Meeting people where the pain is

There is no instrument that measures pain. That fact should shape how the appointment goes.

For high-performing professionals in Chicago and Chicagoland: This article reflects clinical evidence and direct experience. If you're in the Chicago area or Illinois, contact me to discuss your concerns.

Every clinical assessment of pain begins from the same place: the person's own account. There is no scan that quantifies suffering and no blood test that adjudicates it. Imaging shows structure, not experience, and the correlation between what appears on a scan and how much someone hurts is famously poor in both directions.

That is not a limitation to be worked around. It is the nature of the thing.

What follows from subjectivity

If the report is the primary data, then the conditions under which someone gives that report matter clinically, not just interpersonally. A patient who has been disbelieved four times will edit what they say. A professional who fears how a note will read will minimise. Someone who has learned that describing distress leads to being labelled will describe less of it.

Every one of those produces a worse assessment, not just a worse experience.

What meeting someone where they are actually means

Not agreeing with everything. Not withholding a difficult opinion. It means starting from the assumption that the account is accurate, and taking the person's own framing seriously enough to work inside it before proposing a different one.

If someone is convinced their pain is entirely structural and psychiatric involvement is an insult, arguing that point first guarantees you lose them. Working within their frame — treating the sleep, treating the mood that has plainly deteriorated, being useful in a way they can accept — usually earns the conversation later.

Where this differs from reassurance

Meeting people where they are is not telling them what they want to hear. It includes saying that a medication is not helping, that a treatment they are attached to has poor evidence, or that the psychiatric component is larger than they want it to be.

The difference is that those things land when the person believes you took their account seriously first. Delivered before that, they are simply another dismissal.

Why I write about this

Because the population I work with — clinicians, first responders, people in high-consequence roles — is unusually likely to have been handled badly in this specific way. They know how the system works, they know how they will be read, and they self-edit accordingly.

Getting an accurate history from someone like that requires demonstrating first that the history will be believed.

Related: when your pain is not believed, and psychiatric care after critical illness.

Published August 2026 · Reviewed for accuracy against the sources listed above.