My right foot hurts. It hurts in the middle, underneath, but not all the time, and only when I walk or take any weight on it, especially when I get up in the morning, when it becomes difficult to walk. It has been hurting on and off since I did an 80km trek three months ago. It could be a stress fracture, or some kind of fasciitis, soft tissue tear, fatigue, injury or degeneration, but I don’t really care, because I am not going to have any tests or see any health care practitioners to get their version of a diagnosis. I’m just going to leave it alone. I am going to be a person with a predicament that I can cope with, and not a patient with an illness.
Predicament versus illness.
Nortin Hadler makes a clear distinction between a person with a predicament – a condition of which they are aware and which may be causing some interference with their daily life but importantly, a predicament with which they can live. The physical disruption in this case is not causing undue psychological distress. As soon as that person enters a doctor’s office to seek treatment, they will become a patient with an illness. Even if the doctor isn’t sure of the diagnosis, he or she will label the patient with at least a working diagnosis of a disease, and the person will remain under investigation or treatment until they get better or leave that paradigm. If they get better anyway, which is surprisingly common, then the medical treatment will be given credit for the improvement. If the patient does not get better, they will be frustrated with medicine’s failure to treat what appears to be a clear case of an identifiable disease. Their psychological status may deteriorate. Their personal responsibility will have been reduced by abrogating responsibility to the medical profession, and this is reinforced by the medical profession’s attitude that it is not the patient’s fault, and that it should be left to the doctors to manage and cure the condition.
What will happen to me?
It is almost certain that my foot will get better with time without any tests, injections, physical therapy arthroscopies or even rest. In the meantime, however, I don’t care about it. I am continuing to run, socialise, walk and work without interruption, and I am saving money, time and stress in the process.
What can happen to others?
Unfortunately, most people turn to medicine for help whenever symptoms are felt that are unexplained, on the assumption that this is what should be done and that there is a net benefit in doing so. They turn for help even when they are coping, and in seeking help, they may be reducing their own capacity to cope.
Why am I different?
The main reason is that my estimation of the ability of modern medicine to diagnose and improve my condition, and avoiding harm in the process is likely to be very different from the estimation of the public. I have an advantage as a medical practitioner, particularly one in the musculoskeletal field – why see a doctor when I have already diagnosed myself? True, but even my colleagues are amongst the first to order MRI scans and X-rays on themselves and seek out the advice of colleagues for any little niggle, because these are so readily available. Again, it is my estimate of the effectiveness and harms of medicine, even compared to my colleagues, that makes me different. Others can have a similar estimation, if they become more critical and less accepting of medicine’s claims, which is what this blog is all about.
The bottom line.
I am reminded a few times each day about my right foot pain, but I am quick to remind myself that it is not currently interfering very much with my life, and that I do not wish it to interfere any more than it is currently, and that I have better things to think about. Sometimes we can be better off coping with our predicaments instead of rushing to hand ourselves over to the medical system and becoming a patient with an illness.
Dr Skeptic is a surgeon with an interest in evidence based medicine: the science behind medicine. I am interested in finding the true risks and benefits of interventions, and how this often differs from the perceived risks and benefits, as seen by the public, the media, and the doctors themselves.