I can help you!?

Do you suffer from your back, neck, shoulder or somewhere in your arm or leg? I can help you!

 

You will not hear me say this. I can not guarantee improvement of your complaints. I can guarantee you that I will do my best to help you. What I can do is making a prediction of improvement: not likely, likely, very likely. And with a few people I will say: I do not know. What I can do is report the duration of the treatment period that has to be expected. And I can explain to you how I come to these estimates.

  

It is impossible to diagnose with a 100% certainty in musculoskeletal medicine. That is because we are all different. Different in gene packs, upbringing, learning, illnesses and traumas, diet, sport, private and work, partners, environment, and so on. Considering all that and assessing the consequences of the current complaints and the experience of the complaints is not possible humanly. Perhaps that can ultimately be done with 'big data'?

  

But a diagnosis like hernia, for example, is clear? Yes and no. On the basis of the physical complaints and symptoms, the answer is: no. On the basis of an MRI scan, the answer is: yes but ... On an MRI scan you can see the hernia, but not whether the person who belongs to this hernia also suffers from it. Example: in the age group of 60 years and older without complaints in 60% a hernia or hernia-like something is seen on the scan. This is one of the reasons to be cautious about making imaging research.

  

And now the 'helping' out of the title: a diagnosis has finally been made and then a treatment plan is made. The basis of the treatment plan is what appears to be the best approach from scientific studies. The summary of these studies (a review) is about the outcome in a group of patients and is expressed in chances of improvement, worsening or no effect. So it says something about the prior chance of improvement. But we do not know whether an individual patient will get better, we only know that afterwards, after the therapy.

  

Conclusion: every step in the medical process from diagnosis to therapy has uncertainties. These are inevitable because we are all unique and respond to treatments in a unique way. That is why I will not say: I can help you!