Persistent Pain? Must be the patient's fault. After all: i’M tHe SpEcIaLiSt

I spend a lot of time, both on this blog and on social media, talking about how you, the patient, have power and have control over your own experience.  This is both a true and an optimistic statement.  But there also seems to be a weirdly commonplace and an absolutely infuriating dark side to this truth.  In this I refer to the stubborn confidence of the “specialist” who has never come across their patient’s particular pain presentation and subsequently dismisses it.  

Let me break this down.  We chiropractors regularly see a very particular type of patient.  This is the patient who has seen every ‘specialist’ under the sun and no one seems to be able to help.  At all. So they come to us.  So-called mainstream medicine didn’t help so they want to try the weird guy in the corner doing that clicky thing.

Pain is Unique and Complex

The patient usually has some weird pain presentation which, to the credit of the specialist, never makes any damn sense.  It’s usually some wildly illogical sounding thing like, “I get pain every time I sit down in my favorite chair and watch old reruns of ‘Cheers’ I can watch the full run of every spin-off but damned if I don’t get pain all the way down the leg every time I try to watch Cheers”

But here’s the thing.  Your pain is real.  The very fact that you experience an unpleasant sensation whenever you’re trying to watch your 40 year old television series makes it a valid and meaningful experience.  Telling someone that their pain isn’t real is like calling someone an insulting name and then when they act upset you just say “Psshhh, you’re being too sensitive!”  It is a dumb but more importantly an irritating thing to do to someone.  No one else gets to decide if your pain experience is valid. 

Expertise, Dogma and Tunnel Vision

After hearing about these sorts of exchanges again and again I am left with the impression that the specialist’s office is a perfect breeding ground for this toxic combination of professional insecurity and yet professional cockiness.  I keep hearing abou these situations that just read like “Well I mean I’m the hip guy and your hip pain doesn’t make any sense.  Since the pattern doesn’t make any sense it can’t be coming from an anatomical source.  And since it’s ‘iN yOuR hEaD’ I have no responsibility to help you.”  

But it goes even beyond that.  Because you, the patient, had the sheer audacity to show up to the hip doc’s office and then stump them.  How dare you.  Since you’re being so mean to this poor specialist, who never asked for any of this, they have a nice little parting gift for you.  And that gift is the gift of letting you know that the pain is your fault.  It’s not really there, it’s not really coming from your hip and you’re making it up.  It’s not that they can’t figure it out, you’re either a liar or you’re crazy.  So there.

Now this arouses, in me, a very specific anger.  If one makes a mistake because they didn’t have the full information…fine.  Great.  It happens to all of us.  A lot.  But when they then take some inexplicable, annoying pride in these incorrect facts and their ludicrous justifications?  When they actually wield this complete lack of knowledge like its a shield of valor?  That’s what sets me off.  Something about being so haughty in ignorance; being so content within an ‘unknown unknown’… Something about it just makes me want to scream my vocal cords raw into the nearest pillow.

Yeah it turns out that you can treat pain through more options than surgery or just throwing exercises at it, there Doc

The Impactful Harm of Dismissing Pain

Now all of this is frustrating but here is the kicker: the specialist understands that a psychological, emotional, whole-being aspect to pain is important and then they are taking the step of saying “because this pain is less anatomical and more contextual then it doesn’t matter.”  It’s a judgment that is “so close” but it’s also the worst, most harmful, most rage-inducing kind of “yet so far.”

Why is this so harmful?  Well do you know what the next step is?  It’s the step where the patient comes to my office and says “I’m such a mess… No one can figure this out… It must just be a part of getting older… I never recovered from [such and such so many years ago.]”  First do no harm, right doc?

And just like the great and wise Dr. Cox of the hallowed Sacred Heart Hospital, these situations make me want to ask if these doctors are real doctors or doctors like Dr. Pepper is a doctor.  Listen, pain is complex and it is multifaceted.  If you experience pain when its about to storm or when you get stressed or every time a bell rings then your pain is real.  If you have a pain that starts somewhere in your right mid back and then skips over your lateral thigh but hurts on the inside of your knee and your left hand for some weird reason…that too is real pain.  

Every time a bell rings a chiropractor gets a weird theory about fascia

Just because the answer isn’t to stretch your hips or whatever doesn’t mean that is any less important than an achy meniscus or pulled muscle.  It simply means that you need a different tool.  Have you heard of the old saying that “if you have a hammer every problem looks like a nail?”  (And by the way, I’ll freely admit that I myself have a limited number of tools and that I have my own limitations and biases on how I view problems.)  Please understand that you don’t have any damaged or irreparable parts. This is simply a scenario where you needed a screwdriver and after years of being the “hammer guy” your specialist didn’t even know that screwdrivers were real, existing tools. 

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