It is gladdening to read DRR’s editorial (BCMJ 2015;57:5) describing his satisfactory progress from a serious bicycle accident. Within his editorial, DRR refers obliquely to what, elsewhere, has been described as the green poultice.
When taking care of patients who have been injured in motor vehicle accidents, I am often amazed at the influence that the potential for compensation has on their presentation, treatment, and recovery, and I think that if there was no gold at the end of the ICBC rainbow patients would recover far faster.
In his earlier editorial, “Forms, lies, and advocacy” (BCMJ 2014;56:213), DRR expressed similar concern about the sorry state of the medical-legal milieu. The present editorial returns to this theme, blowing a welcome waft of fresh air into what, especially for soft-tissue injuries, has become an odious environment. It should remind us of a plethora of dictums, truisms, maxims, etc. that many practitioners seem to have forgotten—perhaps at the expense of their own self-respect but certainly of their patients’ well-being:
• It is more important to get better than to be compensated.
• Patients feel less pain if they have something better to do.
• Adopting illness behavior as a lifestyle choice is akin to a death wish.
• No opinion is better than the evidence upon which it is based.
• Junk science, masquerading as evidence-based medicine, is malpractice.
• Beware your credit rating becoming inversely proportional to your credibility rating.
• Beware inappropriate medicalization of patients, especially with drugs.
• Beware physical therapists (of all stripes) who practise therapeutic hyperbole.
• Tenderness is not an objective finding.
• A patient’s disability may be only proportional to their pain experience, where their pain experience is directly proportional to the accuracy of their self-report. If so, say so.
• Do not write a medical report the validity of which would receive a failing grade in a qualifying examination.
• Never, ever commit perjury.
Comedian John Cleese would add another, “There is no condition so bad it cannot be made worse by an expensive operation.”
I’m sure there are even more, but then I’ve led such a sheltered life!
—Gerard Ponsford, MBBS
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