Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


SkillfulThe Wise and Skillful:

He has spinal stenosis and degenerative disc disease but tells everyone she has `herniated discs’ Why? 

 “We retain data in areas in which we have strong interest and/or strong responsibility.  We may know what constitutes a concerning temperature in a child without knowing the mechanism for fever.  We may know that plants in our garden are dying without knowing a great deal about the fungus causing this.

Except in the case of our profession or our hobbyist interests, we usually know just enough to get by.  We know that we have a tooth ache but not how many teeth we have.  We work as a plumber and can fix a leak, but we may not know how to repair an electrical circuit.

We are dependent upon, if not vulnerable to, those who have greater knowledge in certain areas.  At one time, we may have sutured our own wounds or extracted our own teeth, but that was long ago.  Today, we do not question why we are inappropriately prescribed antibiotics for the common cold.  Again, we are very dependent, not necessarily skillful.

What is the range of ideas, memories, relationships and concepts held by an individual who has been injured at work?

We make three false assumptions:

1. They know all they need to know.

2. They will comply with care even if they do not know.

3. We know their capacity to understand.

The patient was injured falling from a roof.  Roofing is not his passion, but he does enjoy practicing guitar and fishing.  He would rather be doing the latter, but the reality of life forces him to scramble atop roofs.   He has a GED.

He now has back, leg and shoulder injuries from a fall.  Does he have even a basic understanding of his injuries?  Does he have enough information or will he question others regarding the severity and prognosis for his injuries?

Those upon whom we depend to correct problems have the capacity to take data, analyze and synthesize and come to an accurate diagnosis, and in turn, a plan to correct.

After months or years following injury, if patients have not attempted to learn about their problems, they are relinquishing independence and will passively living out this post-injury period.  

It is not unusual to see a patient 2, 3 or 5 years post injury who have not acquired any data regarding their plight or options.

This reality is no mystery to those providing health care. There is an assumption that patients passively comply without understanding the purpose of aspects of care.  The role of the patient is to be passive-dependent. 

Unless patients are encouraged to ask about, seek out information concerning or question the direction of care, we shall have patients who are not skillful and whose recovery is markedly impaired.”

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