Life and health: Sometimes we are just too close to the ones we love to see the big picture

It is all a matter of perspective. It’s about time.

See time as geologists. Stand back to look at the past and future; you will see changes never imagined: tectonic plates moving, oceans growing, mountains soaring—only hinting to their vastness from the occasional earthquake, we theorize on dinosaurs, formation of tar pits, oil and coal. Similar far-away thinking, catapulted Charles Darwin to a perspective never before realized—evolution. By standing back and looking at the continuum of life, Darwin saw patterns that were not imaginable when looking at an individual.

So it goes with medicine today, patterns go undetected because our vision of the moment is myopic. Thus observations of even a skilled provider can be misleading. The patterns seen up close in the moment may not be representative of patterns present over a lifetime. By applying the scientific method, doctors/scientists utilize the power of mathematics to substantiate hypotheses; the blinded, crossover study for acquisition of new medical information. It is with mathematics that patterns of life and disease become understood. Frequently the scientific method undermines common beliefs and sentiments.

The scientific method is especially important when it comes to understanding pain. The presence of pain requires individual interpretation of electrical-chemical changes inside a nervous system; first a pain chemistry (nociception), then interpretation of electrochemical information. It is the interpretation of the information that determines whether a patient has pain or not. There is no way of measuring the pain scientifically, at least not yet. A doctor without tools to measure is at the mercy of the patient’s perception. Often, patients respond to affection, touch, love, or other intangible variable. Without objective measure, it is very easy for a physician to provide treatments that seem to be effective, but when adequately challenged scientifically they do not connote benefit.

Today many treatments are provided for pain, many with relatively little scientific rigor and only supported on anecdotal observation providing the limited perspectives of both physician and patient. This is worrisome, since many treatments are operative and carry great costs. Although applying the scientific method to individual care impossible at this time, we all can stand back and try to take a look at the broader implications of treatments; will the selected treatment for example, in a patient with chronic benign pain with a life expectancy of 30 years, help for 30 years or create complications? Answering or at least attempting to answer these questions before operating is an important step. We we provide the best life care plan possible.