Blanquerna School of Health Sciences at Ramon Llull University, C/Padilla 326, 08025, Barcelona, Spain.
Philos Ethics Humanit Med. 2021 Oct 6;16(1):8. doi: 10.1186/s13010-021-00105-x.
The evaluation of pain remains one of the most difficult challenges that healthcare practitioners face. Chronic pain appears to affect more than 35% of the population in the West, and indeed, pain is the most common reason patients seek medical care. Despite its ubiquity, studies in the last decades reveal that many patients feel their pain is dismissed by healthcare practitioners and that, as a result, they are denied proper medical care. Buchman, Ho, and Goldberg (J Bioethic Inq 14:31-42, 2017) point to this phenomenon as a form of "epistemic injustice": an unfair and harmful downgrading of credibility affecting some individuals and groups, which prevents them from receiving appropriate and beneficial medical care.
By exploring the existing literature on this downgrading of patients' credibility written by healthcare professionals and scholars in medical humanities, I identify and examine the reasons patients are often not believed about their pain and why healthcare is too-often unhelpful or hurtful to people presenting with chronic pain. I also explore to what extent it is possible to forge an alternative epistemological model.
I suggest that most of the causes of this downgrading of patient's credibility result from either the difficulty in communicating pain or the widespread belief that pathology is always the result of objective tissue damage. I examine whether pain has to be effectively communicated and have an objective cause in order for it to be deemed credible. In the end, I argue that in the case of pain, both communication and objectivity are highly problematic.
I conclude by suggesting that, although alternative epistemological models might be impossible to build, believing patients has both moral and clinical benefits, and this warrants further research.
疼痛评估仍然是医疗保健从业者面临的最具挑战性的问题之一。慢性疼痛似乎影响了西方 35%以上的人口，事实上，疼痛是患者寻求医疗护理的最常见原因。尽管疼痛很普遍，但过去几十年的研究表明，许多患者感到他们的疼痛被医疗保健从业者忽视了，因此他们被拒绝了适当的医疗护理。Buchman、Ho 和 Goldberg（J Bioethic Inq 14:31-42, 2017）将这种现象称为“认知不公正”：一种不公平和有害的信誉降级，影响了一些个人和群体，使他们无法获得适当和有益的医疗护理。
通过探索医疗人文科学领域的医疗保健专业人员和学者撰写的关于患者可信度降低的现有文献，我确定并检查了患者的疼痛经常不被相信的原因，以及为什么医疗保健对患有慢性疼痛的人常常没有帮助或有害。我还探讨了在多大程度上可以建立替代认识论模型。
我认为，这种降低患者可信度的大部分原因要么是沟通疼痛的困难，要么是普遍认为病理学总是客观组织损伤的结果。我检查了疼痛是否必须得到有效沟通并且有客观的原因才能被认为是可信的。最后，我认为在疼痛的情况下，沟通和客观性都存在很大的问题。
我得出的结论是，尽管替代认识论模型可能难以建立，但相信患者既有道德上的好处，也有临床上的好处，这值得进一步研究。
