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February 4, 2017

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Stuff I Wish My Patients Knew Ep 1: Healthcare Is Not Perfect

Unfortunate, but true. There are the egregious cases that come to mind where

surgery is performed on the wrong body part, patients are misdiagnosed causing a series of complications, harmful medications are prescribed to patients with a known allergic reaction, and so on. Of course, some of these instances result in the death of the patient. The purpose of this blog is not to elaborate on how or why those instances occur, but to speak to something that is seen more commonly in the physical therapy world: the misdiagnosis or mistreatment of a patient which results in wasted time and money, as well as unnecessary suffering.

 

When it comes to pain, things can be tricky when diagnosing and treating a patient. What is the origin of the pain? The significant overlap between the muscular, neurological, and skeletal systems makes the process of establishing a working diagnosis extremely difficult at times. On top of that, one must take into account the most important factor affecting pain perception- the brain. Our understanding of pain is ever evolving, but these days, it is widely accepted that the brain can perceive pain in the absence of tissue damage. Below is a short video demonstrating how easy the brain can be manipulated. And here’s another, showing that research subjects respond differently to an inert (placebo) pill based on the color of the pill- red increases respiratory and heart rate, while blue decreases both. Understand that the brain is constantly processing information and making decisions without your conscious input. This is why optical illusions work, and are simultaneously puzzling and entertaining.

 

 

 


My point is this: pain is incredibly complex, so be skeptical when you receive a diagnosis from a medical professional regarding your pain. At the end of the day, it is simply one person’s (albeit an expert’s) best guess as to why your brain is presently perceiving pain. Even diagnostic imaging does not definitively show the source of your pain, it simply provides a snapshot of the anatomical structures that could potentially be causing pain (see infographic below). The examples previously highlighted show how the brain can perceive pain and other “things” in the absence of a meaningful stimulus, but also realize the opposite is true: the body may NOT perceive pain despite the presence of a pain-generating stimulus- like a snake bite.

 

 

 

With this in mind, I’d like to encourage you to keep an open mind when a healthcare professional expresses their opinion regarding your pain. Take phrases like “bone-on-bone”, “degenerative disc disease”, “spondylosis”, “pinched nerve”, and “herniated disc” with a grain of salt. To be clear, I’m not arguing that these conditions don’t exist. I'm not arguing that these conditions aren't extremely painful. I'm also not arguing that pain is "in your head", so to speak. These conditions may in fact be present, but your brain’s response to phrases like these can have a profound impact on your pain levels. Sometimes that impact is enough to avoid surgery, but sometimes surgery is the best option (as much as it pains me to say that!). But surgery can be avoided in many cases by receiving an accurate diagnosis regarding your pain triggers, and learning how to avoid those pain triggers in your daily life. Therefore, it behooves you to do your research regarding your diagnosis, ask your healthcare provider thoughtful questions, and obtain multiple opinions if possible. 

 

 

Dr. William Richardson is a board member and program director for Work Out Help Out. As a licensed physical therapist, William has extensive knowledge about the human movement system and is passionate about joining exercise and volunteer service to change the health of the nation.

 

 

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