Patients, family physicians, and pain: Visions from interview narratives

Background: Family physicians reportedly underestimate their patients' pain severity. Explanations for this remain unexamined. This study explores the understanding family physicians and their patients have of the common experience of pain. Methods: We studied six culturally homogeneous private practice family physician-patient pairs from Connecticut using a qualitative, cross-sectional long interview design. Interview were taped in the office or home and analyzed by the research team using an editing style derived from the constant comparative method. Results: The patients described pain as spiritually awakening, experienced in the body, and part of everyday life with conceptual, behavioral, functional, and spiritual dimensions. The patients all claimed that physicians don't listen. The family physicians expressed a personal understanding of pain similar to the patient and a professional one which was more biomedical, concerned about addiction, and related to control of and connection with patients. Patients and physicians described the role of the doctor as a four-stage process of listening, knowing, responding, and taking time, but they meant different things. Conclusions: This study reveals family physicians and their patients struggling to communicate about pain. The role of family physician socialization, strategies for listening and sharing power in the clinical encounter, and a new four-dimensional classification of pain are briefly discussed.