Biases in medicine

I am constantly prone to biases in judgement because of what I don’t know.  What I know is finite and what I don’t, infinite. I think research aimed to study how people are treated differently due to their gender, race, social economic status, etc.  reminds me to be more mindful and slower to judge. I think the solution to diminish these biases is to be continually open to new perspectives and possibilities. I have noted certain recurring themes around the topic of pain.

I find pain to be a common humanity and provides valuable opportunities to share the wellness perspectives with my patients.  Pain is a warning signal of one, or more often, many common root causes. It is important to identify all these root causes and apply their true solutions.  Diagnostic challenges are relatively uncommon given the many investigations now available. What is much more common is the scenario where root causes are not identified and discussed, true solutions not applied and only symptoms reactively treated with substitutes.
A 45 year old man who injures his wrist the third time weight training (this time doing 300 lb chest presses ) presents with wrist pain.  He is built like a tank and obese. He is surprised that his wrist is not better after 2 weeks. I ask him if his purpose of exercise is to be healthy.  He tells me he “loves” weight training and can’t possibly stop as I ask.
Challenge (after investigations): chronic traumatic arthritis in the wrist aggravated by inappropriate usage.
Root causes:
Poor dietary and physical habits dues to misplaced and misguided attention on what brings pain and suffering rather than true wellness.
Eating in ways the mind wants rather that what the body needs (he is no doubt prediabetic or one in the making)
Mental craving and compulsion to use his body inappropriately without control and regard of consequence to his body.  His behavior meets the “4 C’s” definition for addiction.
In this case his pain, suffering and wrist injuries are all just partial symptoms and evolving consequences of these common root causes.
The real solutions are interventions that helps him develop mindfulness in eating, appropriate exercising, waiting (for the body to heal) and self-compassion.  Eg. Individual or Group Self-management education and support.
As for substitute solution, there are too many to enumerate.  Block the symptom with analgesic, anti-inflammatories, allosteric mu receptor modulators (CBD), etc.  Become attached to some other object of addiction with similar or more esoteric, more harmful and more delayed symptoms and consequences.



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