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.

But she pushed through. Refusing to use a walker or a cane at school as she didn’t want the kids to see her like that, she would roll around class on her rolly chair and walk around school with an umbrella as a cane. The only narcotic medication she ever took that I can recall was on my wedding day, so she could do the Macarena (yes, I’ve been married THAT long).

Finally she had a hip replacement, and boy was she zooming all over the place! “Can you do the rest of me?” she asked the orthopedic surgeon.

Actually they were planning on eventually doing her other hip and probably her knees, but a brain aneurysm took her life at 48, and on June 8 of this year, I will have been 15 years without my mother, one of the strongest, most amazing people I’ve ever met.

Ironically, I believe since RA is a connective tissue disease (along with the hypertension she suffered due to the long-standing prednisone use), the disease did actually play a large factor in her death. Her pain was over, though.

My own personal struggles with pain began in 2005. Not wanting to have a baby during med school since my husband and I lived apart all those years, I was on some type of hormonal contraception, and had been for almost 10 years.

Midway through my third year, I went off the patch. The next month, I had the “worst headache of my life.”

My husband happened to be there, and I was vomiting no matter what I tried to take: ibuprofen, Tylenol, Percocet left over from a surgery I’d had. Petrified after watching my mother die of pretty much the exact thing, he rushed me to the emergency department.

A CT scan, a lumbar puncture, Reglan and some fluids later, I was feeling better. Ironically, I was on my neurology rotation and ended up with a post-LP headache.

One of my attendings sent me to the clinic for some triptans, and then diagnosed me with my first migraine.

We all know those people, too. “I have migraines, and I’m allergic to everything under the sun, including the sun, which is why the sun’s reflection off the moon bothers my eyes so much that in the dark, I have to wear these sunglasses even in the dead of night …” Who do you think you are? Corey Hart?

So, I am a chronic migraine sufferer (sans sunglasses), and up until about 2 weeks ago I was having about 15 headaches a month, so pain is not a new thing for me. I will get into the migraine thing in another column, as I have some great migraine stories.

Some new pain assessment techniques my colleagues and I have begun to employ are pretty simple – and AWESOME!

First of all, most of these people have never had pain worse than a blister from new shoes, so you have to put it into perspective for them. People with kidney stones or those going through childbirth or broken long bones notwithstanding.

Here is my new one. Granted, I use this on patients I gauge will tell me a 10 even if they are sleeping and talking in their sleep about Care Bears.

“So, how would you rate your pain, on a scale of 0-10, if 0 was no pain and 10 was pain you would have if someone chopped both of your legs off.”

No lie: I do use this. It usually gets an honest response. The key is to say the last phrase sort of quickly and catch them off guard.

Another friend of mine uses his special scale only on those who give him an answer of 10 on the pain scale. His next question is, “A 10, huh? OK, then how would you rate it on a scale of 1 to 1,000?”

Patients look at him quizzically, and then always answer some odd number like, “Umm… 847.” If it was a 10, why wouldn’t it be 1,000? I sense inaccuracy here, people.

What do you mean? Inaccuracy in medicine? The horror!?!

I’m sure all of you have your own Spidey-sense to hunt down the posers out there. It is not uncommon for me to think (sometimes aloud…) “10/10 pain my a–” when departing a patient encounter. I mean, even as a rookie, you get good at sniffing out the bull pretty quick.

All in all, being an emergency physician is not just about making an accurate diagnosis, treatment plan, and disposition, it’s 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 be able to do that.

Dr. Bundy is an assistant medical director at Baptist Medical Center East in Montgomery, Ala., and a former photojournalist. She not only sings in the car, but also talks to herself, is addicted to diet drinks and shoes, and thinks emergency medicine is the greatest specialty.