The most problematic cases are in multiple physical therapies, have had numerous series of injections, are maintained on hard core narcotics, and have been recommended for spinal column stimulators and morphine pumps.
Does blanket approval for everything recommended help mobilize the patient.
The problem is not the medication or the procedure per se.
The problem is that no one knows the degree of commitment the patient feels to the proposed (or ongoing) treatment.
How many of them go home and exercise within their objective limits. How many of them cease smoking, drinking or gaining voluminous amounts of weight? How many are seeking narcotics from multiple providers and then taking the drugs as they please?
How many of them even understand the goals of the treatment they are receiving?
Most importantly: do these patients truly have any goals other than relying upon medication and passively accepting everything offered them.
I submit that the patient_s treatment is based solely upon the symptoms that he/she reports. As long as symptoms are reported, someone is willing to treat them independent of whether the patient is truly seeking to recover.
What should happen? The cornerstone of care should be a meticulously careful and complete understanding of how much the patient is willing to invest in recovery and whether the patient understands his/her condition and the limits of what can be done.
After years of treatment for a failed back (for example), it is not unusual for a patient to state _I just want to get back to how things were before the accident._ And that goal is most often unattainable.”
