He does sound like a jerk, a bit. But there's something that I fairly often want from a doctor, that sounds like what he's trying to say, that seems socially difficult for them to clearly communicate: "Yes, you're sick. From examining you, I'm pretty sure I know what's wrong. There's not much I can do in terms of treatment, but this is the sort of thing that resolves on its own in about [whatever] amount of time, and it's generally not something you're going to need to worry about long term. Doing X,Y, or Z might make you feel better, but if they're not working for you, don't worry about it."
I mean, there's lots of things where a doctor isn't going to do much for you, it's just that it's reasonable to want a doctor to tell you whether whatever you've got falls into that category.
The phrase "we need to stop medicalizing symptoms" irks me. They're symptoms! It makes it seem like symptoms shouldn't be brought for consideration. If he said, "we need to stop over-treating symptoms" I'd be more sympathetic.
Why the fuck wouldn't you take a pill if you are going to be active? Pills for temporary relief of pain work pretty well.
It doesn't sound jerkish at all. "We," presumably includes doctors: not every symptom indicates a problem that requires the intervention of a doctor or pharmaceutical.
The article could well be a summary of "Healing Back Pain" by Sarno, which might have been fringey once upon a time, but seems to have been borne out entirely.
My brother and sister both suffered from terrible back pain. My sister chanced upon Sarno's book (this was about 25 years ago) and sent it to my brother. They both bought into his thesis and have been much better ever since.
"They have to believe their life can get better," Dr. Standaert said. "They have to believe they can get to a better state."
Sorry to make this a politics thread but hahahahahahahahahaweeps.
The basic premise is sound. But take the only example in the actual article:
Measures that help patients get back to their usual routines can help along the way, as Sommer Kleweno Walley, 43, of Seattle, can attest. Last spring, she slipped on the stairs in her house and fell down hard, on her back.
"After a couple of hours I could barely walk," she said. "I was in real pain."
She saw a physical therapist, but the pain persisted. Eleven days later, she showed up at the office of Dr. Christopher J. Standaert, a spine specialist at the University of Washington and Harborview Medical Center. She expected to receive an M.R.I., at least, and maybe a drug for pain.
But Dr. Standaert told her an M.R.I. would not make any difference in her diagnosis or recovery and that the main thing was to keep active. She ended up getting anti-inflammatory medication and doing physical therapy. A few months later, her back stopped hurting.
Actually, now that I reread it, this example is dumb. First of all, her back pain is not mysterious. Second, she did start with PT. Third, she only did physical therapy for 11 days before complaining that it wasn't working? Fourth, what ended up working was...PT and advil? and yet this is evidence not to use PT and advil?
Why the fuck wouldn't you take a pill if you are going to be active? Pills for temporary relief of pain work pretty well.
They work pretty terribly for chronic pain, though.
Yes, but if you need to stay active, temporary pain relief makes it much easier.
It makes it seem like symptoms shouldn't be brought for consideration. If he said, "we need to stop over-treating symptoms" I'd be more sympathetic.
Right, this is exactly the distinction I was trying to make less clearly. If you go to the doctor with some upsetting symptoms, and the doctor's response is "Yep, that's a thing, no, there's nothing useful for medical science to do about it, but if you go home and wait for it to get better you almost certainly will," that's a successful and appropriate medical interaction, not you being a hypochondriac.
Anyway, I've got a book that I should write: Everyone Needs Dry Needling Stat. No joke, I'm evangelical now.
(I assume it only works for some specific kind of ongoing muscle spasm, and so I'm not actually advocating everyone get it. But my god was it effective. One single application!)
Can I still make vasectomy jokes or is it too serious for that?
Then he opened me and looked down me, and clutched hold of my wrist, and then he hit me over the chest when I wasn't expecting it - a cowardly thing to do, I call it - and immediately afterwards butted me with the side of his head. After that, he sat down and wrote out a prescription, and folded it up and gave it me, and I put it in my pocket and went out.
I did not open it. I took it to the nearest chemist's, and handed it in. The man read it, and then handed it back. He said he didn't keep it.
I said: "You are a chemist?"
He said: "I am a chemist. If I was a co-operative stores and family hotel combined, I might be able to oblige you. Being only a chemist hampers me."
I read the prescription. It ran: "1 lb. beefsteak, with 1 pt. bitter beer every 6 hours. 1 ten-mile walk every morning.
1 bed at 11 sharp every night. And don't stuff up your head with things you don't understand."
I followed the directions, with the happy result - speaking for myself - that my life was preserved, and is still going on.
11: and if it doesn't work on someone, then you'll know they're a witch!
Glad to hear the dry needling worked!
I don't think Weinstein's advice is bad, but I'm conservatively inclined with respect to most interventions so his advice nicely confirms my biases. And I think he's exactly right about back pain. See the doctor to rule out anything major, but otherwise, it mostly gets better on its own, and exercise usually makes it better. I may be overly influenced by a sports doc I saw when I was 21 after I injured my knee, who said roughly that I needed to have strong muscles so my joints wouldn't need to work as hard. I don't think that's exactly how it works, but it's not a bad rule of thumb.
The trouble is the toxic interaction between the emerging guideline "there are many things current medicine can't do, often the best option is to wait and see" and the tendency to not take seriously the symptoms of women/POC.
16 is right. Send everyone to PT.
I'm assuming backs must be simpler. Because everybody only has one, you don't have to control for intra-subject correlations when you do a model.
Further to 16: Fat people must be extra subject to dismissal of the sort, "Come back when you've lost some weight and I bet the problem cures itself!" and particularly the intersections of fat people, women, and POC.
20: I never felt like that in dealing with the medical system, but then I'm not very burdened by intersections.
OTOH, there was a particular symptom when I was obese that I saw specialists for a couple of times, and got head-scratching and prescriptions that didn't do much, and was somewhat resigned to it absent losing weight, but a couple years later when I talked to a doctor in my weight management program she was able to say "Oh, it sounds like __, here's the prescription" and it worked like a charm.
16,20: Agreed. When I went to the hospital to have Pebbles, the nurse at the desk was polite, but obviously humoring me. I couldn't really be in active labor yet, but she'd get me to a room anyway. (I was 7cm, it turned out.) I'd put it down to one nurse having dealt with too many new moms who come in at the first contraction, except that every time I go to the doctor, which isn't all that often, I feel like they never believe that I'm sick. Like I'm too perky or coherent to be really sick; I feel gaslighted by doctors. (Actual GP is very good about not doing this.)
(Still annoyed at the DO last week who told me to drink herbal tea and eat local honey for a sinus infection, mostly because if I wanted basic care advice, I could Google and not waste time in the clinic, and also, without a suggestion for a source for local honey, that's not actually all that helpful given an industrialized food system.)
Yeah, I don't like this, maybe because I know people whose back pain isn't pain you can just work through. I have low back pain which radiates to the leg right now (also numbness!!!) and have been prescribed PT and no meds, but that's fine because the pain itself is annoying and occasionally makes things difficult, but I can function almost normally. But what happens when the pain is so bad that you can't work, and just moving around the house is exhausting because it hurts so much?
I expect we'll see a continuing opioid problem paired with really shitty, med-withholding behavior that will make people who legit need meds suffer. Being in severe pain itself is bad for your health.
Staying active through pain really aggravated my plantar fasciitis. If I'd have stopped training for the second 1/2 marathon, I'd probably be able to run today.
I'm going to assume my plantar fasciitis hurts about as much as having a baby, since I'm a feminist.
I expect we'll see a continuing opioid problem paired with really shitty, med-withholding behavior that will make people who legit need meds suffer.
That does sound like the kind of "Worst of both worlds" solution at which the US excels.
"Because everybody only has one,"
We know that God considers walking to be twice as important as lying down because we were given two knees but only one back. Thus you should sleep 8 hours a day and be awake for 16. Please buy my book.
Are you saying that God likes us on our knees better than on our back?
I guess a kernel of my religious upbringing still lingers within me, because 28 shocked me.
It was an innocent question, you filthy-minded heathen.
Recently-uncovered texts reveal that none of Gideon's warriors were stomach sleepers.
34, cont'd: Judges 7:6 must have the lowest pornography-to-cupping/lapping/kneeling/slurping ratio of all Bible verses.
While I've long had god experiences with Kaiser, my wife has been struggling of late. She was recently diagnosed with Diabetes, which led to a round of everything else in her life (including shoulder pain) getting lumped under that diagnosis, instead of being carefully evaluated--despite several visits with Ortho, PT, etc.
She was recently diagnosed with Frozen Shoulder, to which they told her that she'd be suffering for years, mostly unable to use the arm, and so sad, nothing can be done for the pain either.
Since Kaiser hadn't done much providing of good information after her diabetes diagnosis, she was skeptical about the new frozen shoulder plan. She found a book about the condition and has finally gone for her first paid trigger point massage, to treat it per the book. If it works as written, it should cut the "years" of disability down to weeks or months. Fingers crossed.
Dry needling is based on most of the same theoretical framework as trigger point massage, AFAIK.