Where is your pain? It’s sketchy

Illustrations of symptoms may help patients better describe what they feel, says Rachel Borrill.

ARE you embarrassed discussing your symptoms with a doctor? Are you unable to accurately describe your pain?

Hopefully, this may soon change, thanks to the use of colour and imagery.

Professor Peter Whorwell, a consultant gastroenterologist specialising in irritable bowel syndrome, and Helen Carruthers, a technical and scientific illustrator at the University Hospital, South Manchester, have devised a system using imagery and colour. They say the system may help patients communicate more effectively with their doctors.

“Some people do find it very embarrassing to talk about their bodily functions. And some of the questions doctors have to ask can also be embarrassing. I have to say, ‘What do your stools look like?’ Patients then go bright red,’’ says Professor Whorwell.

“To describe pain can be very difficult. Is it squeezing? Is it burning? Is it stabbing? So, instead, of asking them ‘what does your pain feel like’? we show them various pain images — like one with their chest on fire — and they can point to that and say, ‘Yes, my tummy feels like that’.’’

Whorwell and Carruthers will be explaining their theories tomorrow, at 10am, at The Experience of Illness — Learning from the Arts conference at University College, Cork.

Helen Carruthers has painted 14 images depicting a variety of symptoms, from heartburn and pain to bloating and a toilet (for sufferers of diarrhoea). Their research, at the University Hospital, South Manchester, has revealed that patients are more comfortable discussing their illness in conjunction with the paintings, which they point at. This allows them to express themselves more clearly.

“We do need to draw a lot more images. I think around 20 to 30 would cover it and I think we need more bowel images, because the toilet one only covers those patients with diarrhoea, as that is all they can think about. ‘Where is the next toilet’?’’ he says.

Professor Whorwell says these visual images work for patients of any age, men and women, across all cultures and any language barriers.

“Taking someone’s blood pressure is a standard procedure from here to Timbuktu. But if you are asking someone in Timbuktu to describe their pain, it would be easier to use the images,’’ he says.

“Men find it very useful, too. One of the images is of a pregnant woman, to represent bloating, and a lot will point to it and say; ‘That’s how I feel.’ Men don’t get quite so much pain, but when they do, they cope with it badly. Women in pain tend to go for the more graphic images.’’

Carruthers has also created a colour wheel that can act as a quick screening test for mood disorders like depression. The chart includes black, grey, and white, as well as various shades of red, yellow, green, blue, purple, brown and pink.

For their research they asked hundreds of men and women, some of whom were suffering from depression, which of the colours best represented their mood, which they were most drawn to and which was their favourite. Those in a ‘normal, healthy’ mood chose yellow, while those described as ‘anxious and depressed’ cited grey.

“Depression questionnaires are extremely intrusive, with questions like, ‘Do you feel suicidal? ‘Do you hate the world?’ The colour wheel can help to describe their state of mind and mood, whether it is negative or positive,’’ he says.

“We are trying to think of different ways to communicate with patients. It is actually rewarding to educate patients, to spend time with them, and communication is the key.’’

¦ Experience of Illness — Learning from the Arts, from 5pm – 8.30pm, at University College Cork on Nov 30, and from 9am to 5pm on Dec 1. Admission is free.


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