For a change I completely agree with you Dorko!
;) Isaac
-----Opprinnelig melding-----
Fra: Barrett Dorko [mailto:[log in to unmask]]
Sendt: 24. april 2001 17:21
Til: [log in to unmask]
Emne: Re: diagnosis leading to illness
Scott and Henry,
One of the things about diagnosis commonly ignored is that it comes in two
basic forms: essential and nominal. The former names the offending part or
process and tells you how it's gone wrong (fractured humerus, for
instance). The latter merely gives a name to a disease that we can only
describe by noting some aspect of its manifestation. Lupus
erythematosis is a good example as is fibromyalgia. Neither of these
diagnoses is illegitimate, but neither will help the patient or caregiver
move toward resolution since neither identifies what's wrong. In my
experience, it is the use of nominal diagnoses that lead to trouble and
that will not change until medical science discovers the essential
diagnosis within the syndrome. Often there is more than one, and PT has to
pick out which of those it might appropriately attempt to alter. It sounds
like Scott is already doing that.
There's an essay specifically about nominal vs. essential diagnoses on my
web site entitled "Incantation."
Barrett L. Dorko, P.T.
At 10:44 PM 4/24/01 +1000, you wrote:
>Henry,
>You make a good point here, certainly giving someone a label can lead to
>worse symptoms. Why does this happen? Partly because the patient is now
>using the diagnosis as a reason for feeling the way that they are feeling
>- therefore initially they may feel it is "ok" or acceptable to you and
>the medical profession to be experiencing all these symptoms. After all,
>it was you who gave them this diagnosis. Also, their symptoms worsen
>because the power of suggestion is so stong to the human pysche. This
>often works for us in the clinic, not against. It's amazing how many
>patients get suddenly better once you tell them that their knee/back/neck
>etc. injury isn't serious. Often patients with CFS of FM have read a
>little, or know someone with it - therefore they may relate to what they
>read, or to the friend etc. with the condition. This is a form of
>comfort, being able to relate to another, and may provide an emotional
>security that previously the patient did not experience.
>
>However, I don't think we should throw away the terms at all. We as
>medical professionals need to approach these patients differently. I must
>say, I have made 3 or 4 diagnoses of FM, all of whom responded very
>well. Why? Because that is where I take my hands off - I tell the
>patient that the ball is now in their court. Physio is not proven to be
>an effective treatment for these conditions - what is proven in the
>literature is aerobic exercise, gentle stretching and strengthening, and
>amytriptaline anti-depressants. I often give them a hydrotherapy program,
>advise on walking, and show them specific stretches to target problem
>trigger point areas. Then, I only review them occasionally. This does
>not allow them to use their label as an excuse for their symptoms, but
>empowers them to do something about it themselves. Thus I take the focus
>off the label, and place it on a positive outlook and lifestyle changes
>that will help. That has been my experience anyway.
>---
>Scott Epsley
>PHYSIOTHERAPIST
>Northside Sports Injury Centre
>Brisbane, Australia.
>
>e-mail: [log in to unmask]
>
>On Tue, 24 Apr 2001 09:49:12
> Henry Tsao wrote:
>
>
>
>Get 250 color business cards for FREE!
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