How Much Time Do Low-Income Patients and Primary Care Physicians Actually Spend Discussing Pain?

A Direct Observation Study

Pain is the single source of lost productivity and one of the most common reasons patients seek primary care. While one-quarter of Americans experience pain, it is more prevalent and severe for vulnerable populations such as veterans, racial and ethnic minorities, and those with multiple chronic illnesses. As prevalent as pain is, however, patients and physicians often are frustrated by their discussions about pain and unsure how to improve pain-related communications.

These researchers directly observed and video-recorded primary care patient visits at a Detroit clinic serving low-income Black patients. Patients completed a questionnaire and a 20-item health and pain survey. Observers documented the duration of pain-related discussions, whether doctor and patient had met previously, and who initiated the discussion of pain.

Some 63 percent of patients reported at least moderate pain and 69 percent of visits contained pain-related discussions, even when patients had no complaint of pain. The time devoted to discussing pain was 5.9 minutes. Across all visits, patients and physicians spent 23 percent of visit time discussing pain. Patients and physicians who had met previously spent less time (11% of time) discussing pain, possibly because they had covered the topic in detail on an earlier visit.