Updated: Jun 13, 2021
As patients, we have a need to have our illnesses labeled. We need to know what we've got. And, almost at any cost, we want someone else to sort it out for us.
I've just finished reading a book by Ian Harris, an orthopaedic surgeon. Surgery, The Ultimate Placebo: A surgeon cuts through the evidence. It is a fascinating and and yet a troublesome read.
We go to the doctor because we have an ache or a pain that is interrupting our lives. We can't: do the things we want to do; play sport or go on the daily run that is heavily relied on as a mind numbing cure to a day's mental stress; play footie with the boys; get down on the floor to play with the children, let alone lift them up. Pain can be all consuming. It can stop us sleeping. It interferes with our ability to focus and in some cases will lose us a job. It is real.
It often starts as a whisper we ignore and it then knocks on our door a bit louder. We claim we're too busy to get it seen to and so are the GPs so we don't want to bother them. Then it starts shouting at us. It is then, after much moaning and constantly complaining about said pain and with strong persuasion from a concerned (and fed up) spouse, we eventually take ourselves off to see the doctor.
Nowadays a GP will rarely touch you. When it comes to diagnosing pain - we will be asked to describe it. They might palpate the abdomen, but when it comes to the back, shoulders, knees, elbows and ankles etc., if we can stand on it and move it a bit, we tend to get a prescription for non-steroid anti inflammatory drugs (NSAID) and a referral to the physio for 6-8 sessions. If you have private medical insurance you can get a quicker referral to see a consultant and/or a physio for 6-8 sessions. If it is very acute you've probably been sent to A&E or you've gone on your own accord. Many end up back in the GP surgery some weeks later with no improvement. They get given stronger opioids. They have another test and then a referral and the saga continues. Some get fed up with this system and head straight for the Osteo or Chiro or Sports Masseur. Yet, this too can be never ending. I know this is true as I regularly see people in my practice who have been on this roller-coaster.
In his book, Harris lists the consultants we get referred to, and the illnesses that get those labels we so desperately want, even though there are no pathological findings:
Gastroenterologist: irritable bowel syndrome
Gynaecologist: chronic pelvic pain, pre-menstrual syndrome
Cardiologist: atypical chest pain
Allergy specialist: multiple chemical sensitivity
Urologist: interstitial cystitis, painful bladder syndrome
Respiratory Specialist: hyperventilation syndrome
Neurologist: tension headaches, migraine, restless legs
Dentist: temporomandibular joint syndrome
Sports physician : (insert nearest body part here) dysfunction.
According to Harris this list is not exhaustive and he goes on to say it is virtually inconceivable for doctors to say to a patient.....
"I cannot find an underlying physical cause for your pain. Be reassured there is no evidence of any serious underlying conditions that may cause you harm. There may be psychological and social reasons for your symptoms and I would be happy to explore those with you, but I do not feel that it would be in your interest to continue to investigate your symptoms with more tests, opinions, or treatments."
Harris says "Instead the patient gets more tests and worst of all , they get treatments: Injections, TENS machines, physiotherapy, hydrotherapy, opioid analgesics, spinal cord stimulators and the biggest treat of them all surgery"
His book, as the title suggests, asks questions as to why this happens, how the role of the placebo is used and how the industry has issues with unethical practice. As I said it is a fascinating and a scary read. My take away from this is to make sure you ask all the questions.
In Harris' words, "...be sceptical not gullible".
It is vitally important to understand what is a successful outcome for any practitioner treating you, including the surgeon, because it could be very different to what a successful outcome is for you. (go straight to Chapter 9, sub-heading 'What can patients do?')
For a surgeon, a successful operation is to open you up, either cut a piece away or add a piece and stitch you back up. That is not the same as a successful outcome for the patient.
For me a successful outcome would be within a reasonable time scale to be able to do all the things the pain had stoped me from doing
I've had 6 patients through my door in the past 2 weeks all with unsuccessful multiple surgery stories. They are unlikely to now have the optimum recovery they believed they would get by having surgery. This is not to scare you but to make sure you do ask the questions, check out all your options and make surgery a last resort.. The biggest complaint these people have is as soon as they have the post operation consult the relationship with the surgeon is over, yet they have not yet recovered.
In 2013 the Hospital Authority in Hong Kong approved Bowen Therapy, a neuro-fascia release treatment, to be used pre and post surgery through the physio and occupational therapy departments. I very much look forward to the time we offer that in our hospital system.
I do appreciate at times surgery is the only option and my advice is to properly research the subject, ask the all the questions, know who your team is and ensure they communicate with each other.
This is your body. Manage what happens to it by being "sceptical not gullible"
Dr Ian Harris's book can be bought through amazon
MSTR ™ Scar Tissue Release Therapy https://www.mcloughlin-scar-release.com