My wife recently underwent a surgical procedure. During recovery, the nurses would periodically enter the room to offer her pain medication. Each time, before they would give her the medication, they asked her to rate her pain and would refer her to a chart on the wall as a reference. You may have seen these charts – a series of cartoon faces that go from smiley on the left to weeping on the right and they are paired with a numeric value for your pain. This has always bugged me since we don’t always experience pain in the same way.
When my wife was giving birth to my son, the obstetrician actually called into question my wife’s subjective pain rating:
“How’s your pain now?” she asked.
“I don’t know… 7?” my wife replied.
“Oh, come on… 10 is like having your arm ripped off.”
“Well, I’ve never had my arm ripped off, so I can’t really compare it.”
I had to laugh. I understand that medical professionals have a job to do as far as pain management goes, but I think assigning an arbitrary metric to an experience as nebulous as pain serves to only confuse the conversation. There are a couple of bad assumptions here.
One bad assumption is that there is only one flavor of pain and that it increases in a linear fashion. We all experience pain in different ways and each type of pain affects each of us in a unique way (What about masochists? Do we reverse the scale then? “He pointed to the smiley face! Get the morphine!”). Depending on where the pain is, (head vs. foot, e.g.) the perception of pain will differ as well.
The second bad assumption is that we all know what 10 means. I don’t know what getting my arm ripped off is like, nor can I go back after getting my arm ripped off and revise my earlier answers. Without a clear understanding of the top of the scale, how can any answer in the middle be valid.
It seems like they would be better served having a more in-depth discussion about the level of discomfort the patient is experiencing, or try something like increasing the amount of time between each dose to see how well the patient handles it. Another tactic would be to have a determined task for the patient to undertake and observe how their pain affects their ability to complete it.
Too often, we are guilty of behaving the same way when validating business or design decisions. We throw our strategies, plans, and designs up on the screen and say, “Eh? What do you think?” We may try to quantify it by dividing the proposed solution into facets and then rating and weighting the facets, but it still comes down to artificially rating Exhibit A outside the context of its implementation.
Mayor Koch was notorious for greeting the residents of New York City with, “How am I doing?” While I’m sure he got some interesting (and probably colorful) responses, there probably wasn’t much he heard that materially changed the direction of his administration. It’s probably a better approach for testing ideas and tactics already put in place.
I think there are a few tactics to maximize the value of measuring subjective impressions:
- Be explicit about what you are measuring and what the scale implies
In the hospital, they reframe the question in terms of how difficult the pain makes performing basic tasks and build a scale around a specific task. - Tie the scale to a goal
It’s more effective to ask “How well does this shade of green support our desire for our brand to be perceived as conscientious,” than to ask, “You like this green?” - Have them explain why they chose that rating
It may be that you’re getting unexpected answers because you are asking the wrong question, or asking the right question the wrong way. Having the respondent explain their rating may uncover subtleties of the situation you may have overlooked.
What steps do you take to quantify subjective information?