After a few weeks back in the out patient physical therapy setting I am re-confronted with the pathoanatomical-ness of diagnosis.
The battle for language and context of explanation rages on: full strength, full power, full speed. Whew, just trying to hang on. Daily I must combat the destructive thoughts of a fragile body, or a decaying joint, a shredded tendon, or a tear from here to there.
Sometimes it is very true. Others not. But trying to de-fixate an individual’s thoughts off of the negativity of their structures is unaided by visual proof that they are internally “disfigured.”
They are Victims Of Medical Imaging Technology, made worse by the visual “truth” of their condition.
So, I’m re-sharing this poster/image. The data is good and relevant, the concepts are thought provoking and a challenge to widely held beliefs about what “healthy” looks like. Now, knowledge about your body is not a bad thing. There are definitively times when an image is extremely helpful. The context in which you receive the knowledge is important to the whole picture. Perhaps, as PTs, we see this most clearly.
For example, I am gait training a patient with C4 ASIA-C spinal cord injury. I can tell you, it’s not easy, but an image of his body will not tell you function. In our setting, in rehab, we see what people can do. In the physician’s office, they often don’t have time to see what they can do, so they treat the blood work and the radiology. They often rely on standard age-matched norms of values to determine what is needed to restore the patient to “typical” status.
So in a way, they are certainly right in pointing out to the patient that they have a bulging disc, or less space in a knee joint. Those may indeed be factual. They may or may not be relevant. The point that is being missed is that these images do not show a one-to-one relationship with function, quality of life, or pain. So when a professional in medicine defines a problem for the patient, using imaging and destructive terminology, the patient latches on, and we have to pry them off.
If medical practitioners could come to work with us for a day or two and be shown… be educated first hand, learn the true relationship between an image and a person’s ability… now THAT would be something.
Those of you that read this blog, and others similar to it, are likely familiar with these concepts. In our own field we have therapists who are not on board, do not understand the differences and nuances in language and framing of concepts. I do not mean to set up an “Us vs Them” mindset. I mean to encourage the sharing of these break through ideas. The sharing of positively framed speech, avoiding nocebic terminology.
Tell patients the truth, give an honest prognosis and diagnosis. But don’t let the structure determine your treatment or the patient’s self-image.
Don’t be a VOMIT
*I do not impugn Radiology or the contributions and luxuries we have by being able to look and see. I find the images fascinating.