[Originally in Health Beat, Richmond Register, April 2014]

    Have you ever met anyone who creates the obscene graffiti on the walls of public restrooms?  Me either.  Yet clearly, SOMEONE is out there, writing scatological poetry and drawing pornographic representations of the female and male anatomy.  It’s just that no one will own up to it, right?

    I think unhelpful medical advice is rather like restroom graffiti.  Many patients make reference to it, have even taken it as their personal gospel.  But I’ve yet to meet a physician who who admits to saying such things to the patients.

    It bears pointing out that the doctor-patient relationship is rich with ritual.  A person of status (doctor), using arcane knowledge and esoteric artifacts (stethoscope), goes through predictable steps that impart role expectations to the patient.  Where this ritual goes awry, however, is when the role it teaches leads to patients feeling powerless to help themselves or improve their own health.  And unfortunately, since these ideas are driven home with physician authority and the power of ritual, they are very difficult to uproot when research calls them into question.

    In my extensive history of working with patients, my ongoing frustration has been in dealing with those people who cling to unhelpful advice.  This is because *my* purpose is to illustrate how changing your behavior, making lifestyle improvements, can help you better your health and wellness.  That is hard to do when when so many patients are already 75% convinced before they ever see me that their situation is out of their control, unhelpable.  Poorly phrased messages from medical providers, however well-intentioned, can be damaging.  I’ve written about this before, but it bears repeating, in hopes of inoculating those of you who haven’t yet been stymied by unhelpful advice.

    I cannot count the number of back pain sufferers I’ve evaluated who tell me their physician informed them that if they twist in just the wrong way or lift a ridiculously low weight, they will “end up paralyzed.”  This terrifies patients, and many will fall into deep depression, convinced that any activity in their lives will land them in a wheelchair as a paraplegic.  You’ll find them huddled in bed or on the couch, afraid to move an inch, lest they be thereafter unable to move an inch.

    Now I’ve been trained in social science, not medicine.  So I try not to let my personal anecdotal experience overpower hard data in the formulation of my professional opinions.  But when it comes to medical providers warning people of this type of consequence if they do ordinary activities, I suspect there IS no hard data to push against.

    Even still, forget my experience.  Let’s use YOURS instead!  Ask yourself:  “Have I ever, in all my X years, met a person in a wheelchair who put themselves there by doing ordinary activities around the house?”

    I’m not talking about spinal crush injuries from car wrecks.  And I’m not addressing the horrible changes from progressive neuromuscular diseases.  And we aren’t referring to the person with pain who sits in a wheelchair only because it hurts to move.  Paralysis here means no sensation, no ability to even twitch a muscle…caused by activities akin to walking to the store, changing a light bulb or mopping a floor.  So how many self-paralyzed homebodies have you met?  I’m betting I can guess your answer, huh?

    Lest I be misunderstood, I’m not suggesting you shouldn’t listen to your doctors.  In all likelihood, they truly want to be as honest and helpful to you as they can.  But you should also be sure that the advice you’re getting comes with some options to help yourself afterward.  If you leave the doctor’s office feeling otherwise, you might need a second opinion.  Or a follow-up referral to a behavioral medicine expert.  No matter how bleak the checkup, we can ALWAYS do something to improve our well-being.  You deserve to be encouraged to learn some of those ways.

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