Questions and answers. For doctors and patients.

Treating a shoulder pain. How hard can it be? Give the guy a combination of NSAIDs and add a proton pump inhibitor for the inevitable acidity that will follow the painkillers. You could also add a muscle relaxant of you think there’s an element of spasm involved. That’s it, right?

Why is this damn doctor asking so many questions? Why doesn’t he order an x ray? Either I’ve got arthritis or I haven’t. That’s it, right?

No. That’s not it. I need to know how long you’ve had the pain. Which part of the shoulder hurts. Which movement makes it worse. Whether there’s an element of shortness of breath and sweating along with the pain. Whether you’re diabetic, or a smoker. What your hobbies are, other than getting drunk on hartals and watching TV. What your work involves. How high you’ve got to raise your hand, how many times, while lifting what weight and in which position? Did you fall? Are you playing badminton? Did you throw stones at the neighbourhood strays? Was your new year resolution to join a gym? What kind of pushups do you do, if at all you do any.

What do you think the problem is? What treatment do you expect? How would you react if I told you that it isn’t arthritis? Would you be happy? Or would you feel disappointed that you don’t have a significant enough illness that explains the severity of your pain?

Are you going to go back to your video games and mobile messaging? Do you just want the pain gone for now? Are you planning to do anything to prevent it from coming back?

How committed are you to your own health? Is it worth my time talking to you about all the above?

Or would it be better to just give you what you want?
Take an x ray, “you’ve got early arthritis”, rest for 4 weeks in a sling, take these tablets, be the center of attention of your friends and family. You get advised not to use the arm. If you’d like that, then my job is easier (but distasteful). You’re in and out of the OPD in half an hour maximum. You’ve got an armload of medicines on your working arm. The other one in an expensive, but pointless sling, and a shoulder that will do as it has been asked to do. Stay very still. You are now, a patient. Long term. If you’re lucky (or unlucky) depending on perspective, a permanent patient.

If I were to ask all the questions, and follow my nose down every rabbit hole the conversation would take me, you’d be with me for hours. We’d have to talk about your diet, how much time you spend in front of the TV, instead of sleeping. You’d have to have unpleasant conversations about how you’re making things worse for yourself with the hunchbacked posture. The anxiety that was causing it. Spouse? Work? Kids? And at the end of that long, tiring conversation that tests my patience more than it does yours, you’ll have nothing to show, except some advice that is already fading from your memory. Jumbled and incoherent.

Fine, I’ll relent. I’ll give you what you want. You’ve got two outcomes. You get better. Or you get no relief. If you’re getting better, it’s because your body got rid of the issue, at least temporarily. It’s not the painkillers fixing a pathology. That’s not what they do. If you haven’t gotten any relief, is it my fault? Or yours? Is it the pharmaceutical company’s fault for not making good medicines?

This is a fight I can’t win on my own. Weird part is, I’m fighting for you.

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