Pain is supposed to be the fifth vital sign. How we evaluate it now is just a load of hooey. There are many pain scales out there, but the main ones we use are the numerical one (rate your pain on a scale from 0 to 10, with 0 being no pain, etc.), and the Baker-Wong pain scale (the one with the faces), mostly used in our pediatric patients.

No matter how you slice it, it’s just a totally inept and inaccurate way to evaluate pain in patients.

If I walk in the room and you are texting your friend in the waiting room and tell me that you are in 10/10 pain, chances are, I’m going to think that you are full of it.

If I walk in the room and you are playing Angry Birds on your tablet and you tell me that you are in 10/10 pain, chances are, I’m going to think that you are full of it.

If I walk in the room, and you are chatting away on your cell phone and you tell me that you are in 10/10 pain, chances are, I’m going think that you are full of it.

‘Being an emergency physician is … about sniffing out what’s going on underneath, what’s real and what’s not real, the sick and not sick, and no numeric score will ever do that.’

Hmmm … I could go on.

This is the most frustrating thing to me. Not only are you being rude in the sense that you are texting/

playing Angry Birds/chatting on the phone while I’m trying to assess you, but I pretty much already think you are a big fat liar.

You are taking time away from my patient two doors down who is septic and circling the drain, or that croupy kid who came in with a sat of 88%.

Not to sound unfeeling or unsympathetic, but I do know a little something about pain.

When my mother was in her early 40s, she was diagnosed with rheumatoid arthritis. THAT is a pretty horrible disease. Those are some suffering people with no end in sight. And that was before the days of Enbrel and Humira.

I remember her coming home from teaching 5-year-olds for 6 hours a day and collapsing in the bed for the rest of the evening. Nothing really helped except the dreaded prednisone.

On a particularly horrible day, my mother told my dad that she wished she had cancer instead of rheumatoid arthritis, because, “At least I’ll die from that and it will all end.” Yeah, it’s that bad.