See Pain More Clearly Team
Pain, Behaviour and The Pandemic
We are all learning creative ways to provide care virtually to prevent transmission to vulnerable people, especially those in long-term care facilities. However, we have to remember that careful in-person assessment and care cannot completely be replaced by computer screens. One of the patients in our hospital had been seen in the emergency department with uncontrolled hypertension and was told to follow up with her family physician to prevent strokes. This never happened partly through her fear of infection and she ended up with a massive stroke causing complete inability to mobilize independently, spending many weeks crying in the hospital before eventually moving to long-term care. Her pain was more emotional than physical but yet very real. Other patients with severe cognitive impairment have had very well-meaning virtual assessments that have missed physical symptoms such as urinary retention (inability to urinate causing bladder expansion and severe pain), severe constipation and even sometimes small fractures. Careful consideration and assessment of the many physical and emotional contributors to distress is particularly important in patients who can no longer explain their symptoms, especially now that pandemic related visiting restrictions have decreased the ability of families to help with this.
Lilian Thorpe M.D., Ph.D., FRCP
Geriatric psychiatrist, Saskatchewan Health Authority
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