just come back from attending the Canadian Pain Society annual conference in Winnipeg. I go to this conference every year to present some of my research work, see the research work of other colleagues and acquire new knowledge. Such conferences as well provide opportunity to meet with colleagues around the country and network.

The night before the end of the conference, I was having a bite to eat with a colleague, a mature female physician looking after pain patients for many years, while discussing stories that we thought were unusual or unique. I now feel compelled therefore, to share with you one of my colleague’s recent encounters with a 38-year-old woman who had been hurt in the performance of her duties as a nurse and had developed a chronic pain condition. Let’s call my colleague Dr. M and the patient RN.

RN walks to the doctor’s office visibly upset and agitated. Dr. M asks her to explain exactly what her problem was. RN speaks loud and fast, giving details about her workplace accident and making unflattering comments about her work supervisor and the care she received from her doctors. After 10 minutes of incessant talking, RN paused realizing that Dr. M who has remained totally silent, is scribbling some vertical lines on her note pad.

RN: What are you doing Dr. M?
Dr. M: I am drawing a line every time you use a negative word such as pain, anger, upset, insensitive, not understanding etc. So far in these 10 minutes I marked 38 negative words.
RN: You must be kidding! I find this very rude.
Dr. M: 39!
RN: You certainly seem to be insensitive to my pain!
Dr. M: 40, 41!
RN. This is a joke. You seem to ridicule my pain. I think you are worse than all the other ignorant doctors I saw so far.
Dr. M: 42, 43, 44, 45!
RN: Can you tell me why you use this approach with me?
Dr. M: You are overloaded with negative and angry feelings. These can only feed and increase your pain. Have you discussed with your family how they feel when you come across always so angry and negative?
RN: Leave my family alone. They proved to be indifferent, insensitive, selfish and uncaring anyway.
Dr. M: 46, 47, 48, 49!
RN: Enough! Next you will hear from me, it would be when I file a complaint against you with the College of Physicians (RN storms out of the room).
Dr. M: 50! 

I was amazed. In our line of work, we see a few disgruntled patients who are always dissatisfied with our care, obnoxious, verbally abusive towards us as physicians but also the support staff (secretaries etc), and complain about the care we give them. This type of patients takes a real toll on physicians’ emotions as we have to undergo lengthy processes to exonerate ourselves.

I admire you, I said to my colleague. How did you manage to get through this whole encounter? This is a definite recipe for disaster with a sure complaint to the College of Physicians and Surgeons (the provincial body that grants our license to practice).

Dr. M. nodded. I thought for sure, she was going to file a complaint but I could not resist pointing out her constant negativity. Nevertheless, nothing happened for a couple of months.

And then, I asked with great curiosity. Did she file a complaint?

No, Dr. M. replied. To the contrary, she asked to see me again. I was not happy at all given our previous consult and I expected another shouting encounter. But strangely, it did not happen. To the contrary, I saw a calm woman, coming into my office, sitting in a chair opposite to me and greeting me with a smile. I was stunned. I reciprocated the greeting and asked her what happened.

RN: When I left your office a few weeks ago, I was extremely angry with you for pointing out that I was negative. I went home and asked husband and kids to tell me frankly what they thought of my pain and my general mood. To my surprise, they let me know that they find me angry, negative and complaining all the time.
Dr. M: So, what did you do after you had this talk with the family?
RN: I decided to mark down all my negative thoughts every waking hour of the day for a few days. I then realized with disgust that I could not last longer than five minutes before an angry thought or feeling would pop into my head, which I had to write down. I became very aware of my negative feelings. I am now ready to ask you to help me, so that I can harness my thoughts and maybe I can somehow control my pain.

To make the long story short, Dr. M. worked with RN on her medications for pain and to set objectives and targets for therapy and her recovery. RN responded well to structured goals and also joined a Mindfullness Based Stress Reduction program, to learn to relax. Today, she has returned part time to work on modified duties and works towards her goal to return to full time nursing duties soon.

The story is very didactic and I use it to talk to other pain patients regarding negative feelings and thoughts. Learn to control and curtail negative thoughts and for sure, your pain perception will decrease substantially. Trained professionals, such as pain physicians, psychologists, social workers etc., can very much help you to navigate the sea of negative emotions and restore your emotional balance. 

Angela Mailis, MD, MSc, FRCPC(PhysMed) CIPP/UHN Consultant Adjunct Clinical Professor, Dept. of Medicine University of Toronto, Director, The Pain & Wellness Centre, Vaughan, ON Chair ACTION Ontario