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.