How Responsive are Anesthesiologists to Patient Pain? Residents’ Verbal and Nonverbal Responses to Standardized Patient Pain Cues

Anesthesiologists must recognize and respond both verbally and nonverbally to their patients’ pain. The current study analyzed 65 videotaped interactions between anesthesiology residents, a standardized registered nurse, and a standardized male patient in pain awaiting urgent repair of a perforated gastric ulcer. Interactions were assessed using a modified version of the Empathic Communication Coding System to code verbal and nonverbal responses to pain cues. Nearly 60% of the time, residents responded with denial or disconfirmation of the pain, either completely ignoring or disconfirming that the patient’s pain was real or needed to be addressed. Only 29% of all responses verbally acknowledged the patient’s pain. Residents responded with more empathic verbal responses to verbal pain cues compared to nonverbal pain cues, and to more intense pain cues compared to less intense pain cues. Residents were more likely to respond when the nurse advocated for the patient’s pain rather than when the patient expressed his own pain. Residents who were more responsive nonverbally and had higher total responsiveness had shorter interactions with the patient. Residents who were more verbally responsive were more likely to prescribe pain medication and prescribe it earlier in the interaction, which was the appropriate clinical action in this scenario to reduce patient suffering. These findings suggest that there may be specific skills and behaviors that physicians can learn to improve recognition, acknowledgment, and treatment of acute pain, enhance patient satisfaction, reduce suffering, and allow for more efficient interactions, especially in the acute care context.