1 00:00:01,200 --> 00:00:04,640 Speaker 1: Welcome to Stuff you Should Know from how Stuff Works 2 00:00:04,680 --> 00:00:15,000 Speaker 1: dot com. Hey, and welcome to the podcast. I'm Josh Clark. Hi, 3 00:00:15,520 --> 00:00:20,639 Speaker 1: there's Charles to be, Chuck Bryant Hi, and Jerry's over there. Silence. 4 00:00:22,120 --> 00:00:25,279 Speaker 1: Well you put us three together, you get stuff you 5 00:00:25,280 --> 00:00:28,840 Speaker 1: should know. Sorry in advance, those three you just had 6 00:00:28,880 --> 00:00:33,000 Speaker 1: a disassociative experience. I did because I want to be 7 00:00:33,040 --> 00:00:35,920 Speaker 1: anywhere but where I am right now, which is in 8 00:00:35,960 --> 00:00:39,600 Speaker 1: a lot of pain. Are you in pain? Yes? I 9 00:00:39,960 --> 00:00:42,640 Speaker 1: just hit my hand with a hammer really hard to 10 00:00:42,680 --> 00:00:46,080 Speaker 1: get ready for this episode, right in the middle of 11 00:00:46,120 --> 00:00:49,400 Speaker 1: the middle knuckle. You know that one of the very 12 00:00:49,440 --> 00:00:52,159 Speaker 1: first dumb jokes I made, like, like, really, I think 13 00:00:52,200 --> 00:00:56,920 Speaker 1: I need to go to the hospital. What uh? In 14 00:00:57,040 --> 00:01:01,840 Speaker 1: my very first podcast appearance with you, I said that 15 00:01:01,880 --> 00:01:05,040 Speaker 1: I was a method podcaster and that I just got 16 00:01:05,040 --> 00:01:08,720 Speaker 1: through brushing my teeth and drinking orange juice. Yeah, yep, 17 00:01:08,880 --> 00:01:13,040 Speaker 1: you have revived that dumb joke from thirty seven years 18 00:01:13,040 --> 00:01:17,440 Speaker 1: ago with the hammer, and here we are, and here 19 00:01:17,480 --> 00:01:20,600 Speaker 1: we are Chuck talking about pain. Yeah, you know, I 20 00:01:20,640 --> 00:01:24,920 Speaker 1: thought this one, um, for all it's kind of sameness 21 00:01:25,240 --> 00:01:28,720 Speaker 1: and basicness, was way more interesting than I thought. Once 22 00:01:28,720 --> 00:01:31,200 Speaker 1: you did get in a little bit more. Ye pain, 23 00:01:31,600 --> 00:01:34,000 Speaker 1: how about that? Yeah? I thought this one was pretty 24 00:01:34,000 --> 00:01:37,080 Speaker 1: cool too. We need to do like a pain episode 25 00:01:37,280 --> 00:01:43,039 Speaker 1: just on pain, just in general house of pain. Yeah. 26 00:01:43,240 --> 00:01:46,120 Speaker 1: Uh the TV show and the group. I didn't know 27 00:01:46,160 --> 00:01:49,160 Speaker 1: that's a TV show. Yeah, it's a Tyler Perry show. Okay, 28 00:01:49,320 --> 00:01:54,000 Speaker 1: that explains it. It's about the pains in their house. Yeah, 29 00:01:54,040 --> 00:01:56,880 Speaker 1: I get it. I think it's kind of like Mama's 30 00:01:56,920 --> 00:02:01,480 Speaker 1: Family a little bit didn't either, same production quality, that 31 00:02:01,560 --> 00:02:04,320 Speaker 1: kind of stuff. Looks like it's a recorded on a stage. 32 00:02:05,080 --> 00:02:09,119 Speaker 1: Probably is you know what I'm talking about, Mama's Family. Yeah, 33 00:02:09,120 --> 00:02:12,480 Speaker 1: I didn't watch that. Well, had you, you would have 34 00:02:12,520 --> 00:02:14,920 Speaker 1: known pain, which is weird because I love the Carol 35 00:02:14,919 --> 00:02:18,160 Speaker 1: Burnett show. Yeah, this is a pretty far cry from 36 00:02:18,200 --> 00:02:25,280 Speaker 1: that Mama's House, Mama's Family, Mama's Family with Bubba the grandson. Man, 37 00:02:25,400 --> 00:02:32,360 Speaker 1: it was bad, it was bad. But anyway, um yeah, 38 00:02:32,400 --> 00:02:35,800 Speaker 1: there's no segue. Let's just get back to pain. Yes, 39 00:02:35,919 --> 00:02:39,120 Speaker 1: and not just pain because like you said, we're gonna 40 00:02:39,160 --> 00:02:41,919 Speaker 1: do one on that one day, but pain scale specifically, 41 00:02:42,040 --> 00:02:45,119 Speaker 1: which is are I should say, because there are many, 42 00:02:45,160 --> 00:02:49,280 Speaker 1: many of them? Um. As this article astutely points out, 43 00:02:49,320 --> 00:02:53,080 Speaker 1: there really is no physical instrument, although they have tried 44 00:02:53,080 --> 00:02:56,880 Speaker 1: over the ears that can accurately measure pain, and so 45 00:02:57,000 --> 00:03:01,519 Speaker 1: doctors rely on a couple of methods, which is, hey, dummy, 46 00:03:01,600 --> 00:03:05,680 Speaker 1: how much do you hurt? Hey, hey, you stop crying? 47 00:03:05,840 --> 00:03:09,720 Speaker 1: How much pain? Or I'm gonna look at you and 48 00:03:10,360 --> 00:03:12,120 Speaker 1: talk to you a bit, and I'm gonna make my 49 00:03:12,120 --> 00:03:15,480 Speaker 1: own assessment because I'm the doctor, right and I'm gonna 50 00:03:15,520 --> 00:03:19,799 Speaker 1: write like could could brush his hair a little more? 51 00:03:21,560 --> 00:03:24,200 Speaker 1: I'm gonna make my own observations about you. Man. I 52 00:03:24,240 --> 00:03:26,520 Speaker 1: haven't used a hair brush since I was probably thirteen. 53 00:03:27,400 --> 00:03:28,960 Speaker 1: I have two once in a while because my hair 54 00:03:29,040 --> 00:03:32,400 Speaker 1: is kind of longish now and when the wind blows 55 00:03:32,440 --> 00:03:36,920 Speaker 1: it really turns it into a bird's nest. So yep, 56 00:03:37,280 --> 00:03:39,640 Speaker 1: I stand in front of the mirror like Marsha Brady 57 00:03:39,720 --> 00:03:46,760 Speaker 1: right before bed and strokes. Yeah, so let's talk about 58 00:03:48,040 --> 00:03:50,840 Speaker 1: you know, basically we're talking about self reporting or observation. 59 00:03:50,920 --> 00:03:54,200 Speaker 1: Those are the kind of the two methods because it's important, 60 00:03:54,240 --> 00:03:56,520 Speaker 1: you know, you gotta there's a lot that goes into 61 00:03:56,560 --> 00:03:59,640 Speaker 1: determining how much pain someone's in from the kind of 62 00:03:59,680 --> 00:04:02,800 Speaker 1: meds as they get to relieve that pain, to diagnosis 63 00:04:02,880 --> 00:04:04,760 Speaker 1: of what the heck is going on. Well, yeah, the 64 00:04:05,240 --> 00:04:07,800 Speaker 1: medical community just in the last probably decade or so, 65 00:04:07,840 --> 00:04:10,120 Speaker 1: it's really waking up to the fact that it's doing 66 00:04:10,160 --> 00:04:13,080 Speaker 1: a lousy job, or traditionally has done a lousy job 67 00:04:13,360 --> 00:04:16,640 Speaker 1: of managing pain. Um. There's a lot of assumption that 68 00:04:16,720 --> 00:04:20,840 Speaker 1: people are big babies who don't really need medication. They 69 00:04:20,880 --> 00:04:23,960 Speaker 1: just need to suck it up. Um. There's a lot 70 00:04:24,000 --> 00:04:27,280 Speaker 1: of problems with med seeking where people pretend that they 71 00:04:27,279 --> 00:04:31,240 Speaker 1: have pain that they don't actually have, uh and they 72 00:04:31,320 --> 00:04:35,200 Speaker 1: because they want the drugs. Um. But then there's also 73 00:04:35,320 --> 00:04:40,240 Speaker 1: just this idea that managed pain care isn't quite as 74 00:04:40,279 --> 00:04:43,719 Speaker 1: good as it should be. Uh So, part and parcel 75 00:04:43,760 --> 00:04:46,080 Speaker 1: of that is realizing like, well, then we need to 76 00:04:46,080 --> 00:04:49,279 Speaker 1: be able to quantify levels of pain a lot better. 77 00:04:49,560 --> 00:04:51,919 Speaker 1: And this is the idea that they're waking up to. 78 00:04:52,000 --> 00:04:55,839 Speaker 1: It is fairly new, but the idea that we can't 79 00:04:55,920 --> 00:04:59,760 Speaker 1: quantify pain is a pretty old one. People figured it 80 00:04:59,800 --> 00:05:04,400 Speaker 1: out pretty early on that pain is subjective. It's subjective horrible, 81 00:05:04,720 --> 00:05:07,919 Speaker 1: terrible experience. And I actually ran across one definition of 82 00:05:07,960 --> 00:05:11,919 Speaker 1: pain from a researcher that said pain is whatever the 83 00:05:11,960 --> 00:05:15,279 Speaker 1: person experiencing it says it is. Yeah, it's as simple 84 00:05:15,320 --> 00:05:18,400 Speaker 1: as that. That doesn't really help a doctor who's trying 85 00:05:18,440 --> 00:05:21,800 Speaker 1: to figure out how much medication to give you, or um, 86 00:05:21,920 --> 00:05:24,560 Speaker 1: whether to just go ahead and like put a pillow 87 00:05:24,560 --> 00:05:26,719 Speaker 1: over your face or something make you go to sleep, 88 00:05:27,120 --> 00:05:30,200 Speaker 1: because that's what doctors do. Well, yeah, it's the last resort, 89 00:05:30,240 --> 00:05:34,360 Speaker 1: but they it's in their toolbox. Uh yeah, and they 90 00:05:34,560 --> 00:05:38,200 Speaker 1: It's become so important that there's a group called the 91 00:05:38,240 --> 00:05:41,960 Speaker 1: American Pain Society, which is a great band name. Um, 92 00:05:42,200 --> 00:05:45,680 Speaker 1: oh it really is. Yeah right, probably some sort of metal, 93 00:05:45,800 --> 00:05:49,240 Speaker 1: right or I could see like kind of like a 94 00:05:50,200 --> 00:05:53,040 Speaker 1: sex pop kind of I don't even know what that is. 95 00:05:53,360 --> 00:05:57,920 Speaker 1: I don't either. Edith invented a genre. Yeah, um, they're 96 00:05:57,920 --> 00:06:02,520 Speaker 1: they're calling it the fifth vital Sign, which means that's important, 97 00:06:03,200 --> 00:06:08,080 Speaker 1: kind of like thrill kill cult or um. Who is 98 00:06:08,120 --> 00:06:10,760 Speaker 1: the other Lords of Acid? I don't know who they are. 99 00:06:11,480 --> 00:06:16,919 Speaker 1: What dude, that's your what you got requested at our 100 00:06:16,960 --> 00:06:20,599 Speaker 1: San Francisco show to say that you're so famous for 101 00:06:20,640 --> 00:06:25,400 Speaker 1: saying that when I haven't heard of something. What, well, 102 00:06:25,440 --> 00:06:27,320 Speaker 1: go listen to those bands and you'll be like, oh, 103 00:06:27,400 --> 00:06:32,440 Speaker 1: sex pop, but that's more like sex techno. M I 104 00:06:32,440 --> 00:06:34,560 Speaker 1: don't know what sex pop. It doesn't sound like it's 105 00:06:34,640 --> 00:06:39,360 Speaker 1: up my alley, but I'll give it a shot, all right. So, uh, 106 00:06:39,880 --> 00:06:44,279 Speaker 1: pain or quantifying pain specifically was or pain in general 107 00:06:44,320 --> 00:06:47,640 Speaker 1: actually was, like you said, misunderstood for a long time, 108 00:06:48,200 --> 00:06:50,600 Speaker 1: and it took all the way into the twentieth century, 109 00:06:50,920 --> 00:06:54,040 Speaker 1: quite a bit into the twentieth century with dr still 110 00:06:54,800 --> 00:06:58,080 Speaker 1: kind of struggling with how much you know, anesthesia to give, 111 00:06:58,520 --> 00:07:00,520 Speaker 1: how many meds to give if you were in pain, 112 00:07:00,600 --> 00:07:03,440 Speaker 1: if you were in surgery and childbirth, like you know, 113 00:07:04,360 --> 00:07:08,120 Speaker 1: literally people waking up in surgery and going oh, well, 114 00:07:08,279 --> 00:07:12,120 Speaker 1: uh we we didn't give that person enough anesthetic, And 115 00:07:12,160 --> 00:07:15,000 Speaker 1: we talked about that in our anesthesia episode a little bit. 116 00:07:15,480 --> 00:07:17,400 Speaker 1: There's just a lot of trial and error, Like, I 117 00:07:17,400 --> 00:07:20,200 Speaker 1: guess that's not enough because someone screaming on the table 118 00:07:20,360 --> 00:07:23,760 Speaker 1: in front of me. Well. Plus also, so pain, Um, 119 00:07:23,800 --> 00:07:28,080 Speaker 1: apparently it's pretty widespread. I saw that in the US alone, 120 00:07:28,160 --> 00:07:31,960 Speaker 1: nine out of ten people regularly suffer from pain at 121 00:07:32,000 --> 00:07:36,440 Speaker 1: any given time. Twenty five million people, Uh well, I 122 00:07:36,440 --> 00:07:38,640 Speaker 1: guess over the course of a year suffer acute pain. 123 00:07:38,960 --> 00:07:42,800 Speaker 1: In the US, another fifty million suffer chronic pain, and 124 00:07:42,840 --> 00:07:45,480 Speaker 1: many of those people report suffering chronic pain for five 125 00:07:45,600 --> 00:07:49,000 Speaker 1: years or more. So. Yeah, so the medical community says, 126 00:07:49,240 --> 00:07:50,960 Speaker 1: we need to do something about this, and it's like 127 00:07:51,000 --> 00:07:53,640 Speaker 1: you were saying. The American Pain Society, they say that 128 00:07:53,680 --> 00:07:59,040 Speaker 1: pain is the fifth vital sign, the fifth Beatle. What 129 00:07:59,520 --> 00:08:05,560 Speaker 1: was his clarence, Yeah, it's great Neddie Murphy's gid. Uh So, 130 00:08:05,800 --> 00:08:07,600 Speaker 1: if we go back in time to the time where 131 00:08:07,640 --> 00:08:11,160 Speaker 1: they were trying to be a little more objective about 132 00:08:11,200 --> 00:08:14,440 Speaker 1: it and actually come up with um a little more 133 00:08:14,520 --> 00:08:17,840 Speaker 1: what they thought were like foolproof ways to determine pain 134 00:08:18,000 --> 00:08:23,040 Speaker 1: measurement UM. In nineteen forty, there were some researchers a trio, 135 00:08:23,520 --> 00:08:27,800 Speaker 1: one James Hardy, uh, one Harold Wolf, and one Helen 136 00:08:27,840 --> 00:08:32,920 Speaker 1: Goodell of Cornell University. Those are some nineteen names. Sure, 137 00:08:33,679 --> 00:08:39,079 Speaker 1: Harold Wolf, Yeah, James Hardy, Yeah, Helen Goodell, all three 138 00:08:39,120 --> 00:08:43,640 Speaker 1: of them. Uh. They actually built a device called uh 139 00:08:43,920 --> 00:08:50,000 Speaker 1: dollar LiMETER. And what this was was basically a hundred 140 00:08:50,000 --> 00:08:53,000 Speaker 1: what lamp with a lens that they could focus you 141 00:08:53,000 --> 00:08:57,080 Speaker 1: know how you do when you're burning ants, Yeah, with 142 00:08:57,120 --> 00:08:59,679 Speaker 1: a magnifying glass. That's kind of what they were doing. 143 00:08:59,720 --> 00:09:02,360 Speaker 1: And they were cranking up heat on the you know, 144 00:09:02,400 --> 00:09:05,679 Speaker 1: they got these nurse volunteers apparently. Uh, and I think 145 00:09:05,720 --> 00:09:08,720 Speaker 1: they were all pregnant, which is even a little more sadistic. 146 00:09:09,120 --> 00:09:10,840 Speaker 1: But they what they were trying to do was compare 147 00:09:10,880 --> 00:09:13,640 Speaker 1: it to their pregnancy pains, their labor pains. Yeah. And 148 00:09:13,679 --> 00:09:16,120 Speaker 1: I was like, why would you do that to like 149 00:09:16,200 --> 00:09:20,840 Speaker 1: women in labor, And well, you could predict when something 150 00:09:20,880 --> 00:09:23,440 Speaker 1: was gonna happen. It was one of those few instances 151 00:09:23,480 --> 00:09:26,320 Speaker 1: when you can predict somebody's gonna be a pain. Yeah, yeah, 152 00:09:26,400 --> 00:09:29,320 Speaker 1: I get it. But it was also the right so 153 00:09:29,360 --> 00:09:33,600 Speaker 1: they didn't care, so like that hurts a lot. They're like, great, great, right, 154 00:09:34,559 --> 00:09:36,600 Speaker 1: But I guess these were volunteers, so take that for 155 00:09:36,640 --> 00:09:39,440 Speaker 1: what it's worth. And um, they were either nurses or 156 00:09:39,480 --> 00:09:43,439 Speaker 1: wives of doctors, which is even a bit more sadistic. Um. 157 00:09:43,520 --> 00:09:45,960 Speaker 1: And they would focus this light on the back of 158 00:09:46,000 --> 00:09:50,199 Speaker 1: their hand and make it hotter and hotter and said, 159 00:09:50,400 --> 00:09:52,840 Speaker 1: you know, compare that to your the intensity of your 160 00:09:52,880 --> 00:09:58,040 Speaker 1: labor pains by treking, I guess. And they then made 161 00:09:58,080 --> 00:10:02,760 Speaker 1: up a unit. We've reached equal. They even invented a 162 00:10:02,800 --> 00:10:06,880 Speaker 1: pain unit called dolls d O l s and you know, 163 00:10:06,960 --> 00:10:10,240 Speaker 1: it went supposedly one to ten. But there was a 164 00:10:10,360 --> 00:10:13,480 Speaker 1: lady one of them Uh, tough Marge, who cranked it 165 00:10:13,520 --> 00:10:16,320 Speaker 1: all the way up to ten point five, maxing out 166 00:10:16,320 --> 00:10:19,640 Speaker 1: the machine, and she was still like nope, I can 167 00:10:19,679 --> 00:10:23,480 Speaker 1: take it, which is amazing. Yeah, she was like a 168 00:10:23,880 --> 00:10:29,480 Speaker 1: hurt so good, but she loves sex pop music. But 169 00:10:29,520 --> 00:10:32,319 Speaker 1: there was a problem with the dolorometer, which is they 170 00:10:33,080 --> 00:10:35,520 Speaker 1: h in subsequent experience by other doctors that could not 171 00:10:35,559 --> 00:10:38,720 Speaker 1: reproduce this, which means it's a junk. Well not only that, Like, 172 00:10:38,800 --> 00:10:43,600 Speaker 1: I don't understand how it quantifies pain, right, Well, what 173 00:10:43,640 --> 00:10:46,920 Speaker 1: you're really saying is, uh, compare your labor pains to 174 00:10:47,840 --> 00:10:50,600 Speaker 1: the amount of heat energy that we're applying to you. 175 00:10:51,040 --> 00:10:53,439 Speaker 1: I don't. It just didn't translate to me. I didn't 176 00:10:53,480 --> 00:10:59,240 Speaker 1: understand it. But apparently the it created this um this 177 00:10:59,280 --> 00:11:03,840 Speaker 1: new cottage in industry for machines that were used to 178 00:11:03,880 --> 00:11:07,680 Speaker 1: measure objectively paint. And there's some still around today, but 179 00:11:07,760 --> 00:11:11,680 Speaker 1: they do slightly different things like, um, there's one that 180 00:11:11,840 --> 00:11:15,360 Speaker 1: that is like a ray gun that's used to see 181 00:11:15,520 --> 00:11:20,400 Speaker 1: if someone and under anesthesia, UM is under deep enough, right, 182 00:11:20,800 --> 00:11:23,920 Speaker 1: he's just there, and shoot him with it for fun too. Yeah, 183 00:11:24,360 --> 00:11:27,600 Speaker 1: and if they don't wake up, great the fun gun. 184 00:11:29,360 --> 00:11:31,959 Speaker 1: And then I guess This is just sort of the 185 00:11:32,000 --> 00:11:34,720 Speaker 1: decade of trying to perfect these things before they realized 186 00:11:34,760 --> 00:11:37,800 Speaker 1: I couldn't. Uh. Time Magazine wrote an article on Dr 187 00:11:37,880 --> 00:11:44,079 Speaker 1: Lauren to Julius Bella Glutzek, great name, and um he 188 00:11:45,000 --> 00:11:46,880 Speaker 1: had a had a machine. It didn't use heat, but 189 00:11:46,880 --> 00:11:50,120 Speaker 1: it put pressure on the chin bone an increasing amount 190 00:11:50,400 --> 00:11:53,280 Speaker 1: that sounds awful. Does sound awful? The shin is like 191 00:11:53,400 --> 00:11:58,160 Speaker 1: surprisingly sensitive. Oh yeah, so like you know, just put 192 00:11:58,200 --> 00:12:00,400 Speaker 1: a coffee table in any room. Yeah, it doesn't make 193 00:12:00,400 --> 00:12:02,800 Speaker 1: any sense. It should be like tougher than leather, like 194 00:12:02,920 --> 00:12:06,120 Speaker 1: run DMC, but it's not. No, it's not. Uh. And 195 00:12:06,160 --> 00:12:07,559 Speaker 1: this one, actually I don't know what the name of 196 00:12:07,600 --> 00:12:10,680 Speaker 1: it was, but um he measured it in Grahams to 197 00:12:10,760 --> 00:12:13,920 Speaker 1: quantify it and was supposedly and I think this is 198 00:12:13,920 --> 00:12:21,000 Speaker 1: self reported by Dr Bella Glutzek accurate. But since you've 199 00:12:21,080 --> 00:12:23,560 Speaker 1: not heard of it most of you, that probably means 200 00:12:23,720 --> 00:12:26,080 Speaker 1: that was not true. Yeah. He he thought if he 201 00:12:26,120 --> 00:12:30,560 Speaker 1: said accurate, people would have been suspicious of his findings. Yeah, 202 00:12:30,600 --> 00:12:36,840 Speaker 1: that's right. The funny thing though, is while all this, um, 203 00:12:36,840 --> 00:12:38,800 Speaker 1: I wasn't gonna call it quackery because they were they 204 00:12:38,800 --> 00:12:42,440 Speaker 1: were trying to legitimately invent something. But while at the 205 00:12:42,480 --> 00:12:44,599 Speaker 1: same time all this is going on, there was a 206 00:12:44,600 --> 00:12:48,800 Speaker 1: guy named Kenneth Keel who said, uh, why don't we 207 00:12:48,840 --> 00:12:51,760 Speaker 1: just ask people, Let's use our brains, people have that. 208 00:12:51,920 --> 00:12:54,360 Speaker 1: Why don't we just ask folks and tell him like 209 00:12:54,520 --> 00:12:58,360 Speaker 1: zero one or two or three on the scale of 210 00:12:58,679 --> 00:13:01,120 Speaker 1: you know, not painful to severe painful. Why don't we 211 00:13:01,160 --> 00:13:02,760 Speaker 1: just ask them and see what they say? And that 212 00:13:02,880 --> 00:13:05,079 Speaker 1: kind of caught on is the standard. Well let's take 213 00:13:05,120 --> 00:13:09,040 Speaker 1: a breakman, then we'll get back to when sensible pain 214 00:13:09,200 --> 00:13:37,280 Speaker 1: scales came into effect. That's why Josh Clark. Alright, Chuck, 215 00:13:37,320 --> 00:13:41,360 Speaker 1: So the forties were full of um ding bad ideas. 216 00:13:41,600 --> 00:13:45,880 Speaker 1: The sixties, Well, actually, I guess the guy you mentioned, 217 00:13:46,120 --> 00:13:49,360 Speaker 1: Dr Kenneth Keel, he came up with his idea of 218 00:13:49,360 --> 00:13:52,680 Speaker 1: a pain scale, a subjective self reported pain scale, in 219 00:13:52,720 --> 00:13:55,040 Speaker 1: the forties, but it seems to have really caught on 220 00:13:55,120 --> 00:13:58,920 Speaker 1: in the sixties. Agreed. And so with a self reported 221 00:13:59,000 --> 00:14:02,679 Speaker 1: pain scale with any um, well, yeah, any kind of 222 00:14:02,720 --> 00:14:05,800 Speaker 1: self reported pain scale. It's basically you are asking the 223 00:14:05,840 --> 00:14:10,040 Speaker 1: patient how much pain are you in? And it's not 224 00:14:10,160 --> 00:14:12,640 Speaker 1: enough for them to be like a lot, you know, 225 00:14:13,040 --> 00:14:16,040 Speaker 1: you have to give them, say like you said, a 226 00:14:16,160 --> 00:14:19,000 Speaker 1: scale of like zero to ten or zero zero to 227 00:14:19,040 --> 00:14:22,840 Speaker 1: a hundred. Some people just for fun have one that 228 00:14:22,880 --> 00:14:27,760 Speaker 1: goes up zero to a million. Sure, and everyone chooses 229 00:14:27,800 --> 00:14:31,640 Speaker 1: a million. It's crazy. I always have a difficult time 230 00:14:31,640 --> 00:14:35,560 Speaker 1: because I have a high threshold for pain. Um. But 231 00:14:35,600 --> 00:14:39,720 Speaker 1: that that that's that makes sense because pain is subjective. Yeah, 232 00:14:39,800 --> 00:14:41,720 Speaker 1: but I have a high threshold for pain. But I 233 00:14:41,760 --> 00:14:46,640 Speaker 1: also you know, I want the good pills. So do 234 00:14:46,680 --> 00:14:50,440 Speaker 1: you wink when you're talking? Like, I'm in a tremendous 235 00:14:50,480 --> 00:14:53,560 Speaker 1: amount of pain, doctor, please help me. I usually try 236 00:14:53,600 --> 00:14:55,400 Speaker 1: to quanta and this doesn't happen much because I don't 237 00:14:55,440 --> 00:14:59,280 Speaker 1: often need uh or have an injury to where I 238 00:14:59,360 --> 00:15:02,920 Speaker 1: like would need pain pills or something. Um. But I 239 00:15:02,960 --> 00:15:05,480 Speaker 1: always try to quantify it as if I didn't have 240 00:15:05,520 --> 00:15:09,520 Speaker 1: a high threshold for pain. You know what I'm saying, Like, 241 00:15:09,560 --> 00:15:11,680 Speaker 1: I don't think of my number and then I'll add 242 00:15:11,720 --> 00:15:16,800 Speaker 1: a couple so I can get juiced up. You objectively 243 00:15:16,880 --> 00:15:20,480 Speaker 1: self report then, rather than subjectively yeah, which they say 244 00:15:20,720 --> 00:15:24,320 Speaker 1: is very much wrong and you should be super honest 245 00:15:24,360 --> 00:15:28,440 Speaker 1: with your doctor. Yeah uh, Because like you said, there 246 00:15:28,440 --> 00:15:32,080 Speaker 1: are addicts who who seek this out. Yeah, I'm not one. 247 00:15:32,080 --> 00:15:33,960 Speaker 1: Of those. But I'm just like, you know, the pain 248 00:15:34,000 --> 00:15:35,960 Speaker 1: pill makes the pain feel a little bit better. Even 249 00:15:36,000 --> 00:15:38,280 Speaker 1: if I have a high threshold, doesn't mean I don't 250 00:15:38,320 --> 00:15:41,080 Speaker 1: want that pain to go away something, you know. Yeah. Well, 251 00:15:41,120 --> 00:15:42,840 Speaker 1: the way to get around that though, was to just 252 00:15:42,880 --> 00:15:45,240 Speaker 1: like dress up, you know when you go to the hospital, 253 00:15:45,360 --> 00:15:48,200 Speaker 1: like wear a suit to be sure, tie that kind 254 00:15:48,200 --> 00:15:50,080 Speaker 1: of thing. Yeah, I walk up with my baseball hat 255 00:15:50,080 --> 00:15:52,600 Speaker 1: and beard in a tie. Well, see, you would seem 256 00:15:52,600 --> 00:15:55,480 Speaker 1: med seeking. Yeah, it would at the very least like 257 00:15:55,520 --> 00:15:58,160 Speaker 1: cross their mind. Whereas if you dressed up and you said, 258 00:15:59,000 --> 00:16:03,320 Speaker 1: um and sure, uh, they'd be like, what what drugs 259 00:16:03,320 --> 00:16:06,160 Speaker 1: can we give you? Just write it down, write down 260 00:16:06,160 --> 00:16:09,960 Speaker 1: whatever you want and we'll sign it. I don't know 261 00:16:10,000 --> 00:16:13,320 Speaker 1: the name of any of them. So, uh. Fentanyl is 262 00:16:13,360 --> 00:16:15,840 Speaker 1: a big problem these days, is making its way into heroin, 263 00:16:16,440 --> 00:16:21,320 Speaker 1: killing people what taken with heroin. Yeah, they're using fentanol 264 00:16:21,400 --> 00:16:23,600 Speaker 1: to cut heroin. I don't know if they still aren't anymore. 265 00:16:23,600 --> 00:16:27,040 Speaker 1: But like little towns around America, we're having, like you know, 266 00:16:27,080 --> 00:16:29,640 Speaker 1: it would be normal to have one or two overdoses 267 00:16:29,640 --> 00:16:31,600 Speaker 1: a year, they were having like a dozen or so 268 00:16:32,080 --> 00:16:34,480 Speaker 1: all of a sudden, because people were like it's like 269 00:16:34,760 --> 00:16:41,200 Speaker 1: heroin and then the highest grade pharmaceutical heroine mixed in. 270 00:16:41,800 --> 00:16:44,640 Speaker 1: And apparently people didn't have any warning or else maybe 271 00:16:44,680 --> 00:16:46,600 Speaker 1: they were told this will knock your socks off. I 272 00:16:46,640 --> 00:16:49,240 Speaker 1: think that's what killed Philip seymour Offman too. I think 273 00:16:49,280 --> 00:16:52,440 Speaker 1: they might have had fentenl and his heroin. But it's 274 00:16:52,480 --> 00:16:54,880 Speaker 1: like what these people are used to. The dose they're 275 00:16:54,960 --> 00:16:58,800 Speaker 1: used to normally with heroin would not be a lethal dose, 276 00:16:58,960 --> 00:17:02,640 Speaker 1: but with fetinal mixed it's you They're dead. Wow. That 277 00:17:02,720 --> 00:17:07,199 Speaker 1: reminds me the old, the great Kamal Nagianni joke it was, 278 00:17:07,280 --> 00:17:09,240 Speaker 1: which was my intro to him. I heard on him 279 00:17:09,280 --> 00:17:12,680 Speaker 1: on This American Life. He was talking about a new 280 00:17:12,760 --> 00:17:16,240 Speaker 1: drug the kids are doing, which was Thailand all PM 281 00:17:16,280 --> 00:17:20,440 Speaker 1: with heroin, and he was just like, you're already doing heroin. 282 00:17:21,359 --> 00:17:23,760 Speaker 1: It's like, what could that possibly add to your experience? 283 00:17:24,359 --> 00:17:29,200 Speaker 1: Very funny joke but also sad at the same time. 284 00:17:29,920 --> 00:17:34,160 Speaker 1: Aren't aren't the best jokes? Yeah, a little sad sometimes. 285 00:17:35,160 --> 00:17:39,520 Speaker 1: Um So with self reporting pain scales, Uh, it sounds 286 00:17:39,680 --> 00:17:42,720 Speaker 1: like I said, so basic, like Okay, it's a no brainer, duh. 287 00:17:42,760 --> 00:17:45,240 Speaker 1: You asked someone you've got zero to whatever, three or 288 00:17:45,280 --> 00:17:47,679 Speaker 1: ten or a hundred people say that, and then the 289 00:17:47,720 --> 00:17:51,920 Speaker 1: doctor knows. But you don't think about um like children 290 00:17:52,560 --> 00:17:55,600 Speaker 1: or uh like in their understanding of pain, or maybe 291 00:17:55,640 --> 00:17:59,840 Speaker 1: the elderly and reasons uh how they experienced pain, or 292 00:18:00,680 --> 00:18:04,200 Speaker 1: people that are cognitively impaired and their understanding of pain. 293 00:18:04,640 --> 00:18:06,480 Speaker 1: And then you start to think, oh, wait a minute, 294 00:18:06,880 --> 00:18:10,120 Speaker 1: well we need all kinds of pain scales and ways 295 00:18:10,160 --> 00:18:13,560 Speaker 1: of asking people because not everyone is the same, and 296 00:18:13,600 --> 00:18:17,040 Speaker 1: they do have them. Adults specifically are pretty good at 297 00:18:17,160 --> 00:18:21,320 Speaker 1: rating their pain on a scale using numbers. They can 298 00:18:21,359 --> 00:18:24,800 Speaker 1: also use words like I'm in severe pain or something 299 00:18:24,880 --> 00:18:28,080 Speaker 1: like that, um. And usually if you're being presented with 300 00:18:28,119 --> 00:18:31,240 Speaker 1: the pain scale, it's not open ended, like describe your 301 00:18:31,280 --> 00:18:35,720 Speaker 1: pain in flowery language. It's which of these words best 302 00:18:35,760 --> 00:18:40,640 Speaker 1: describes your pain, like no pain, moderate, severe, intolerable. The 303 00:18:40,640 --> 00:18:44,560 Speaker 1: one that gets me is um, the worst pain imaginable. 304 00:18:45,600 --> 00:18:48,440 Speaker 1: That's that's as bad as it gets, Like I can't 305 00:18:48,520 --> 00:18:51,320 Speaker 1: conceive of any pain worse than what I'm in right now. 306 00:18:51,400 --> 00:18:54,000 Speaker 1: That's it just runs a chill down my spine, thinking 307 00:18:54,040 --> 00:18:58,080 Speaker 1: that something could happen that could put any of us 308 00:18:58,080 --> 00:19:03,480 Speaker 1: in that situation where you're seriencing the worst pain imaginable. 309 00:19:03,760 --> 00:19:06,200 Speaker 1: It's just I just don't think that should be able 310 00:19:06,200 --> 00:19:08,760 Speaker 1: to happen to a person. Yeah, and it's weird too. 311 00:19:08,800 --> 00:19:12,760 Speaker 1: It seems like a lot of times, um injuries like 312 00:19:12,920 --> 00:19:16,960 Speaker 1: whether it's a cut or a broken bone or something 313 00:19:17,040 --> 00:19:19,160 Speaker 1: I've heard. I've never broken a bone, but I've been 314 00:19:19,400 --> 00:19:21,800 Speaker 1: cut open a lot of times. You better knock on wood. 315 00:19:21,920 --> 00:19:26,480 Speaker 1: I know I'm knocking right now. Um, it seems like 316 00:19:26,520 --> 00:19:29,639 Speaker 1: those injuries are are less painful a lot of times, 317 00:19:29,640 --> 00:19:32,560 Speaker 1: and other kinds of injuries, like I hear people say like, yeah, 318 00:19:32,600 --> 00:19:34,560 Speaker 1: I broke my bone, but it was just sort of 319 00:19:34,640 --> 00:19:38,000 Speaker 1: numb and it looked awful, but I didn't feel actual pain, 320 00:19:38,840 --> 00:19:43,120 Speaker 1: whereas like like pulled muscles and things like that are 321 00:19:43,119 --> 00:19:46,280 Speaker 1: the things that really hurt or bad pain for God's 322 00:19:46,280 --> 00:19:48,639 Speaker 1: sake is the worst, you know. I'd like to do 323 00:19:48,680 --> 00:19:53,959 Speaker 1: a call out to emergency room physicians or um nurses 324 00:19:54,119 --> 00:19:57,159 Speaker 1: or orderlies, anybody who's seen people in a lot of 325 00:19:57,160 --> 00:20:02,320 Speaker 1: pain and tell us what is reliably the worst type 326 00:20:02,320 --> 00:20:06,199 Speaker 1: of jury pain wise? I think burns. Oh yeah, I'll 327 00:20:06,240 --> 00:20:09,600 Speaker 1: bet burns of of uh. I've heard that. That's just 328 00:20:09,800 --> 00:20:12,520 Speaker 1: you know, and you know, I've I've had small burns 329 00:20:12,560 --> 00:20:16,359 Speaker 1: that it's just that pain that won't stop. Uh. And 330 00:20:16,720 --> 00:20:19,040 Speaker 1: you know, I can't imagine like working in a burn, 331 00:20:19,119 --> 00:20:23,160 Speaker 1: you know, the kind of pain those people suffered. Man. Uh. 332 00:20:23,200 --> 00:20:26,560 Speaker 1: So talking about children, UM, there's this really great story 333 00:20:27,080 --> 00:20:36,560 Speaker 1: about the Wong Baker Faces all caps that's right, um 334 00:20:36,760 --> 00:20:39,879 Speaker 1: for for treating kids with discomfort and pain. Uh. And 335 00:20:39,920 --> 00:20:43,280 Speaker 1: it was developed in the early eighties by two women. 336 00:20:43,760 --> 00:20:48,439 Speaker 1: Donna Wong who was a well, Connie Baker is I 337 00:20:48,480 --> 00:20:52,119 Speaker 1: think first started with the idea, and Connie Baker was 338 00:20:52,200 --> 00:20:56,159 Speaker 1: a life child child life special excuse me, which I 339 00:20:56,240 --> 00:20:58,440 Speaker 1: had never heard of. But it's a really cool job 340 00:20:58,840 --> 00:21:01,840 Speaker 1: where they work in hospital and they work with children. Uh, 341 00:21:01,880 --> 00:21:07,760 Speaker 1: not in like a nursing capacity, but and she's I'd 342 00:21:07,760 --> 00:21:09,439 Speaker 1: love to hear from someone who does this, but it 343 00:21:09,480 --> 00:21:11,439 Speaker 1: seems like they kind of work in a more of 344 00:21:11,480 --> 00:21:15,400 Speaker 1: a social services capacity and helping a kid just deal 345 00:21:15,480 --> 00:21:21,440 Speaker 1: with being hospitalized. Does that sound about right? Yeah, that's 346 00:21:21,560 --> 00:21:24,680 Speaker 1: that's my impression, okay. Uh. And then Donna Wong, who 347 00:21:24,800 --> 00:21:29,240 Speaker 1: was a pediatric nurse consultant and apparently an author, well 348 00:21:29,320 --> 00:21:32,000 Speaker 1: not apparently an author, very much an author, but apparently 349 00:21:32,040 --> 00:21:34,960 Speaker 1: just this legend in the nursing industry, and she came 350 00:21:35,000 --> 00:21:38,800 Speaker 1: to visit uh in Tulsa, where Connie Baker worked, and 351 00:21:38,880 --> 00:21:41,480 Speaker 1: they got to talking and she was like, I had 352 00:21:41,480 --> 00:21:46,200 Speaker 1: this idea where we can do better with with trying 353 00:21:46,200 --> 00:21:49,160 Speaker 1: to determine and get self reporting out of children, because 354 00:21:49,200 --> 00:21:53,479 Speaker 1: children don't you know, sometimes they're pre verbal or nonverbal. Uh, 355 00:21:53,480 --> 00:21:55,720 Speaker 1: and sometimes they don't get like the numbers or the 356 00:21:55,760 --> 00:21:59,879 Speaker 1: color charts. So we need a better way. And ingeniously 357 00:22:00,040 --> 00:22:03,480 Speaker 1: they developed this with children. They started with just blank 358 00:22:03,600 --> 00:22:07,960 Speaker 1: circles and said, hey, you draw a face that that 359 00:22:08,480 --> 00:22:11,760 Speaker 1: looks like the pain that you're having, right, and the 360 00:22:11,880 --> 00:22:13,919 Speaker 1: kid would draw and maybe like this is terrible. Do 361 00:22:14,000 --> 00:22:16,199 Speaker 1: you do a better job than this? What is that? 362 00:22:16,320 --> 00:22:18,520 Speaker 1: Is that a chimney with smoke coming out of it? 363 00:22:19,640 --> 00:22:22,680 Speaker 1: They're like that, I feel like I'm on fire. Uh. 364 00:22:22,760 --> 00:22:24,399 Speaker 1: So these kids, you know, you look at some of 365 00:22:24,440 --> 00:22:26,439 Speaker 1: these early drawings as super cute. You know, they've got 366 00:22:26,480 --> 00:22:29,280 Speaker 1: these crayons and they put these details like hair and 367 00:22:29,359 --> 00:22:34,280 Speaker 1: noses and you know, the typical kids drawings. And um, interestingly, 368 00:22:34,440 --> 00:22:36,239 Speaker 1: some of them drew left or right, some of them 369 00:22:36,320 --> 00:22:38,520 Speaker 1: right to left. I don't know how to explain that, 370 00:22:39,280 --> 00:22:42,000 Speaker 1: but UM, I guess maybe kids hadn't learned to read 371 00:22:42,080 --> 00:22:45,520 Speaker 1: yet might have done right to left and not understood 372 00:22:45,520 --> 00:22:47,400 Speaker 1: that that's sort of the opposite of how we learned 373 00:22:47,400 --> 00:22:49,479 Speaker 1: to read, or they grew up in a culture that 374 00:22:49,520 --> 00:22:52,280 Speaker 1: reads right to left as I don't think so. I 375 00:22:52,280 --> 00:22:58,120 Speaker 1: think these were just like, you know, normal dumb American kids. Uh. 376 00:22:58,160 --> 00:23:01,399 Speaker 1: And so these kids actually participated started drawing these little 377 00:23:01,400 --> 00:23:06,479 Speaker 1: faces that range from smiling, um two tears, And they 378 00:23:06,520 --> 00:23:09,160 Speaker 1: got a little bit of heat for using tears as 379 00:23:09,160 --> 00:23:13,800 Speaker 1: well as the smiles. Well, they you know, some researchers said, like, 380 00:23:13,800 --> 00:23:16,359 Speaker 1: you probably shouldn't use those, but they said, no, you 381 00:23:16,400 --> 00:23:19,919 Speaker 1: know that every kid drew smiles, so we think it 382 00:23:19,960 --> 00:23:23,159 Speaker 1: should kind of we think that is really informative to 383 00:23:23,280 --> 00:23:26,520 Speaker 1: us and them describing how they feel. So let's let's 384 00:23:26,600 --> 00:23:29,400 Speaker 1: keep that. Uh. They kept the tears, but they told 385 00:23:29,400 --> 00:23:31,159 Speaker 1: the kids, and they continue to tell kids when they 386 00:23:31,200 --> 00:23:33,600 Speaker 1: look at this thing, Um, you don't have to have 387 00:23:33,680 --> 00:23:36,639 Speaker 1: tears necessarily to have the worst to be in the 388 00:23:36,680 --> 00:23:40,800 Speaker 1: worst pain, because not everybody cries when they're in pain. Gotcha. 389 00:23:40,920 --> 00:23:43,800 Speaker 1: That's why they said you shouldn't have tears on there. Yeah, 390 00:23:43,800 --> 00:23:48,639 Speaker 1: I think so, Yeah, exactly. So what they did was 391 00:23:48,680 --> 00:23:53,520 Speaker 1: then they got a professional artist and basically kind of 392 00:23:53,520 --> 00:23:57,280 Speaker 1: picked out the most frequently drawn features and had them 393 00:23:57,359 --> 00:24:00,960 Speaker 1: draw like a professional composite of these faces, you know, 394 00:24:01,000 --> 00:24:03,520 Speaker 1: and I think they ended up on six circles after 395 00:24:03,600 --> 00:24:07,719 Speaker 1: experimenting with like less or more and children actually helped 396 00:24:07,760 --> 00:24:11,160 Speaker 1: develop the the faces chart, which is, you know, it's 397 00:24:11,160 --> 00:24:13,760 Speaker 1: an awesome story. It is. It's pretty cute, yeah, in 398 00:24:13,760 --> 00:24:18,960 Speaker 1: a sad way, which makes it a joke. Alright, So Chuck, 399 00:24:19,040 --> 00:24:20,800 Speaker 1: let's take another break and then we'll come back and 400 00:24:20,840 --> 00:24:25,040 Speaker 1: talk about some other ways of assessing pain. That's why 401 00:24:25,240 --> 00:24:49,480 Speaker 1: same we should know. Why knows but Clark, So, Chuck, 402 00:24:49,520 --> 00:24:54,199 Speaker 1: you've got pain scales that use numbers. You've got some 403 00:24:54,280 --> 00:24:57,560 Speaker 1: that use faces for little kids. But one of the 404 00:24:57,600 --> 00:24:59,879 Speaker 1: things they have in common is that they exist on 405 00:24:59,880 --> 00:25:04,640 Speaker 1: a spectrum. One of them is so advanced that you 406 00:25:04,640 --> 00:25:06,960 Speaker 1: you have on one end no pain and on the 407 00:25:07,000 --> 00:25:10,000 Speaker 1: other end extreme pain, and an adult or somebody will 408 00:25:10,000 --> 00:25:12,960 Speaker 1: point to them wherever they are on that scale, and 409 00:25:13,000 --> 00:25:16,840 Speaker 1: then the doctor has to get out a ruler and 410 00:25:17,080 --> 00:25:21,120 Speaker 1: measure in millimeters, right, and then they mark that down. 411 00:25:21,160 --> 00:25:26,840 Speaker 1: And then one of the benefits of objectively assessing someone's pain, 412 00:25:27,000 --> 00:25:30,160 Speaker 1: even through self reporting is that you can track whether 413 00:25:30,200 --> 00:25:33,879 Speaker 1: it's getting better or worse by by assessing it several 414 00:25:33,920 --> 00:25:38,680 Speaker 1: times over time, right, um. But part of the problem 415 00:25:38,760 --> 00:25:44,440 Speaker 1: with self reporting pain scales is there's there could be obfuscation. 416 00:25:44,520 --> 00:25:47,399 Speaker 1: Like we said, like if you're med seeking um, the 417 00:25:47,520 --> 00:25:50,920 Speaker 1: elderly apparently don't like to talk about their pain. Yeah. 418 00:25:51,000 --> 00:25:52,760 Speaker 1: I mean there's a lot of reasons for that, from 419 00:25:53,800 --> 00:25:57,000 Speaker 1: the shame of like getting older and not feeling well 420 00:25:57,560 --> 00:26:01,280 Speaker 1: to um all, like you said, just like they don't 421 00:26:01,280 --> 00:26:03,360 Speaker 1: want to be a bother a lot of times. Yeah, 422 00:26:03,400 --> 00:26:06,960 Speaker 1: I read that they they don't like to talk about 423 00:26:07,040 --> 00:26:10,000 Speaker 1: their pain or whether they're in pain, but they will 424 00:26:10,240 --> 00:26:13,840 Speaker 1: respond to other words that are virtually the same thing, 425 00:26:13,920 --> 00:26:18,320 Speaker 1: like sore, ache, discomfort, and that if you're a good 426 00:26:18,560 --> 00:26:22,399 Speaker 1: um physician, you're going to figure out what what words 427 00:26:22,480 --> 00:26:25,280 Speaker 1: they respond to most and then just replace pain with 428 00:26:25,359 --> 00:26:27,119 Speaker 1: that to get them to talk about the type of 429 00:26:27,119 --> 00:26:29,560 Speaker 1: pain they're in. They have a little, uh a little 430 00:26:29,600 --> 00:26:35,320 Speaker 1: translation chart pretty pretty much. Yeah, sore it's like a 431 00:26:35,400 --> 00:26:40,280 Speaker 1: two achy say three point five and doc oy this 432 00:26:40,400 --> 00:26:43,639 Speaker 1: is killing me, that's a eleven. I wonder if there 433 00:26:43,640 --> 00:26:47,359 Speaker 1: are any pain scales where it's like like like weather 434 00:26:47,440 --> 00:26:51,560 Speaker 1: patterns like you know, spring day to Tornado of Pain, 435 00:26:52,400 --> 00:26:55,600 Speaker 1: Tornado of Pain. There's another band name and yeah, oh 436 00:26:55,680 --> 00:26:58,480 Speaker 1: yeah that probably is a band. Uh and then they 437 00:26:58,480 --> 00:27:03,280 Speaker 1: make them draw that too, right, job better tornado. Oh 438 00:27:03,400 --> 00:27:05,680 Speaker 1: I ad meant to say something too about the uh 439 00:27:05,800 --> 00:27:08,880 Speaker 1: the faces chart for kids. A lot of times they'll 440 00:27:08,920 --> 00:27:11,440 Speaker 1: still even though they have the chart, let kids draw 441 00:27:11,480 --> 00:27:13,479 Speaker 1: it because they found that kids really enjoy doing it. 442 00:27:14,080 --> 00:27:16,200 Speaker 1: It probably takes their mind off of things. Yeah, and 443 00:27:16,240 --> 00:27:17,680 Speaker 1: the kids will like draw it and then take it 444 00:27:17,760 --> 00:27:20,800 Speaker 1: home and stuff and uh, yeah, it's kind of cool. 445 00:27:20,880 --> 00:27:23,760 Speaker 1: And while they're busy drawing that, the doctor sneaks up 446 00:27:23,760 --> 00:27:25,760 Speaker 1: behind them and injects them with a heavy dose of 447 00:27:25,760 --> 00:27:34,040 Speaker 1: opioids right into their neck while they're distracted. And most 448 00:27:34,080 --> 00:27:36,560 Speaker 1: of those drawings have like a big cran streak going 449 00:27:36,600 --> 00:27:40,960 Speaker 1: off the edge of the page. So um. Some other 450 00:27:41,040 --> 00:27:44,480 Speaker 1: reasons that you might need to pull out different charts 451 00:27:44,560 --> 00:27:47,960 Speaker 1: is maybe someone doesn't speak the language that the doctor 452 00:27:47,960 --> 00:27:51,800 Speaker 1: speaks right, Or maybe there's a cultural difference that just 453 00:27:51,960 --> 00:27:55,080 Speaker 1: makes the scale a little more difficult to grasp or 454 00:27:55,480 --> 00:28:00,000 Speaker 1: or translate, or like you said, they could be cognitively challenged. Um, 455 00:28:00,000 --> 00:28:03,440 Speaker 1: there's a lot of different reasons why self reporting scale 456 00:28:03,800 --> 00:28:06,919 Speaker 1: might not work in a situation, and so in that case, 457 00:28:07,240 --> 00:28:09,960 Speaker 1: the doctor needs to rely on his or her own 458 00:28:10,040 --> 00:28:13,200 Speaker 1: observations to come up with a pain assessment. And there's 459 00:28:13,200 --> 00:28:18,160 Speaker 1: actually I found this extremely interesting that regardless of your 460 00:28:18,280 --> 00:28:22,359 Speaker 1: level of consciousness, if you are conscious and receptive to pain, 461 00:28:23,040 --> 00:28:27,360 Speaker 1: your body is going to make you react in predictable 462 00:28:27,640 --> 00:28:31,480 Speaker 1: and from what I can tell, universal ways. Right, So, 463 00:28:31,520 --> 00:28:33,160 Speaker 1: no matter where you are in the world, no matter 464 00:28:33,200 --> 00:28:37,080 Speaker 1: whether you um are cognitively challenged or whether you have 465 00:28:37,960 --> 00:28:43,480 Speaker 1: Alzheimer's or whether you are nonverbal baby like, there are 466 00:28:43,520 --> 00:28:45,959 Speaker 1: going to be things that you are going to do 467 00:28:46,040 --> 00:28:49,320 Speaker 1: when you're in pain, Like, for example, facial expressions tend 468 00:28:49,400 --> 00:28:56,160 Speaker 1: to change and take on reliably a reliable um expressions. Yeah, 469 00:28:56,200 --> 00:28:57,920 Speaker 1: Like if if you have back pain, then you go 470 00:28:58,000 --> 00:29:01,000 Speaker 1: to sit down like they're they're sessing you before they've 471 00:29:01,040 --> 00:29:04,600 Speaker 1: even started asking questions. So you come into the room 472 00:29:04,640 --> 00:29:06,239 Speaker 1: and you do like, you know, you grab the arm 473 00:29:06,240 --> 00:29:08,080 Speaker 1: of the chair and do that when you sit down. 474 00:29:08,920 --> 00:29:10,960 Speaker 1: That's a big you know, queue to a doctor, like 475 00:29:11,160 --> 00:29:13,600 Speaker 1: you know, this person is having trouble sitting and standing 476 00:29:13,600 --> 00:29:15,520 Speaker 1: there and so much back being Yeah, and if someone 477 00:29:15,560 --> 00:29:17,400 Speaker 1: took a picture of you at that exact moment, you 478 00:29:17,440 --> 00:29:20,880 Speaker 1: would see that your eyes are drawn shut tightly, your 479 00:29:20,880 --> 00:29:23,080 Speaker 1: lips are drawn back away from your mouth, and your 480 00:29:23,080 --> 00:29:27,280 Speaker 1: teeth are clenched down. You're you're grimacing in pain. Uh, 481 00:29:27,360 --> 00:29:32,840 Speaker 1: and you're doing it involuntarily. So these are behavioral behavioral cues. Yeah, 482 00:29:32,840 --> 00:29:36,560 Speaker 1: there's there's basically two categories. You can um put observational 483 00:29:36,600 --> 00:29:40,600 Speaker 1: pain assessment into behavioral and physiological. Right. Yeah, So on 484 00:29:40,640 --> 00:29:45,200 Speaker 1: the behavioral hand, you've got um facial expressions like grimacing, 485 00:29:45,280 --> 00:29:50,160 Speaker 1: You've got sounds like moans, grunts, um, even people just 486 00:29:50,280 --> 00:29:53,720 Speaker 1: talking about their pain, but not not because they're being interviewed, 487 00:29:53,880 --> 00:29:56,760 Speaker 1: just being like you know this this oh my back 488 00:29:56,880 --> 00:30:00,720 Speaker 1: or something like that. I make him back. Yeah. It 489 00:30:00,840 --> 00:30:05,720 Speaker 1: really worked me like a dog today. Uh. And these 490 00:30:05,760 --> 00:30:08,040 Speaker 1: are super important for all the reasons we talked about 491 00:30:08,120 --> 00:30:11,680 Speaker 1: people either not being able to report their pain accurately 492 00:30:11,920 --> 00:30:14,440 Speaker 1: or um and we talked about a couple of reasons 493 00:30:14,520 --> 00:30:17,080 Speaker 1: like the drug seeking, but like little kids may not 494 00:30:17,160 --> 00:30:19,479 Speaker 1: want little kids might be afraid of needles and they 495 00:30:19,560 --> 00:30:21,680 Speaker 1: might think I'm gonna get I mean, I actually remember 496 00:30:21,760 --> 00:30:25,400 Speaker 1: doing this. I remember under reporting pain because I was 497 00:30:25,440 --> 00:30:27,840 Speaker 1: afraid I was going to get a shot if I 498 00:30:27,880 --> 00:30:31,160 Speaker 1: said I was in too much pain. And so maybe 499 00:30:31,200 --> 00:30:32,720 Speaker 1: that's why I have a high threshold now it has 500 00:30:32,760 --> 00:30:34,720 Speaker 1: something to do with it. But um, I used to 501 00:30:34,800 --> 00:30:38,640 Speaker 1: be really really needle phobic and I am not anymore. 502 00:30:39,040 --> 00:30:41,680 Speaker 1: Like I don't love it still, but the needles have 503 00:30:41,720 --> 00:30:43,840 Speaker 1: gotten so tiny that it's not that big of a deal. 504 00:30:44,880 --> 00:30:48,520 Speaker 1: So when I was a kid, yeah, needles, you know, 505 00:30:48,560 --> 00:30:51,960 Speaker 1: they were a lot bigger. It wasn't like I mean 506 00:30:52,040 --> 00:30:54,080 Speaker 1: obviously wasn't like the eighteen hundreds where they have like 507 00:30:54,160 --> 00:30:58,560 Speaker 1: a railroad spike, but it's not like today where those little, tiny, 508 00:30:58,560 --> 00:31:01,760 Speaker 1: tiny thin needles. Um, I don't know the gauges, but yeah, 509 00:31:01,760 --> 00:31:04,959 Speaker 1: when I was growing up, they were Yeah, they hated 510 00:31:05,280 --> 00:31:07,800 Speaker 1: getting shots. Yeah. I wasn't really big on it either, 511 00:31:07,880 --> 00:31:10,800 Speaker 1: But I don't know if I would, i'd be needle phobic. 512 00:31:11,040 --> 00:31:15,040 Speaker 1: Do you watch The Needle go In? Sometimes it depends 513 00:31:15,040 --> 00:31:18,440 Speaker 1: on my mood. Really, it depends on your mood. Yeah, 514 00:31:18,480 --> 00:31:20,840 Speaker 1: I mean if I'm feeling curious and frisky, yeah, I'll 515 00:31:20,840 --> 00:31:22,960 Speaker 1: watch it and I'll be like, oh, oh you missed 516 00:31:23,040 --> 00:31:26,400 Speaker 1: that one. Just try to psychom out. Yeah, that is 517 00:31:26,480 --> 00:31:29,320 Speaker 1: kind of bad when they can't find the vein sure 518 00:31:29,320 --> 00:31:32,720 Speaker 1: for blood drawing, right, but but yeah, sometimes I'm just 519 00:31:32,760 --> 00:31:37,720 Speaker 1: like I'm not into it today. Look away. Uh. The 520 00:31:37,760 --> 00:31:39,560 Speaker 1: other cool thing too about when you get blood drawn 521 00:31:39,560 --> 00:31:42,720 Speaker 1: today is they used to Um, they've just come so far. Man. 522 00:31:42,760 --> 00:31:45,440 Speaker 1: Remember they used to have to if you had multiple 523 00:31:45,560 --> 00:31:49,280 Speaker 1: blood tests, you would get stuck like six times. And 524 00:31:49,360 --> 00:31:51,840 Speaker 1: now they have those awesome little tubes that they can 525 00:31:51,880 --> 00:31:58,960 Speaker 1: just unscrew. Um. But huh is that what that's called? It? 526 00:31:59,120 --> 00:32:06,160 Speaker 1: It's whoever to that? Mr Flobo or Mrs Flobo Phoebe Flobo, MD, 527 00:32:06,480 --> 00:32:10,360 Speaker 1: I salute you because that has really changed things for me. Um, 528 00:32:10,400 --> 00:32:16,720 Speaker 1: But I still weirdly have this fear of of like 529 00:32:16,800 --> 00:32:18,760 Speaker 1: when they're when they're doing that unscrewing it, I had 530 00:32:18,760 --> 00:32:20,760 Speaker 1: this fear that they're gonna knock the needle and it's 531 00:32:20,760 --> 00:32:23,560 Speaker 1: gonna kind of like rip out of my arm me too. Okay, 532 00:32:23,600 --> 00:32:26,280 Speaker 1: So that's is that a common thing? Maybe? Oh? Yeah, 533 00:32:26,320 --> 00:32:29,120 Speaker 1: for sure. It's so flimsy looking and it's basically being 534 00:32:29,120 --> 00:32:31,200 Speaker 1: held in by the needle, but there's this big, top 535 00:32:31,240 --> 00:32:34,880 Speaker 1: heavy tube that's attached to it. Yeah that Yeah, it's 536 00:32:34,880 --> 00:32:36,840 Speaker 1: just gonna rip it out and it's gonna pull like 537 00:32:37,120 --> 00:32:39,360 Speaker 1: all of your veins and your muscle out right after 538 00:32:39,400 --> 00:32:42,120 Speaker 1: it like a bunch of bloody party streamers. Yeah, I 539 00:32:42,200 --> 00:32:44,880 Speaker 1: know what you mean. And I'm with slightly phobic still 540 00:32:44,920 --> 00:32:47,520 Speaker 1: about them not being able to find the veins so 541 00:32:47,560 --> 00:32:49,080 Speaker 1: like you know, they give you the ball to squeeze. 542 00:32:49,840 --> 00:32:53,800 Speaker 1: I turned that thing into dust because I want I want, 543 00:32:53,880 --> 00:32:56,120 Speaker 1: like and I'm watching them and they're like, I think 544 00:32:56,120 --> 00:32:57,400 Speaker 1: I got one here. I'm like, are you sure? I 545 00:32:57,400 --> 00:32:59,760 Speaker 1: don't see it? Like I want to see that vein 546 00:33:00,000 --> 00:33:02,880 Speaker 1: aulging out for them to go in with that needle. 547 00:33:03,720 --> 00:33:06,000 Speaker 1: I don't. Maybe I'm still needle phobic. It sounds a 548 00:33:06,040 --> 00:33:10,040 Speaker 1: bit like it. Yeah, I don't think you like the needles. No, 549 00:33:10,320 --> 00:33:12,240 Speaker 1: but I mean, hats off to the nurses. That's a 550 00:33:12,280 --> 00:33:14,640 Speaker 1: tough job because there are varying degrees of needle phobia, 551 00:33:14,680 --> 00:33:17,680 Speaker 1: and I know it's probably never any fun. Well that's 552 00:33:17,720 --> 00:33:20,680 Speaker 1: good though. That means your chances of becoming an intravenous 553 00:33:20,760 --> 00:33:26,040 Speaker 1: drug user like zero, yes, exactly zero chance, so um chuck. 554 00:33:26,400 --> 00:33:30,560 Speaker 1: In addition to those behavioral cues, right like, body language 555 00:33:30,600 --> 00:33:32,960 Speaker 1: is another one to where you like you're you you've 556 00:33:32,960 --> 00:33:35,560 Speaker 1: got your arm kind of guarding your broken rib or 557 00:33:35,600 --> 00:33:40,240 Speaker 1: something like that, like get back and back everybody stay back. Um, 558 00:33:40,280 --> 00:33:44,120 Speaker 1: that's fairly universal from what I understand. There's also physiological 559 00:33:44,200 --> 00:33:49,680 Speaker 1: changes too, like, uh, you may become nauseous, or your 560 00:33:50,400 --> 00:33:56,560 Speaker 1: heartbeat or respiration starts increasing, you sweat. Um, there's a 561 00:33:56,600 --> 00:33:59,200 Speaker 1: lot of changes that the body undergoes that can be 562 00:33:59,240 --> 00:34:03,320 Speaker 1: objectively observed with that where it's like, oh, that guy's 563 00:34:03,360 --> 00:34:08,560 Speaker 1: sweating like a like a chuck okay, Um, he he 564 00:34:08,719 --> 00:34:10,839 Speaker 1: must be at like a ten right now, and though 565 00:34:10,840 --> 00:34:13,560 Speaker 1: he can't talk. Because that's another one too, like you 566 00:34:13,600 --> 00:34:17,440 Speaker 1: may be in so much pain that you can't you 567 00:34:17,520 --> 00:34:21,520 Speaker 1: can't talk, you do, you can't focus or concentrate on talking, 568 00:34:21,600 --> 00:34:24,080 Speaker 1: so you certainly can't self report your pain. Yeah, or 569 00:34:24,160 --> 00:34:27,000 Speaker 1: have an injury that keeps you from talking. Yeah, you know, 570 00:34:27,120 --> 00:34:28,719 Speaker 1: like I've been almost bit my tongue off when I 571 00:34:28,760 --> 00:34:31,400 Speaker 1: was a kid, oh man, and uh, you know I 572 00:34:31,400 --> 00:34:35,120 Speaker 1: couldn't talk very well. Yeah. Well now you talk great, 573 00:34:36,200 --> 00:34:38,919 Speaker 1: so much so that I do it for a living. Uh. 574 00:34:38,960 --> 00:34:40,640 Speaker 1: And they're all like you said, there are so many 575 00:34:40,640 --> 00:34:43,759 Speaker 1: of these pain scales, and they some of them can 576 00:34:43,800 --> 00:34:46,680 Speaker 1: get very specific for the kind of person that the 577 00:34:46,680 --> 00:34:49,759 Speaker 1: they're they're treating. Um, there's one called the c n 578 00:34:49,800 --> 00:34:56,040 Speaker 1: p I Checklist, and this is specifically for uh, cognitively 579 00:34:56,160 --> 00:35:01,400 Speaker 1: impaired elderly. Oh, that's specific, and it's a nonverbal checklist 580 00:35:01,400 --> 00:35:05,000 Speaker 1: basically that doctors can use. And we've talked about cognitive impairments. 581 00:35:05,000 --> 00:35:08,680 Speaker 1: Doctors have to be really uh skilled and careful there 582 00:35:08,760 --> 00:35:13,960 Speaker 1: because when they're assessing pain, because if you're assessing behavioral 583 00:35:14,000 --> 00:35:17,839 Speaker 1: traits and and someone has a cognitive impairment, it can 584 00:35:17,880 --> 00:35:20,279 Speaker 1: be very confusing to assess that because there may be 585 00:35:20,360 --> 00:35:23,880 Speaker 1: another need not being met, like they might be hungry 586 00:35:24,000 --> 00:35:27,880 Speaker 1: or over stimulated or thirsty and that's coming out, or 587 00:35:27,920 --> 00:35:30,279 Speaker 1: anxiety maybe and that's coming out and in the way 588 00:35:30,320 --> 00:35:32,840 Speaker 1: they're acting, and the doctor has to be able to 589 00:35:33,040 --> 00:35:36,200 Speaker 1: kind of wade through that to get an accurate reading, right. 590 00:35:36,280 --> 00:35:40,799 Speaker 1: And then so with with these observational UM scales, in 591 00:35:40,840 --> 00:35:43,319 Speaker 1: some cases the doctor will just be like, oh, that 592 00:35:43,360 --> 00:35:47,279 Speaker 1: guy is really grimacing horribly, so he's probably at like 593 00:35:47,320 --> 00:35:53,640 Speaker 1: a ten um. Other ones actually quantify these different observations, 594 00:35:53,680 --> 00:35:58,360 Speaker 1: like the CRIES tool for for um Infants in Pain, 595 00:35:58,640 --> 00:36:01,200 Speaker 1: which is about a sad of thought as there is, 596 00:36:01,760 --> 00:36:07,239 Speaker 1: but um it's it's basically several different observations like that 597 00:36:07,400 --> 00:36:12,360 Speaker 1: fall into behavioral physiological tranches. And then you know, the 598 00:36:12,480 --> 00:36:15,399 Speaker 1: doctor rates each one on I think zero to two 599 00:36:15,480 --> 00:36:18,080 Speaker 1: or something like that, and then if the sum total 600 00:36:18,160 --> 00:36:21,360 Speaker 1: of each category as up to four more, then it's 601 00:36:21,480 --> 00:36:24,040 Speaker 1: the baby's in a type of pain that would require 602 00:36:24,120 --> 00:36:26,640 Speaker 1: some sort of medication. Yeah. I looked into this one 603 00:36:26,640 --> 00:36:29,120 Speaker 1: a bit more. Um c R I E S stands 604 00:36:29,200 --> 00:36:36,920 Speaker 1: for crying, requires oxygen for saturation. Greater than that is 605 00:36:37,120 --> 00:36:41,120 Speaker 1: a terrible acrimiment. I for increased vital signs E for 606 00:36:41,200 --> 00:36:45,439 Speaker 1: expression as for sleepless. Zero would be a cry that's 607 00:36:45,520 --> 00:36:50,759 Speaker 1: not high pitched. Yeah, I guess like a whimpering cry too, 608 00:36:50,960 --> 00:36:53,919 Speaker 1: I'm sorry. One would be high pitched, but the kid 609 00:36:54,040 --> 00:36:57,240 Speaker 1: is easily consoled, and a two would be high pitched 610 00:36:57,280 --> 00:37:05,480 Speaker 1: and not inconsolable. Well, the oxygenation Um basically is there 611 00:37:05,480 --> 00:37:09,239 Speaker 1: an is there an decrease? Sorry? And O two at 612 00:37:09,239 --> 00:37:12,560 Speaker 1: certain levels? Uh number three the vital signs, which is 613 00:37:12,600 --> 00:37:15,560 Speaker 1: heart rate and blood pressure. In this case, zero's unchanged 614 00:37:15,640 --> 00:37:19,520 Speaker 1: increase less than is the one greater than is it 615 00:37:19,600 --> 00:37:26,120 Speaker 1: to expression? No grimace zero just a grimace by itself, 616 00:37:26,239 --> 00:37:30,799 Speaker 1: is a one and a griminace, sorry, a grimace with 617 00:37:30,880 --> 00:37:36,240 Speaker 1: a non crying grunts it too well because they've already 618 00:37:36,239 --> 00:37:39,399 Speaker 1: covered crying, So yeah, a non crying grunt. And then uh, 619 00:37:39,560 --> 00:37:44,160 Speaker 1: sleepless continually sleep zero, awaken frequently one and always constantly 620 00:37:44,200 --> 00:37:48,800 Speaker 1: awake two and then they total those up, like you said, 621 00:37:49,120 --> 00:37:51,879 Speaker 1: that is a sad scale. It is, man. I think 622 00:37:51,920 --> 00:37:54,920 Speaker 1: I've said before. I used to do um p a 623 00:37:55,040 --> 00:37:57,399 Speaker 1: jobs in l A for this one company who did 624 00:37:58,239 --> 00:38:01,120 Speaker 1: uh well. They did to to hospitals. They did City 625 00:38:01,120 --> 00:38:03,360 Speaker 1: of Hope Cancer Research, which is where I saw the 626 00:38:03,360 --> 00:38:07,439 Speaker 1: head in the bucket, uh, and then Children's Hospital Los 627 00:38:07,440 --> 00:38:12,560 Speaker 1: Angeles h l A, which was really rewarding experience, but 628 00:38:12,680 --> 00:38:17,480 Speaker 1: the toughest job I ever had, Like you know, the 629 00:38:17,520 --> 00:38:20,760 Speaker 1: worst stuff you can imagine. And I gotta say, kids 630 00:38:20,800 --> 00:38:28,000 Speaker 1: are the bravest, uh bet best attitudinal. They had the 631 00:38:28,040 --> 00:38:30,120 Speaker 1: best attitudes and they were the bravest of it like 632 00:38:30,160 --> 00:38:32,239 Speaker 1: any humans I ever saw in the face of like 633 00:38:32,480 --> 00:38:35,400 Speaker 1: the most daunting things, like compared to adults. I was 634 00:38:35,440 --> 00:38:38,040 Speaker 1: just like, man, adults need to take some lessons from kids, 635 00:38:38,600 --> 00:38:41,920 Speaker 1: because it's amazing, like the attitudes these kids had, that's 636 00:38:42,440 --> 00:38:44,160 Speaker 1: it was. And you know, I've also been in the 637 00:38:44,200 --> 00:38:49,400 Speaker 1: emergency room on the flip side and seeing adults that 638 00:38:49,520 --> 00:38:51,200 Speaker 1: I think they think they might be able to get 639 00:38:51,239 --> 00:38:57,759 Speaker 1: soon sooner if they wail in pain, like when they're 640 00:38:57,800 --> 00:38:59,840 Speaker 1: wailing and wailing and then you see them like oh, 641 00:39:00,000 --> 00:39:03,160 Speaker 1: in one eye and look around, and you'll say that 642 00:39:03,160 --> 00:39:04,799 Speaker 1: because maybe they are in that kind of pain and 643 00:39:04,840 --> 00:39:07,759 Speaker 1: that's just how they express it. But usually in when 644 00:39:07,760 --> 00:39:09,719 Speaker 1: I'm in the emergency room, there's one person that's just 645 00:39:09,760 --> 00:39:14,960 Speaker 1: like oh, and I'm like, come on, man, you're just 646 00:39:15,000 --> 00:39:17,080 Speaker 1: trying to get to the front of the line. H 647 00:39:17,239 --> 00:39:19,960 Speaker 1: u r t s. And then I see these kids 648 00:39:20,000 --> 00:39:22,320 Speaker 1: in the cancer war that are just like smiling and playing. 649 00:39:22,440 --> 00:39:25,279 Speaker 1: I'm like, you know, it's hard to not be a 650 00:39:25,320 --> 00:39:28,640 Speaker 1: little cynical about adults and how they handle that stuff. Yeah, no, 651 00:39:28,760 --> 00:39:31,400 Speaker 1: it's true. It does seem like you do kind of 652 00:39:31,440 --> 00:39:35,080 Speaker 1: get woosier as the as you age. Yeah, up to 653 00:39:35,160 --> 00:39:38,239 Speaker 1: a point. Yeah, I agree. So you got anything else? 654 00:39:39,520 --> 00:39:41,719 Speaker 1: Uh No, I mean there's you know, there's tons and 655 00:39:41,719 --> 00:39:43,719 Speaker 1: tons of pain scales that we didn't cover, and they're 656 00:39:43,760 --> 00:39:47,000 Speaker 1: all basically after the same thing in slightly different ways. 657 00:39:47,120 --> 00:39:50,720 Speaker 1: So let's just leave it at that. Okay, pain scales. 658 00:39:50,760 --> 00:39:53,040 Speaker 1: Who the thought that we would do pain skills before 659 00:39:53,120 --> 00:39:55,960 Speaker 1: we did one on pain. Well, now when we do 660 00:39:56,040 --> 00:39:58,239 Speaker 1: one on pain, we can just say and they're also 661 00:39:58,280 --> 00:40:02,160 Speaker 1: pain scales, which we've detailed. Thirdly, yeah, we do that, 662 00:40:02,239 --> 00:40:04,640 Speaker 1: don't we. All Right, Well, if you want to know 663 00:40:04,680 --> 00:40:06,880 Speaker 1: more about pain scales, type those words in the search 664 00:40:06,920 --> 00:40:09,239 Speaker 1: part how stuff works dot com. And since I said that, 665 00:40:09,320 --> 00:40:14,480 Speaker 1: it's time for a listener mail, I'm gonna call this 666 00:40:14,600 --> 00:40:19,120 Speaker 1: just an email from a seemingly very nice guy or 667 00:40:19,160 --> 00:40:22,319 Speaker 1: a big phony. Hey, guys, been a listener for three 668 00:40:22,360 --> 00:40:23,880 Speaker 1: or four years. I think I've always wanted to write in, 669 00:40:23,960 --> 00:40:26,319 Speaker 1: but with shy, I thought it was worth mentioning that 670 00:40:26,400 --> 00:40:29,560 Speaker 1: I listened to about thirty hours of podcasts per week, 671 00:40:30,160 --> 00:40:32,919 Speaker 1: and you are in my top two favorites. Those guy's 672 00:40:32,920 --> 00:40:35,960 Speaker 1: a pro, which basically that means we're number two, or 673 00:40:36,000 --> 00:40:38,520 Speaker 1: he said we're his favorite. Yeah, I guess you're right, 674 00:40:38,760 --> 00:40:40,960 Speaker 1: which is fine. I guess I kind of want to 675 00:40:40,960 --> 00:40:44,080 Speaker 1: know what number one is though, Yeah, i'd like to 676 00:40:44,120 --> 00:40:46,120 Speaker 1: know as well. To Scott follow up on this, please 677 00:40:47,120 --> 00:40:49,479 Speaker 1: uh A second but related, I'm a Master's level Board 678 00:40:49,520 --> 00:40:53,360 Speaker 1: certified behavior UH analyst A B C B A and 679 00:40:53,440 --> 00:40:55,560 Speaker 1: I am almost finished with my PhD. And I think 680 00:40:55,680 --> 00:40:57,880 Speaker 1: you might enjoy hearing that you guys actually do a 681 00:40:57,880 --> 00:41:02,479 Speaker 1: pretty decent job handling psychological concepts where many other podcasts don't. 682 00:41:02,960 --> 00:41:06,759 Speaker 1: Oftentimes they're too cursory to credulous, or they oversimplify or 683 00:41:06,800 --> 00:41:09,440 Speaker 1: something else, And you guys do a great job. Uh. 684 00:41:09,480 --> 00:41:11,520 Speaker 1: And it brings me to my third point. You guys 685 00:41:11,520 --> 00:41:14,319 Speaker 1: have been on a super hot streak lately. I think 686 00:41:14,320 --> 00:41:16,799 Speaker 1: the last month contains some of my favorite material to date. 687 00:41:17,160 --> 00:41:19,239 Speaker 1: I don't know what's going on, but keep it up. 688 00:41:19,800 --> 00:41:25,480 Speaker 1: I've been listening for two months. We're on steroids, that's it. Uh. 689 00:41:25,520 --> 00:41:28,160 Speaker 1: And finally, I really loved your episode on pacifism. Actually 690 00:41:28,160 --> 00:41:32,200 Speaker 1: consider myself only more extreme endo pacifism. Do not wish 691 00:41:32,239 --> 00:41:38,200 Speaker 1: harm on anyone under any circumstance. Uh. That's that's nice, right. Um. 692 00:41:38,239 --> 00:41:40,680 Speaker 1: I like to believe I would die to protect my enemy, 693 00:41:41,040 --> 00:41:44,680 Speaker 1: to save a life. Wow, he really is on the 694 00:41:44,680 --> 00:41:48,000 Speaker 1: far end. Yeah, he makes Gandhi look like d I mean, 695 00:41:49,360 --> 00:41:51,799 Speaker 1: although I've never actually I've never actually tested this to 696 00:41:51,840 --> 00:41:54,120 Speaker 1: be fair. That being said, I also don't think that 697 00:41:54,160 --> 00:41:57,080 Speaker 1: I could allow someone to come to harm if I 698 00:41:57,080 --> 00:41:59,120 Speaker 1: could do something about it, although I'd prefer to take 699 00:41:59,560 --> 00:42:03,480 Speaker 1: their play ace and then rather than hurt their attacker. 700 00:42:04,160 --> 00:42:05,960 Speaker 1: Also similar to what Chuck said about his wife, I 701 00:42:05,960 --> 00:42:08,439 Speaker 1: cannot stand to see harm come to animals. As John 702 00:42:08,480 --> 00:42:11,920 Speaker 1: Lennon said, war is over. If you want it, you 703 00:42:11,920 --> 00:42:14,120 Speaker 1: guys are fantastic. I wish you all the best. If 704 00:42:14,160 --> 00:42:17,040 Speaker 1: you ever have any questions about behavioral psychology, be happy 705 00:42:17,080 --> 00:42:18,839 Speaker 1: to be as much of a resource as I can be. 706 00:42:18,920 --> 00:42:24,080 Speaker 1: And that is from Scott Miller of the University of Nebraska. 707 00:42:24,440 --> 00:42:28,560 Speaker 1: Go corn dogs, corn huskers. Oh yeah, that's right. You 708 00:42:28,560 --> 00:42:30,399 Speaker 1: gotta husk the corn before you can make it into 709 00:42:30,400 --> 00:42:33,400 Speaker 1: a corn dog. That's true unless you're doing it like 710 00:42:33,480 --> 00:42:36,560 Speaker 1: farmhouse style, in which case you would include the husk 711 00:42:36,760 --> 00:42:39,200 Speaker 1: into the ultimate corn meal. Yes, and you can find 712 00:42:39,200 --> 00:42:42,880 Speaker 1: those at county fairs. Thanks a lot, Scott. If you 713 00:42:43,000 --> 00:42:44,879 Speaker 1: wanted to get in touch of this, like Scott did, 714 00:42:45,000 --> 00:42:47,640 Speaker 1: you can tweet to us at josh um Clark or 715 00:42:47,960 --> 00:42:50,520 Speaker 1: s Y s K podcast. You can hang out with 716 00:42:50,600 --> 00:42:52,880 Speaker 1: us on Facebook dot com slash Stuff you Should Know, 717 00:42:53,040 --> 00:42:57,520 Speaker 1: or Facebook dot com slash Charles W. Chuck Bryant. You 718 00:42:57,560 --> 00:42:59,879 Speaker 1: can send us an email to Stuff Podcast at House 719 00:43:00,000 --> 00:43:02,120 Speaker 1: of Works dot com and has always joined us at 720 00:43:02,160 --> 00:43:04,279 Speaker 1: our home on the web. Stuff you Should know dot 721 00:43:04,280 --> 00:43:11,360 Speaker 1: com for more on this and thousands of other topics 722 00:43:11,480 --> 00:43:19,360 Speaker 1: because at how stuff works. Dot com m