In musculoskeletal medicine, we are trained at length in anatomy, physiology and how to diagnose the conditions within our scope. Over time, that training conditions us to focus on symptoms and physical findings, and patient care can quietly turn into a mechanical process of sorting symptoms into diagnostic algorithms. But in doing so, are we missing something deeper? Are we treating the condition and forgetting the person it belongs to? Is musculoskeletal medicine lacking soul?
The mechanistic approach to diagnosis
Sorting and labelling has its place, but we can lose sight of the very thing driving most of what presents in front of us. It is easy to treat the disease entity and not the person who has walked through the door looking for help.
Consciousness and pain
I recently read a thought-provoking paper by Wallden and Chek titled The Ghost in the Machine: Is Musculoskeletal Medicine Lacking Soul? It arrived at a time when questions of past, present and future were already on my mind. Two lines in particular stayed with me:
Researchers in the field of human consciousness estimate that between 95 and 99 percent of human cognitive function is unconscious.
Pain is a conscious experience. As such, pain can be viewed as a mechanism that brings the unconscious to our awareness.
What shapes that unconscious? Our thoughts, beliefs, behaviours and attitudes, the people around us, and the things we read, watch and listen to. So are we not, in a sense, building an experience out of algorithms formed by our unconscious?
The unconscious mind and health
Until you make the unconscious conscious, it will direct your life and you will call it fate.
That line is Carl Jung's, and it is hard to shake. What is fear, and why do we avoid things? What is the anxious feeling that drives so many of our decisions, or our lack of them? If most of our cognitive function sits below conscious awareness, what effect are those unconscious processes having on our health?
Treating the person, not just the condition
The paper is worth reading in full, but I will leave you with one more line that captures the shift in thinking:
Pain is not an object we can do something to, it is an experience we can seek to help the patient make sense of.
Final thoughts
It is worth reflecting, as practitioners, on whether our clinical processes are truly serving the patient or merely the diagnostic algorithm. Pain is complex and deeply personal, shaped by far more than the physical body. Perhaps it is time to reconsider the approach, and to connect with the human experience of pain rather than treat it only as a problem to be solved.
If you are dealing with pain that has not been fully heard or understood, book a visit and we will start with you, not just the diagnosis.
