Vas Shmas

I recently had to asses a new musculoskeletal outpatient with shoulder pain. She had limited English and limited hearing. A simple but easy to miss measure that became ingrained on a previous gero prac is to ask whether the patient can hear more easily from one ear or another. This patient could so I repositioned the chairs so I could 'talk to her good ear', which helped immensely. During the assessment it became apparent that scoring pain  out of ten was completely unsuited to this patient. Normally if patients struggle to score their pain I ask them to choose mild, moderate or severe... and if say all three painful areas are moderate I ask them which is the worst & which is the best etc. I tried this and saw the empty look she responded with. It was obvious those terms were unfamiliar vocabulary for her. So I repeated the sentence but used 'a little bit', 'middle', and 'big' in conjunction with my hands showing increasing amounts and my face going from 'I can cope' to 'this feels like I'm giving birth'. She easily graded her pain this way. Throughout the session I consistently used these terms to avoid confusion and eventually she gave me the information without even requiring prompts. 

This has confirmed to me that watching your patients body language is essential for good communication. Had I been 'talking to my assessment sheet' I might have wasted time trying to obtain VAS scores or persistently repeating mild, moderate severe, under the assumption that her hesitancy was related to the hearing impairment. It reminded me that simple adjustments make matters a whole lot simpler.