In my last post I introduced the case study of a 67-year-old whose subjective experience of her diagnosis left her so unsatisfied that her story of the incident actually changed. (Rereading the prior post might offer a helpful refresher.) This was just the beginning though of her treatment’s failure to engage her subjective experience.

Looking at the hospital procedures, we find the first thing this patient was offered, according to common practice, was morphine for the “pain.” When she stated that she had no actual pain, she was told to take it to avoid the ensuing pain. After four days awaiting surgery (her injury not being considered an emergency), she kept wondering when to expect the pain.

She was then offered oxycodone as a weaker pain drug. When another source informed her it was highly addictive and coated with codeine she opted out, to avoid exacerbating her existing constipation. This decision was “allowed” by the nurse and filed as her having taken all prescribed medications.

Eventually she only took two doses of extra strength Tylenol and Arnica Montana (a homeopathic remedy prescribed for trauma following surgery). Her query whether it was normal to have no pain received varying responses, from “We always give morphine,” to “I don’t know, it never comes up. We automatically put it into the IV drip.”

The clear presumption of this standard practice is that all fractures are painful and require painkillers. The standard practice is that subjective patient experience does not alter automatic Objective annotations, the Assessment or the Plan.

We see with this patient that right through the process her subjective experience was at odds with a heath care treatment regime unable or unwilling to address her actual experience. What’s going on here? We’ll find out in the next post.