As a Healthcare Professional, Are You Checking All the Vital Signs to Evaluate Total Patient Condition?

As a Healthcare Professional, Are You Checking All the Vital Signs to Evaluate Total Patient Condition?

Please Remember to Check Pain and Emotional Distress when Taking Vital Signs

For many years, four vital signs were used to determine the condition of a patient. Today, modern health care professionals are checking two more vital signs, pain and emotional distress. 

Six vital signs are now recognized by many healthcare professionals to determine a patient's total condition: 

1. Body Temperature,
2. Heart Pulse Rate,
3. Blood Pressure,
4. Respiratory Rate,
5. Pain, and
6. Emotional Distress 

The first four are routinely measured, either manually by a person or automatically by a medical monitor. The last two, pain and distress, are new vital signs and are determined by patient interview. Pain is determined by asking the patient to rate their pain using a pain scale. Similarly, emotional distress is determined by asking the patient to complete a questionnaire. 

It might be said that pain and emotional distress could be combined, since a patient in pain is also in distress. Conversely, when a person is stressed the perception of pain is greater.

Wouldn't it be helpful if pain and emotional distress could be measured quantitatively just like the other vital signs?

 

Perhaps they can. Biofeedback devices, such as galvanic skin response sensors, could measure and record the ongoing distress situation within a patient. Biofeedback has been used to for years to evaluate stress also called distress. There are many forms of equipment and devices available, some even for home use. Here are some points to ponder:

• It is well known that inflicting pain, e.g. skin pinching, produces a strong biofeedback response. Therefore, perhaps, biofeedback could be used to measure and track pain. Detecting pain in infants is one example of where biofeedback is now used to detect pain and distress.
• It is also well known that emotional situations, e.g. being frightened of medical procedures, can also produce a strong biofeedback response.
• Lastly, it is also well known that a relaxed patient is easier to treat and will heal better and faster.

Therefore, doesn't it make sense to include biofeedback sensors along with the usual thermometer, stethoscope, and sphygmomanometer?

 

Taking this concept one step further, the bedside medical monitor is already measuring all the information necessary from which to calculate the emotional distress or pain level.  

Perhaps, future medical monitors will have an emotional stress (distress) indicator.

 

Takeaways:

• All six vital signs should be measured to determine the total condition of a patient.
• Pain and emotional distress can be measured and recorded just like the other vital signs.
• Biofeedback devices could be one way to track pain and emotional distress.

For more information:

• Emotional distress: the sixth vital sign-future directions in cancer care
• Medical Monitor with an Emotional Stress Indicator - an Idea Ahead of Its Time
• Guide to Implementing Screening for Distress, the 6^th Vital Sign
• Vital Signs
• Pain as the 5Th Vital Sign Toolkit
• Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age
• The Connections Between Emotional Stress, Trauma and Physical Pain

Disclaimer - Article is for informational use only and is not medical advice.

Are You “Sick and Tired” of Being “Sick and Tired”?

Are You “Sick and Tired” of Being “Sick and Tired”?

Usually people go to the doctor expecting, or at least hoping, for relief. Many times relief occurs. 

Sometimes things do not get better, though. After repeated doctor visits, the doctor labels your condition as chronic. The doctor might even say "it is all in your head" and that "you have to learn to live with it". The doctors are doing their best….or are they?

 

Another word for Doctor is Physician. Physicians mainly deal with physical symptoms. That is what they do. 

Whether you and/or your doctor like it, the mind is connected to the body. Your mind affects your body. Your body affects your mind. That is just how it works. 

Practical examples of mind-body interaction are stress headaches, stress stomachaches, depression after amputation, etc. Has your doctor considered how your mind is affecting your symptoms?

 

Think about this for a minute. Doesn't it make sense to consider your whole mind-body system instead of just physical symptoms? 

Yes, doctors now use the term "stress", but do little to help patients find what the patient's stressors are, and much less, what to do about them. 

Some doctors really do want to help you but many are constrained in their efforts. Performance quotas have to be met, employer restrictions, and peer pressure are just some of the obstacles preventing your doctor from doing what they might want to, or should, do. In addition, most patients just do not want to consider mind-body interaction. Thus, doctors give patients what they want and maybe not, what they need. That might work for others but you want better. You are just "sick and tired" of being "sick and tired". 

Okay, by now, it might make sense to you that the body and mind are connected. Now, please consider your physical symptoms might be related to your mind. Maybe your doctor was partially right in saying that "It's all in your head." The head is where science thinks a good share of the mind exists. 

The mind is seldom logical. A good example of the mind at work is dreaming. Seldom can we make sense and logic out of dreams. The mind knows what it is doing though. Whether you know it or not, much of your body functions are controlled by the subconscious part of you, which might be viewed as your mind. Examples of subconscious or autonomic body functions are breathing, heart function, digestive action, etc. 

Physicians typically do not deal with the subconscious part of you. However, maybe your subconscious mind is making you sick or keeping you sick. Doctors are trained to deal with facts and logic, so do not expect typical doctors to consider mind-body interaction. Today, there are but a few doctors utilizing Mind-Body Medicine or Psychoneuroimmunology. Research has been slow in this area, probably due to lack of interest by the public and health care businesses. In the future, Mind-Body Medical Doctors might be the norm, however. 

Dr. Albert Schweitzer wrote of his medical profession, "We are at our best when we give the doctor who resides within each patient a chance to go to work."

 

You have tried to get better with Physicians and maybe even Specialists. Maybe it is time to check with your own "Doctor Within" to see what is going on.

 

If you are ready to do something radically different, consider answering the following questions. 

• It is important to answer honestly, as your life, or quality of life, might very well depend on your honesty. 
• Take some time before you answer each question. Do not answer how you SHOULD answer. 
• Answer honestly. Tell it like it is and not how you were taught to respond. 
• Give your "gut answers" and not your "head answers". 
• Your answers are yours and yours alone. 
• Your answers are your truth. 
• It is time to get real and honestly face up to some tough questions. 
• What do you have to lose?

You do not have to answer all the questions at once. Take your time. This works best if you are relaxed and not rushed. Even one question a day would be good. It took a long time to get a chronic condition. A few more days will not make that much difference. You can do it. 

You might even feel better just by "doing something", especially when you feel hopeless.

If you do not want to answer all the questions, just answer the one(s) that you do not want to answer. As you scan the questions, which ones make your stomach jump? These are the most important questions to answer. Please continue though, since your answers to the other questions help fill in the big picture of what is really going on. 

Are you ready? 

First, get in a comfortable position in a quiet spot where you will not be interrupted. Take a few deep breaths to relax and calm your mind. Relax your body as best as you can. Quiet your mind as best as you can. Let everything else go for now. 

Here are the questions:

1. Do you want to live? Do you really want to live anymore?
2. How long do you want to live? Are you willing to make lifestyle changes to live longer or feel better?
3. If you want to live, what do you have to live for?
4. Do you want to get better? Do you really want to get better? Are you getting anything from remaining sick, e.g. extra attention, money or benefits, exemption from duties, penance, sickness "badge of honor", etc.?
5. Why do you want to get better? If you had the health you desire, what would you do with it?
6. Do you have an inner conflict that is affecting your physical health? Do you have a lot of anger? Do you have a big resentment? Have you been hurt big-time? Are you keeping a secret? Are you fearful of your life or well-being? Generally, what is bugging you that might be affecting your health?
7. Do you need to forgive someone? Do you need to forgive yourself? Are you grieving?
8. Do you think you have sickness as a punishment for something? Do you deserve to get better? Do you think your suffering is good for you or for someone else? Are you sick because someone else is sick? Are you consciously or unconsciously choosing to wither away and die?
9. Is there anything else you know is adversely affecting your health that you have not acknowledged up to now? Now is the time to say so. Your good health and maybe even your life depend on your answers.
10. Do you trust your doctor? Are you following the doctor's recommendations? Are you honest with your doctor? Are you telling your doctor one thing and doing something else? Are you willing to share your answers to these questions with your doctor? Are you afraid to show these answers to your doctor?

Take a rest. Review your answers. Believe it or not, you are healing already. At least you know what you are dealing with now. You might even have a sense of peace, as if you have taken a big load off your shoulders.

Decide what you want to do about your answers. Maybe resolve the issues or just accept them. You might very well be surprised how your health improves, now that you are in the action mode. 

Before, you were in the reaction mode. Your symptoms were controlling you. You are in control of your symptoms now. You are going to decide what to do next. You might even seek help to do what it is that you want to do. You do not have to ask anyone else what is bothering you and making you sick because now you know. The answers were inside of you. 

Consider discussing these answers with your doctor. If you do not trust your doctor, find someone you do trust. Also, try to find a doctor you are not afraid of, or at least not as much. Everyone is afraid of their doctor, since they are an authority figure. Help is out there. All you have to do is ask around. 

If you are reading this as a doctor, please consider some of these questions in your practice of medicine. Most importantly, please listen to your patient. Ask them what they think the problem is. Ask them what they think they need to get better. You might be surprised at your patient's insight. 

Doctors or Patients of the future might have better tools or knowledge to access the "Doctor Within". For now, though, much can be done by just asking your "self" questions and answering honestly. 

TAKEAWAYS -

1. Ms. Fannie Lou Hamer's tombstone reads, "I am sick and tired of being sick and tired." Maybe you can do better.
2. Your subconscious mind might be making you sick or keeping you sick.
3. Resolving inner conflict might very well improve your health. Facing up to your inner truths can help you heal.
4. Once you know what you are really dealing with, you can decide what to do about it.
5. You can seek help, as needed or wanted.
6. The future might have better tools or techniques to help find symptom triggers, thus improving overall health and lower health care costs.

For more information:

• Psychoneuroimmunology
• Mind-Body Medicine: A Clinician's Guide to Psychoneuroimmunology by Alan Watkins, Elsevier Health Sciences, 1997  
• Tension myositis syndromeTension myositis syndrome
• Primary and secondary gain
• Will to Live
• Accompanying Video - also show how to use Biofeedback to better answer questions above.

Disclaimer - Article is for information only and is not medical advice. Seek professional help, if needed.