I’ve spent a lot of my life sick, and a fair bit injured. In my twenties I spent 3 months in the hospital all in one go. When I left I weighed 90 lbs and could barely walk. (Full details here.) I’d had back issues in hospital (sacroiliac joint) and about 6 months later, I picked up some boxes and moved them about 50 feet. No big deal. Went to bed, woke up next morning, and the least movement would cause my lower left back to clench in the most excruciating way. It wound up that the fire department had to break down the door to my room (I was living in a moderately unpleasant rooming house), sheet pull me and take me to the hospital.
Over the next six months I saw plenty of doctors. One thought I was faking (and to this day I hate him with a blinding passion—I could barely walk, couldn’t sit down, couldn’t get out of bed without excruciating pain), the others gave me a variety of anti-inflammatories and muscle relaxants, none of which had an noticeable effect. Finally I found a doctor who wasn’t paranoid about pain killers and at least gave me a prescrition: she was 7 months pregnant.
I was amused, but not happy.
Over time it fixed itself. After about 6 months I could get out of bed, bend over, sit down, put on shoes, etc… without the expectation of major pain. Still inadvisable to do any manual labor, but I did some, because I needed the money, and I paid for that money with agony.
After a few years, it resolved itself.
About three weeks ago, the day after a heavy lower back workout in the gym, I was out for a walk. Stepped off a curb, twisting slightly as I did, and felt the left lower back go: felt it clench up agonizingly, and my left leg lost almost all its strength. I dropped into a squat with my feet together, to take pressure off my back, steadying myself against a lamp-post. Gingerly stood up. Found that I could barely walk, but that I could barely walk. Found that the least jostle or bump would cause the muscle to clench agonizingly.
I was about half way to the local farmer’s market. Because I’m cussed I walked the rest of the way, then walked home. That night I went to bed with codeine, a phone, and a book next to my bed, in case I couldn’t get out of it.
I could, but it was a long and painful operation.
I suffered for about a week, then I had an appointment with my naturopathic doctor. He said, “I have no idea what’s wrong, I want you to see this sports therapist.”
Next day I walked in to see that sport’s therapist, who has worked for multiple professional teams. Within 5 minutes of meeting me, he said, “the muscle in your lower back which attaches to your lower spine on the left side is in spasm, protecting your spine’s curve.”
A diagnosis! I went to a pile of doctors in the 90s—not one of the diagnosed what was wrong with me. Not one of them sent me to a physiotherapist, sport’s therapist, chiropractor or even a decent massage therapist. (And one of those doctors was a rheumatologist.)
The sports therpaist does some massage, using elector-accupuncture to try and tire out the muscle so it’ll relax so that magnesium can get into it so it can relax more.
Minor results: I felet a bit better. Second session didn’t seem to do anything.
So I lookedup a chiropractor, searching online till I found one who seems to deal with such problems and sounds competent. Dr. Kevin Ho. I go in, he looks me over, he tells me my hips are misaligned, so the muscle is, in part, in spasm to protect the spine from my right hip pulling it out of alignment.
He goes to work, tells me to see the sport therapist to wear out the muscle: next day I don’t feel much better. I go see the sport’s therapist, he does his thing.
The next day (today) I feel vastly better. I can put on shoes and pants and underwear without the expectation of agony! I go see the Chriopractor again, I ask him how much of the hip alignment he had corrected in the first session.
“Oh, about 50%, but you’ve lost 15% since then.”
Now this is interesting to me, because some time ago I saw a chiropractor regularly, for about a year. In that year, I do not recall him making as much progress as Dr. Ho has made in, oh, one session.
He works away, by the time I leave, I can bend over more than twice as far as when I came in.
Now what’s interesting to me about this (other than not being in so much pain, which is of great interest to me, but probably much less to you) is that these guys, between them, appear to have diagnosed what is happening and why, and gone a long way to fixing it when a pile of doctors before couldn’t even diagnose it, let alone fix it!
(And I left out the massage therapist on Sunday who made it worse.)
But this does accord with my experience with doctors: most doctors are mediocre. They do what they do, which is hand out prescriptions for a few problems they see regularly, they are horrible diagnosticians, and they do not care. As with most people working in any field, about 9 out of every 10 is a drone, barely competent, doing the bare minimum not to be charged with malpractice.
About 1 in 10 is actually good, knows what they are doing, and doesn’t work by rote, but can actually diagnose and fix problems.
(And about 1 in ten of the good ones is more than good, is brilliant.)
This seems to be true of healthcare practitioners in general. Over the last few years I’ve had maybe two dozen massages. One of those massage therapists was brilliant, a couple were good, and that’s it. The brilliant one was taught by her father, a blacksmith, and at age 50, as part of her two hour fitness routine, started with 20 pull ups (most marines in their 20s can’t do 20 pullups.) If you had, say, a headache, when you left it was almost gone and two hours later it was gone completely: guaranteed. She regarded your problems as a personal affront to be healed.
When I was young, to me a doctor was an M.D., and if I needed to see someone else, I figured the M.D. would refer me. As I’ve aged I’ve learned that for body mechanics issues most M.D.s are worthless, and that most physical therapists are mediocre, but the good ones are amazing. I’ve learned that, in fact, alternative medicine often has the people who can actually make you feel better, but that most of them are mediocre too. I’ve learned that if you want a doctor to actually sit down and listen to your symptoms and history, you’re going to have to pay for that out of pocket, even in Canada. Traditional Chinese Medicine is FAR better for something like Eczema than anything western Medicine has, and so on.
We have, for one thing, too few doctors right now. They are actively scared of seriously sick people, because they have to push you out the door in fifteen minutes. This is supply and demand, we need to have more doctors, they will also cost less. We have systematically chosen doctors for their cold manner for decades, because people who cared would “burn out”. Going to a TCM doctor from China was a shock to me, he looked at my skin and made what sounded like genuine sounds of sympathy: he seemed to understand it was painful, and care, in a warm, human way. I can think of maybe two M.D.s who have ever given me that feeling.
The Skeptics movement are a bunch of authority worshipers. A lot of alternative medicine does work, and they do not apply their own skepticism to standard medicine: where if you get all the studies for many medicines you discover they are little better than active placebos in many cases, only work for a minority of the population when they do work, and have nasty side effects besides. For many illnesses regularly treated with powerful neuro-active drugs, exercise is as effective, or more, and does no harm, besides. We should be prescribing a lot more exercise, for those who can stand it, and a lot less drugs, and we should be looking at drug trial results with a great deal more skepticism because many of them are badly designed and the ones which fail are generally not released to the public.
We should also be doing far more research into why some drugs are very effective only for a minority of people with the condition. What are the markers that determine such effectiveness? And we should be completely cleaning up our food system, because the reason we have so much illness is bad diet and no exercise in far too many cases (plus various forms of pollution.) Healthy food costs more, but we are subsidizing unhealthy food, and paying for it on the back end with illness and the costs of illness.
But to bring it back to the first point: most healthcare practitioners are borderline competent, and only a small minority are actually good. Throughout my life I’ve seen that this is the case. When you’re looking for a competent one, look for one of two things:
1) someone who takes your disease or injury as a personal affront, to be defeated at all costs, because Goddamn It, no fucking disease is going to beat them; or,
2) someone who manifestly cares and wants you to be better, because they hate seeing you suffer.
Absent caring in one of these two ways, very few healthcare practitioners are any good. They fall quickly into a rut, giving out prescriptions or doing treatments just to get through patients, through the day, and back home.
If your doctor or therapist doesn’t care, either about you or their own pride, get the hell away from them.
steelweaver
Great post! And, speaking as a healthcare practitioner, a timely kick-in-the-butt reminder to get my routine of daily study and training back on track so I can help my patients better.
David Kowalski
My uncle was an excellent diagnostician as a local general practicioner in a small town in the coal country of eastern PA (Glen Lyon). In the 1960’s he sent patients with problems similar to yours (and other muscle problems, maybe a lot more) two and a half hours away to acupuncture treatment at Rutgers. I had heard of accupuncture, of course but circa 1966 or 1968 it was not in widespread use. It worked for a lot of his patients.
He sent other patients to the University of Pennsylvania Hospital in Philadelphia, also roughly a 2 and a half hour drive at 2 hours and 21 minutes per MapQuest. They were able to handle more serious or unusual medical issues although they often found that “Doc” was right. His obituary includes a quote from a doctor at the University of Pennsylvania that makes Uncle Stan sound like Dr. Greg House (from TV), he was always right and sometimes we couldn’t figure out hoe he came up with the diagnosis.”
The man unfortunately was involved in politics flipping from the Democratic Party to the Republican Party and back to the Democrats again. He got elected County Commissioner once but his big mistake was accepting the job of Commissioner of Health from a man he had helped to elect, particularly in the primary. Uncle Stan clashed with the Governor’s office as he clashed with many in authority. Governor Shapp, a Democrat. who had ambitions of becoming President not only fired him but prosecuted him as well. Uncle Stan took a plea bargain, paid a reasonable fine, and no longer participated actively in state wide politics.
Shapp wasn’t so crazy. Lawrence served four terms as Mayor of Pittsburgh and only one as Governor. Uncle Stan at least pictured himself as a player in Lawrence’s downfall, switching the anthracite area (Scranton-Wilkes Barre) against the Governor. Don’t know if that was an overstatement but he was the leading player in Luzerne County (346,00 people in 1960).
The point of this is that great diagnosticians get it. Maybe outsiders don’t understand the “logic” but it is both intuitive and global within their specialty or sub-specialty. Being able to understand the problem but not being able to communicate the reasons makes one a great insurgent (you know the levers of electoral power and how to use them) but terrible at elected or particularly appointive office. You just become a stubborn SOB who so happens to be right almost all the time.
One of the levers of electoral power is to get those who don’t vote out for elections. Primaries are usually low turnout affairs so (as the TV movie version of LBJ said in LBJ: The Early Years, “I got my people out of the hills to vote for me. They really came.”)
Jeff W
Thanks for sharing a fascinating personal story (in making a larger point). It’s terrific that you got an accurate diagnosis that you can act on.
So what happens now? Several trips to Dr. Ho? Therapeutic exercise? How do you deal with the hip misalignment or correct it long-term, if possible?
Bill H
My father was a physician of the type who would not send a bill to a patient if he knew the patient would have trouble paying it. Patients loved him, as did nurses he worked with. He invariably failed financially in private practice and reentered the military, because he made people well and seldom got paid for it.
My present cardiologist, the least bad one I have been able to find, but necessary according to my primary given my history of two heart attacks and several unresolved arrythmias, responds to my description of symptoms with, “it usually it happens differntly,” I manage to resist telling him to fuck off, and continue to see him once per year to keep my primary doctor happy.
Ian Welsh
Dr. Ho seems to think he can correct most of it with chiropractic adjustments and some muscle exercises. We’ll see, but so far he’s been doing a good job.
David
Not too long ago I had lunch with woman who was the dean of major
medical school. I asked her what motivated her to become dean and she
said it was to do what she could to raise standards. Her motivation was that her husband died at age 27 from what she now knows was incompetent care and she
wants to minimize the chances of that happening from the schools graduates.
I asked her how does one recognise a incompetent doctor and she said pretty much
what you said and to also beware of a doctor who does not listen or explain.
Ian, I wish you a speedy and complete recovery.
guest
I don’t think even those two guidelines you offer are that great as far as finding good practitioners (it sucks when you find them and they move or you move). I would add, keep an open mind, be sceptical, and readreadread up on lots of different approaches. A lot of people pick some approach, like ayurveda, and then they become blind followers of that like a religion, despite what the results say. I say try it out, see what commonalities it has with chinese medicine or homeopathy or whatever.
For me, I love accupuncture just because it is so cool to feel the energy in the meridians or whatever else is going on. But of the few accupuncturist I’ve been too, only 1 was really really good. Also, for massage, nothing beats tui na/tuina. But myofacial release can be really good too for really tight muscles. And for excercise, screw yoga and try the kung fu stances and forms of mei hua zhuang. Kung fu is much more dynamic than yoga (even when it is static, like in stances). It’s not just about stretching tight muscles (which seems to be all yoga does), it is even more about strengthening them so you have much more range of motion in the hips, back (twisting more) and shoulders. But opening up tight hips is a long slow process.
guest
PS I should add that I have been going to chiropractors and massage therapist over the last 20 to 30 years (as funds would allow, sometimes going without for years, but more often now that I’m old and can afford it). I never had horrible back issues, but 4 months after I started kung fu, I stopped needing to see a chiroprator again.
I wouldn’t go to an accupuncturist for back pain. They can help, but acupuncture affects a system that is so subtle, I would look for more drastic means. Also, for accupuncture, you need to read up on the relationships of the organs and the way energy moves around the body, and try to understand what is going on and what you and your body are getting wrong as far as diet and stress and lifestyle. I haven’t found a new accupuncturist, but if I do, it would be half for general health issues (colds, coughs, stomach problems, digestion, or whatever) and half just out of curiosity to learn more, firsthand
Celsius 233
Fortunately I grew up in a house that had vast experience with the medical profession. My younger brother was born with a cleft lip and palate, glaucoma, and a hole in his skull (it didn’t close as is normal). My father was in pharmaceuticals (that was before they went shit).
I interviewed my potential doctors. Answer my questions or you’re history.
My last doctor (a GP) (before I left) was a Seventh Day Adventist; his first question when I met him for some tests was, how do you feel? I knew I had the right guy. We had a great 10 year relationship. He practiced good medicine. He actually gave a shit.
After a number of bad experiences in my new country, I found another doctor who practices good medicine; she is a gem.
atcooper
I’d like to chime in with my own short anecdote about alternative medicines. I’ve long suffered from depression and anxiety issues. About two months ago I started Vipassana meditation, and it has worked better than any therapy or medication ever did. Before, it was like bees constantly buzzing in my head – now I can think clearly, or at least much more so than before.
someofparts
guest, or others with information – could you recommend any good reading material on acupuncture, homeopathy, chriopractic, naturopathy?
Ian – glad to hear you are okay – sorry for all that you’ve been through – wish I lived close enough to be a helpful old neighbor
tw
I have had quite a bit of experience with this very topic. You are correct that finding great practitioners is difficult, but there are many out there in all professions. I think the primary issue is the expertise in their one area with a lack of knowledge beyond that. Any practitioner that has a wider view is going to be more resourceful and better at getting a favorable outcome.
Having a structural back issue I can empathize with your dilemma. I would recommend finding a specialist in ART which is active release therapy. Up here it is a branch of chiropractic medicine. Find someone who deals with professional athletes. If you are not receiving this from your chiro already, this additional step could be what you need. I have used this for nearly a decade, and it allows a high level of sport (mtb and downhill skiing plus training) and virtually pain free 95% of the time.
Just keep in mind that art breaks down scar tissue that may have developed over many years so initially several visits may be necessary. After that you may have maintenance only. I go maybe once every 6-8 months unless I develop another periodic (non back) injury.
markfromireland
You’ve just described my friend (and mentor) Maryam the Iraki pediatric oncologist about whom you wrote in your ‘comment thread everyone should read’ posting. She takes any illness in any patient as a personal insult to be ruthlessly dealt with.
Glad to read you’re feeling a bit better.
mfi
someofparts
MFI – Thanks for your reading suggestions. Printed out and read your own talks. Also just finished Warriors of God, Nick Blanford’s terrific book. Much appreciated and I mean it to be just the start of continuing to learn more.
Dan H
Id add a third thing to look for with any medical practitioner, which you already sort of mentioned. Find out what that practitioner does for their own health, ie what specific exercise regime do they follow and what is their take on dietary importance. We have a good chiro who trains BJJ at our school…lots of business for him; and experienced, targeted treatment for us because he understands exactly what we go through. Im also going to recommend BJJ as an exercise regime. It is easy to go overboard, and I cant deny the likeliness of inuries. But getting twisted up can be a great acute stressor.
Matt Stoller
When I started really exercising on a regular basis, roughly five years ago, I began to realize that injuries are a fact of life. The only way to not be injured is to not exercise, but that just means your body deteriorates in much more harmful ways.
The reason I was finally able to start exercising is because I had an actual personal trainer for a year who helped me work out. When I was a teen, I got injured a lot whenever I exercised, and I went to physical therapy or doctors to get better. The therapists gave me shitty pointless exercises that didn’t help, and then told me I wasn’t doing them right and I needed to keep seeing them. The doctors could never diagnose what was wrong, but wanted to do back surgery anyway. I refused.
My trainer wasn’t great at getting me into shape, but he was an athlete and so he knew how injuries worked. He taught me that, say, when your shoulder gets hurt doing a certain exercise, the best thing to do is rest it, and then experiment with ways of lightly working it out until it got stronger but didn’t hurt. I went to doctors who took x-rays and clearly just didn’t know what they were doing. They couldn’t help me. Eventually I was able to learn to manage my body, and that’s where I am now. Western medicine has its place, it works great in certain ways. But it sucks at dealing with pain and things that have to do with lifestyle and exercise, ie. things for which there is no profit to the medical-industrial complex.
This is another way of saying that the practical person with ‘horse sense’ was a far better option for me than the expert. It’s like talking to an actual foreclosure defense attorney who deals with the court system about systemic solutions versus a housing economist. The economist doesn’t even know what he doesn’t know.
RJ
I’ve had a fair bit of experience with doctors as well and I think you’re precisely right (also w.r.t. other professions too).
I had an 8 hour surgery back in 2005–abdominal, highly invasive–to remove a cancer site from some lymph nodes. My surgeon was great and everything went fine during the procedure. Afterwards, they put me in a corner room where I would be recovering for the next week or so.
When the surgeon found out which room they put me in, he immediately and forcefully insisted that they move me somewhere else. We were confused at the time about why, but a nurse later told us the story: The surgeon had lost a patient in that room some number of years back and was still so shaken by it that he never allowed any of his patients to be in that room again. Of course he knew that the room didn’t do it, but it was so traumatizing to him that he couldn’t bear to use the same room again or to even be in the room for any length of time.
Another example: About two years back I was having some odd, chronic muscle pain around the perineum area. Since my cancer had somewhat involved this area and there were some complications in healing from my surgery, I was afraid something was going wrong with me. My general MD doctor saw me, ran a couple quick tests (bloodwork, phsyical exam, etc.), didn’t know what was wrong and basically told me to come back if it persisted. Ugh. It was getting to the point where cumulative sitting during the day was becoming excruciating.
My oncologist is a great guy and I have his personal cell number (he gives to all his patients). I called him up to try to get a referral from him and ended up leaving him a voicemail describing my problem. He calls back the next day, asks me a question or two, and tells me that my pants are too tight. And he was right. I was pretty embarrassed that it was so obvious, but I’d gained a bunch of weight over the past 6 months without noticing and my pants were cutting into my waist, unexpectedly doing something to the muscles much further down…
But the real kicker is that he just asked a couple questions over the phone and knew exactly what it was–and he’s a specialist, not someone who I’d expect to figure out that my pants are too tight. My general doctor saw me in person, did a whole bunch of tests, and, as a generalist, had no idea what was happening.
alyosha
As someone who’s fortunately only rarely had to use doctors and the like, I really appreciate these insights/conclusions into a world I only dimly understand, but as I leave middle age, am ever more likely to need.
That said, I’m about to head off to a great chiropractor, who I just lucked onto by chance. There was the initial point of confusion in my injury – something I did to my shoulder – where I wasn’t even clear about who to see (a regular MD, a chiropractor, a massage therapist, just ride-it-out-and-it-will-get-better?).
What I love about this guy, and what I’ve read elsewhere, is that great doctors and medical people are great diagnosticians. They will take the time to get your history in detail and figure out what’s going on. This is practically impossible if all they can give you is a 15 minute time slice.
RayS
Old joke: “What do you call the guy who graduated last in his class at med school?”
“Doctor”.
I understand where you’re coming from and sympathize. All too many professionals – including doctors – have a one-size-fits-all mindset. A good diagnostician is to be cherished.
My wife has been in chronic pain for 35 years after being run over by a Mercedes. Many operations, much joint damage, arthritis was aggravated, three total joint replacements, etc.
Chronic pain changes the body at the cellular level – what’s unpleasant to me is painful to her; what’s painful to me is agonizing to her. Higher doses of pain meds are required than in cases of acute pain. Most MDs don’t handle it well – fear of being labelled as too lenient, many MDs are reluctant to prescript pain killers.
It has taken us 15 years and a couple dozen docs to find a genuine pain management specialist (as opposed to several anesthesiologists who moonlight as pain specialists). For the first time in the last 35 years, her pain is tolerable. Not gone, but tolerable – on a good day, it’s at 4-5 insted of 7-8, and her mobility and activity is still sharply limited.
Dan H
Also a good, easy question for a doc: sleep recommendations. Any one not stressing the dire importance of 8hrs/night minimum is a capitalism addled quack.
Theo
I sympathize with you and support your assertion that so many of us don’t care about the pain of others. As it is obvious in our politics and conditions here and around the world, so it is in the medical profession. Lack of empathy on the part of human beings is our major problem. With it, we can collectively solve our problems or at least ameliorate them. Without it, we are defeated. Empathy involves not only the imagination to enter into the lives of others but to recognize the forces and conditions that have contributed to the people they are and to recognize our own actions that may be, and very often do, contribute to the situation in which they find themselves.
As to pain, I have been in chronic muscular as well as arthritic pain since my early teens. It grew exponentially after surgery for cancer. And throughout my life I have been subject to muscle spasms and know they are excruciaating. After surgery I had tremendous back pain that radiated up and down my back and my upper back and neck especially. I have read that some pregnant women never rid themselves of the pain caused by an epidural delivery. That experience and my experience with chronic pain/fatique syndrome (which is real) lead my oncologist to prescribe morphine sulfate ES, 30 mg, twice a day every 12 hours. It does not get rid of all the pain and its effect tapers off after, say, nine hours, but alleviates it to such an extent that I can cope. Some days it doesn’t work as well as it might, but I have never abused it and it has never given me a high. I have also read that testosterone may have an effect on the experience of pain and may help to alleviate it. Although that may be true in some cases, it sounds demonstrably untrue in your case and perhaps is not true after all. Just another unproved theory. It may be, just as with so many things, pain is not fealt by all of us in the same way.
As to your comment regarding pharmaceuticals in general, I remember reading a few years back the remarks of the head of Glaxo Wellcome (now GlaxoSmithKline), the pharamaceutical/health firm, that most of the drugs used in treatment do not work in all people in the same way and in some people at all. And some are allergic to certain drugs. The implication of his remarks is that we should not believe that every drug will help us, as they so often do nothing at all for us and in some cases kill us.
I have written to reporters from time to time telling them of my situation in response to their pieces on the rise in use of pain medication, obtained legally or illegally, to tell them that there are many reasons for pain and that we have a human right to have our pain treated. As I never received a response, I don’t know if the emails were even read.
I too believe that the poisons in our atmosphere, land, water, the products we use, and heavy applications of insecticides and herbicides on the food grown under these conditions, and the use of GMO in certain cases are adding to our discomfort, and causing a great part of the illness we are now experiencing. I would add to these the psychic pain caused by political and other rich elites who refuse to deal fairly with most of the populations of their countries and would easily see them starve in the hedgerows to use an old expression.
Our country makes the need for and administration of pain relieving drugs into a cause for moral censure–as the destructive war on drugs attest–so pain goes untreated or under treated for people who need it most and people are made into criminals for needing to obtain some relief from the psychic or physical pain of their lives. I have read results of research that show that the pain of women and nonwhites of both genders often goes untreated. Prejudice against individual patients, whether males or females of whatever race, drives this. One of the inconveniences of this mania for drug control is that patients must submit prescriptions in person to a pharmacist and produce their idea of valid ID, no matter the age or condition of the patient or difficulty traveling. I have had five surgeries and luckily have had doctors who were unafraid to treat pain, and I have dealt with both doctors and nurses on call in hospitals who were singularly lacking in empathy and seen the physicians of other patients similarly situated as myself given Tylenol if that. A dentist I visited recently for an extraction was taken aback that I was on morphine and had no intention, he said, of prescribing any thing further, which I hadn’t asked of him anyway.
Another major problem is that pain medication as simple as morphine is unavailable to most of the world’s suffering people, while in the west, in which it is abundantly available, it isn’t always given to out groups, and I assume never to those without health insurance except perhaps at the end of life if they are lucky to be helped by a hospice, and, as you know, that doesn’t happen very often. Women go without help for the pain of childbirth and the victims of wars waged by America go without succor in most cases.
Best to you and here’s hoping you will never experience such agony again.
EGrise
While lack of empathy certainly plays a part, another important part is that the DEA has spent a lot of energy cracking down on physicians who “over-prescribe” (whatever that means) painkillers. Many legitimate doctors (or the organizations by whom they are employed) are very reluctant to give out anything more potent than Tylenol lest they get a visit from the feds (the ones too incompetent/chickenshit to go after drug cartels but are more than happy to roll into a suburban clinic with their machine guns and body armor), so too bad about your suffering.
Or maybe it’s just the case that the lack of empathy is more widespread than we realize.
Mandos
How weird am I as a person if I say that I like my medical practitioners somewhat impersonal? I don’t care if they appear particularly caring. I do want them to understand that I am mostly capable of handling medical/scientific terminology, though, and want to be spoken to like an educated adult.
Celsius 233
Mandos
December 12, 2013
I do want them to understand that I am mostly capable of handling medical/scientific terminology, though, and want to be spoken to like an educated adult.
~~~~~~~~~~~~
Ditto. I’m not concerned with personalities per se; just good medicine along with effective communication.
dcb
I am not going to disagree with the author, but it would be nice if he had a better understanding of our healthcare system. medical schools and the system train people in a certain manner. hence they get a worldview, and that’s what happens. had he in fact seen the correct doctor for his initial problem. pain specialist and given trigger point injections there is a very good chance the pain may have gone away right away. the reality is most disk pain goes away on it’s own over time, and yeah besides steroid injections we aren’t trained to do much.
the author complains of a problem with Md’s, but also that problem is compounded because the author knows so little. I don’t call an electrician for a plumbing problem.
occam’s razor applies as well, so of course Md’s like everyone in the world is better at dealing with things they see everyday. Like the rest of the world 10% of folks maybe give a damn about their job, but mainly it’s about the paycheck.
I’m a healthcare professional, and also like in most fields people are afraid to say, or won’t admit they aren’t sure.
Go to your sports therapist, or chiropractor when you get pneumonia and what would you think of them? The only problem your md’s may have made was not suggest sports therapy, or a chiro guy themselves. Md’s prescribe antibiotics for viral infections when they often know it won’t do anything. tell the patient you don’t prescribe something and they find another doctor who does.
more reality is you got the treatment you’d get from someone educated in the system they did. is the md supposed to do chiro, sports therapy, acupuncture. they are all different modes and models of treatment.
if the problem was a small tumor on the never and it didn’t get better with the chiro guy, and sports guy would he be attacking them?
Not very enlightened or educated view
McMike
Trying to engage most practitioners is very much like trying to talk to people about the economic bubbles… in 2006. You get a lot of blank stares, and not a little hostility.
Most people are mediocre, and why not, this is not Lake Wobegon after all. More so for doctors, they are in fact terrified of that reality. They are faking it. And they have been told they must be God.
So, like alcoholics who learn how to walk without bumping into things. Or amnesiacs in movies who write important notes on their arms as compensation. They fall back on their facade of infallibility, and rely on their scripted rituals of diagnosis/prescription. The stakes are very high for Doctors of course, so the requirements for faking it are that much more intense. In addition, the system punishes them for getting curious, for taking time, and above all for taking risks. They is a very high price for getting it wrong. [I would assume that Medical school in fact shows the door to anyone who takes a risk or goes off script]
There is an easy test though, when I see a practitioner, I simply interrupt their script and ask a hard question, one that shows independent thought. They either get flustered/ ignore me/ or show a flash of hostility… or they pause and genuinely engage with me. That reflex reveals a lot.
Truth is, you could have written the same post about auto mechanics, or journalists, or cops, or university professors. It’s a complicated world that comes down hard on making mistakes and highly rewards those who act like they know what they are doing. People with genuine curiosity and a willing to take creative risks are in the minority. Personally, as a business consultant, I have had to learn not to think out loud, or admit that a problem has me stumped.
Fake it till you make it.
Try being a vaccine skeptic, and learn how fragile the facade is, how intensely it defends intellectual its fiefdom – even as the lies and entropy is undeniable. It’s not unlike being a Nader voter at a DLC fundraiser.
Sara K.
This reminds me of a story my friend told me.
She started constantly throwing up everything she was eating. She went to many doctors, some of whom assumed she had a eating disorder such as bulimia (she did not, by the way), some made her take expensive tests which did nothing to explain her sickness, and others who had no clue.
After a few weeks, her body was in bad shape since she was essentially unable to benefit from the nutritional value of food, and one of her symptoms was dizziness. After she described her dizziness to a doctor, the doctor prescribed a drug to treat dizziness. She explained to the doctor that her real problem was that she couldn’t eat food, and that the drug wouldn’t solve that problem. ‘But … you feel dizzy’ was the doctor’s response.
Finally, she met a doctor who said ‘I think you might have a food intolerance. Let’s put you on a diet which has as few possible allergens as possible’. This was the first hypothesis which made any sense to her, and as it so happens, eating a low-allergen diet is a fairly cheap test. Lo and behold, after she started eating the restricted diet, she stopped throwing up, and body recovered quickly because she was actually eating again. After that, the doctor suggested adding foods back to her diet one by one so they could isolate the problem. Over the following weeks, they did so … and she started throwing up again when dairy was added back to the diet. Thus he intolerance to lactose was diagnosed.
aliena
I had kind of same symptoms for years, excruciating pain in the lower back and SI joints, same bad luck with regular MD.
Turns out it’s Lyme disease. As a test, take some teasel root and see if it starts an Herxheimer Reaction.
A good website and a good herbalist:
http://buhnerhealinglyme.com/
Other websites:
Teasel Root and Lyme Disease
http://www.tiredoflyme.com/teasel-root.html#.Unz0ghDfJ8E
Endotoxin
http://www.tiredoflyme.com/endotoxins-and-lyme-disease.html#.Un0AvxDfJ8E
The Jarisch-Herxheimer Reaction (Herxing)
http://berkshirelyme.blogspot.com/p/jarisch-herxheimer-reaction-herxing.html
allys gift
What’s so interesting about the elimination diet story above, is that no one needs a doctor to tell them to do this. The doctor, with all her years of medical school and multiple initials after her name, adds an air of authority. We have credentialed and monetized knowledge that used to be folkways, or common sense, or serendipity, or curiosity. In other words, we now pay people for things no one ever used to pay people for, and thus, we have become less free, relying on money rather than ingenuity.
Richard Clyde
I recently had a conversation with a medical specialist in the Canadian system, in which he cheerfully described spending a day being wined and dined by three pharmaceuticals who were seeking to market a new drug. There was no problem or conflict of interest, he explained, because all three companies had an equal chance to sell him on their product. He further explained that, as he was a “thought leader,” less experienced specialists in his field would observe and copy his prescription decisions as a guide to best practice. The circumstances called for politeness, so I avoided making any comments.
marian
Interesting article. Quick comments
1. Having the same back issue you describe, I have had a lot of relief using a small lift in my right shoe. You might check with your doctor to see if this might help.
2. Doctors are highly variable in my experience. I don’t care if I like them or they like me or if they cheat on their wives or taxes so long as they are good at their job. The best way to tell the good from the bad is somehow to get in touch with the hospital nurses. They always know. You can either link up through family members or if you can’t do that ask who they or their family members go to. In our town there was one fashionable doctor who had been killing people for years—everyone but the nurses went to him.
3.. Alternative medicines have a lot to offer, but again you need to find the right practitioner. They are even more variable than doctors, if possible.
Good luck!
Ian Welsh
In the Canadian medical system you are expected to go to an M.D. He or she will then refer you to the specialists you need. That is how the medical system works in Canada. I am very aware of how the medical system works, thanks.
Note also that a rheumatologist should be able to accurately diagnose such a problem.
A smart practitioner, faced with a problem that they are not trained to deal with, will know so and move you to the people who do know how to deal with it. Faced with something they can’t diagnose, will refer you to someone who knows how to diagnose.
That is how the system is supposed to work, and that is how doctors are trained.
subgenius
@someofparts
As far as TCM goes, Ted Kaptchuck’s “The Web That Has No Weaver” is a classic for an overview. If you want a look at the state of the art in western terms, D. Kendall’s “The Dao Of Chinese Medicine” is a winner.
“Anatomy Trains” by T Myers is also an interesting book wrt the kinds of problem that Ian describes.
A lot of lower back issues arise from foot/knee/hip misalignment. The arch of the foot and the achillies tendon should act as springs, but they often don’t in people in the west (no walking, too much time in chairs) and the impact gets transmitted into the hips and lower spine, causing problems. Same thing (but much greater forces) in heel-strike runners (which is why there are barefoot running aficionados in ever growing numbers).
Walking a lot with conscious effort to find and keep correct alignment is a way to sort it out. Barefoot is better than shoes. If you don’t let the heel strike the ground, sort of walking on tip toes but not as extreme (only allow the ball of the foot to hit the ground) the muscles that give the foot it’s form will slowly strengthen and adjust so the foot “fills out” and the improved alignment resulting ripples up the body. But it takes a lot of time (think year+)
If you suffer fallen arches the above strategy can slowly rebuild the arch – if you use wedges in shoes the muscles continue to weaken. Instead the above practice with an emphasis on a feeling of lift from the arch up the inside of the ankle and lower leg will start to retrain relevant muscles.
David Kowalski
Just a quick add on, my current doctor is a specialist in heart failure and heart transplant. He does care. The only time Barbara, my significant other saw him run, was when things turned bad on me in a hurry while I was in the hospital. he’s personally done 450 heart transplants and his hospital has done, over 600, third most in the nation.
Just as a follow-up. Ian I am finishing my first round of doctor, test, and evaluation appointments and the heart transplant still looks like a go. it should add at least 15 years to my life and maybe as many as thirty. Good medicine is a wonderful thing. Bad medicine sucks.
Jeff W
marion’s comment
is a really good one, Ian. In addition to the sports therapist and Dr Ho are doing, a good physiotherapist may recommend an orthosis, if needed, or some other therapy that might supplement what the other practitioners are doing. I think it might be worth checking out.
NP
I don’t take issue with the premise that most people in probably any field suck at their job and are just going through the motions, and often misdiagnose or ignore things. Or that most doctors have poor bedside manners and a lack of empathy. I’m currently dealing with this myself, as my dad recently had a stroke and will be more or less a vegetable for the rest of his life.
What I do take issue with is that anyone skeptical of alternative medicine is an “authority worshiper”. It’s really not unreasonable to ask for proof when people claim to be able to cure illness, especially when that is almost surely followed by charging money for these services. Often a lot of money.
Since traditional Chinese medicine appeared prominently in the main post and in the comments, I’ll remind everyone that traditional Chinese medicine is why endangered species are being slaughtered, bears and other animals are being tortured non-stop, etc. etc. etc. All because some guy in Beijing mistakenly believes ground up tiger testicle will help him get a boner. Does it make you an authority worshiper to not think this is ok at all?
And everyone is sharing anecdotes, so I’ll share 2 famous ones and then a personal one. Bob Marley and Steve Jobs both had treatable forms of cancer, but rejected modern medicine in favor of alternative medicine. Both ended up dying, whereas they probably wouldn’t have if they had gone in for modern western medicine while they still had time.
And now for a personal anecdote. A female coworker of mine and her husband had been trying to get pregnant for almost a decade. She eventually became very depressed about the situation. In those 10 years, she and her husband spent a lot of time and money on every alternative medicine solution they could find, but to no avail. Eventually she went to a regular, modern doctor who prescribed a fertility drug. BAM. She got pregnant the very next time they tried.
My view on alternative medicine is that of Tim Minchin: http://24.media.tumblr.com/tumblr_m7bovcH63y1qa64bjo1_500.png
That said, bedside manner counts for a lot in stress reduction, and the placebo effect is often a very real thing.
Ian Welsh
For every horror of TCM, I could raise you a hundred horrors of modern pharmaceutical medicine. And for every person who has died doing alternative medicine for cancer (which I don’t necessarily recommend), a hundred have died while doing chemo–and been butt fuck miserable due to the chemo while dying. I’ve seen what chemo does to people far too many times, up close and personal.
Each treatment modality must be justified on its own merits. The evidence for much of modern pharma is extraordinarily weak, beyond a few key drugs (sulfa drugs, antibiotics, maybe 18 others).
But go ahead and keep giving kids stimulants for ADD, in geometrically larger numbers.
Ludicrous.
(China’s state medical system is in large part TCM, by the way, and there are plenty of peer reviewed papers on its effectiveness, in Mandarin. You know how to read and right Mandarin, right?)