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hyporational comments on Stupid Questions December 2014 - Less Wrong
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It seems like we suck at using scales "from one to ten". Video game reviews nearly always give a 7-10 rating. Competitions with scores from judges seem to always give numbers between eight and ten, unless you crash or fall, and get a five or six. If I tell someone my mood is a 5/10, they seem to think I'm having a bad day. That is, we seem to compress things into the last few numbers of the scale. Does anybody know why this happens? Possible explanations that come to mind include:
People are scoring with reference to the high end, where "nothing is wrong", and they do not want to label things as more than two or three points worse than perfect
People are thinking in terms of grades, where 75% is a C. People think most things are not worse than a C grade (or maybe this is just another example of the pattern I'm seeing)
I'm succumbing to confirmation bias and this isn't a real pattern
In medicine we try to make people rate their symptoms, like pain, from one to ten. It's pretty much never under 5. Of course there's a selection effect and people don't like to look like whiners but I'm not convinced these fully explain the situation.
In Finland the lowest grade you can get from primary education to high school is 4 so that probably affects the situation too.
How do you then interpret their responses? Do you compare only the responses of the same person at different times, or between persons (or to guide initial treatment)? Do you have a reference scale that translates self-reported pain to something with an objective referent?
Yes. There's too much variation between persons. I also think there's variation between types of pain and variation depending on whether there are other symptoms. There are no objective specific referents but people who are in actual serious pain usually look like it, are tachycardic, hypertensive, aggressive, sweating, writhing or very still depending on what type of pain were talking about. Real pain is also aggravated by relevant manual examinations.
This is actually what initially got me thinking about this. I read a half-satire thing about people misusing pain scales. Since my only source for the claim that people do this was a somewhat satirical article, I didn't bring it up initially.
I was surprised when I heard that people do this, because I figured most people getting asked that question aren't in near as much pain as they could be, and they don't have much to gain by inflating their answer. When I've been asked to give an answer on the pain scale, I've almost always felt like I'm much closer to no pain than to "the worst pain I can imagine" (which is what I was told a ten is), and I can imagine being in such awful pain that I can't answer the question. I think I answered seven one time when I had a bone sticking through my skin (which actually hurt less than I might have thought).
Maybe they think that by inflating their answer they gain, on the margin, better / more intensive / more prompt medical service. Especially in an ER setting where they may intuit themselves to be competing against other patients being triaged and asked the same question, they might perceive themselves (consciously or not) to be in an arms race where the person who claims to be experiencing the most pain gets treated first.