Take No Prisoners

The Crisis of Competence in the Medical Professions

A crisis of incompetence has infected the medical professions. I’m not talking about that bullshit the scientologists spew about treating your own diseased kids or that religious nonsense about not taking a life-saving blood transfusion because it will somehow steal your soul. I’m talking about the silo-fication of medical education.

Suppose you have a sore shoulder – nothing special, just a vague pain in your shoulder. If you go to a GP, you’ll probably be told to rest it for a couple of months (the ignore it and hope it goes away approach). If that doesn’t work, the doc may offer you a cortisone shot. This is a direct result of the doctor’s training: joint pain = inflammation; cortisone is a good drug for fighting inflammation.

Suppose you don’t want to get a shot, so you go to a physiotherapist. The physio ices your shoulder, puts an ultrasound on it, and then uses electrical stimulation to strengthen the muscles around it. He may give you exercises to do with bands or weights. If that doesn’t work, suppose you go to a chiropractor. The chiro will look at your spine and its relationship to your shoulders, tell you your spine isn’t straight, and adjust it. If that fails too, and you go to a massage therapist, the RMT will inspect the muscles surrounding the shoulder, find that they are too tight and compressed, and try to work out the knots.

The problem is that none of these “medical professionals” have a clue why your shoulder hurts. Instead, they look for things the kind of bodily imperfections they have been trained to treat. You may, in fact, have inflammation in the shoulder joint, weak muscles around it, tight muscles compensating for the weak muscles AND a crooked spine. However, none of these quacks knows what combination of these things, if any, is causing the pain. All they do is look for things they can fix, and assume that what they can fix must be causing the problem.

Ideally, the first person you visit should be the GP. Your GP should identify the cause of the problem and refer you to the appropriate treatment; e.g., if it’s tight muscles, go to an RMT. This, however, reveals the fundamental weakness of medical education: GPs are primarily trained to treat viral and bacterial pathology using drugs. Many of them simply cannot diagnose biomechanical ailments effectively. They don’t know who to send you to.

This problem is and will likely continue to become more pronounced in the next decade. As we continue to encourage people to become more active – to run, to lift weights, to play sports, to hike, to bike to work, to swim – people become less susceptible to heart disease, cancer and bacterial illnesses at the cost of increased minor biomechanical ailments. The occasional torn tendon, trained ligament or sore muscle is the price of protecting ourselves from the obesity and muscular atrophy that threatens our lives overall. Healing these minor biomechanical ailments is an integral part of caring for the populace and making exercise more pleasurable and sustainable.

The increasing importance of treating biomechnical injury, therefore, makes improvements in the training of GPs imperative for a healthy society.