I received a letter from a fellow healthcare worker the other day.
She wrote to me regarding a patient of mine, demanding that I “do something”. Her letter was, to be quite honest, rude and uncalled for. She knew very well that I had already seen the patient, assessed the patient correctly and that the patient had the ability to make decisions regarding her own medical care.
This isn’t an uncommon occurrence. I spend a significant part of my working day telling patients and other healthcare professionals that nothing needs to be done. And that often doing nothing is more beneficial than doing something for the sake of doing it.
But why are patients and people in general like this? Why, for example, does a patient with lower back pain for a grand total of two days turn up at my clinic demanding an urgent MRI scan, which would bring no benefit to the patient whatsoever? Why do they get angry and upset when I explain that physiotherapy and lifestyle changes are the way forward?
I think there’s a simple answer:
The patient is worried that they are going to die*.
And who can blame them for having this outlook? Most people from a young age have been conditioned to think that death is lurking right around the corner.
The thinking even in primary school was something along the lines of: “If you don’t do well in school, then you’ll end up without a job, then you’ll end up homeless and then you’ll die a sad and lonely death.”.
Of course for the people who made it through school and are not dead – which happens to be the majority of mankind – the above line of reasoning is clearly false.
Yet the same thinking often persists and manifests itself in absurd ways later on in other parts of their life.
This is not what it’s like to start a business
I think a lot of people avoid going into business for themselves due to this reason. Even though it would be better for themselves, their family and those they serve to go it alone, they don’t. Or worse, they say “someday”…
The fear of death manifests, in the form of being someone elses devoted employee for the whole of their healthy adult life. “I’m not a risk taker”, they tell themselves.
Look, I get it. It’s fine if you are truly happy as an employee. What I can’t tolerate is when people make up BS excuses for not doing something with no logical reason.
So how to think about things? How do you decide what is truly risky and what isn’t?
The Two Types of Risk
I believe that there are two types of risk.
This is the type of risk which builds up over time and then ultimately does result in poor life outcomes such as bankruptcy and death. Ironically people take these risks all the time without any consideration for their ultimate effect.
For example the decision to not exercise today, or the decision to just have that pizza instead of sticking to the diet. These types of risk compound over time and then one day give you a heart attack or stroke.
These are risks that can be calculated and taken with no hidden / compound effects. If for example you decide to buy a car with cash you can easily calculate if you can afford it and what type of risk a reduction in your bank balance will lead to.
The problem is that these two types of risk often become conflated.
People think that starting a business is a “compound risk” instead of a “simple risk”. When in fact starting a business has a limited downside and a possible large upside. It’s a calculated, simple risk.
Or people think that “eating one more slice of pizza “is a “simple risk” and not a “compound risk”. They think that one more slice of pizza or drinking one more alcoholic drink is no big deal. They fail to realise how the risk compounds with time and that that “one more” may lead to an unpredictable heart attack somewhere in the future.
This conflation of the types of risk is what’s happening in the patients who have back pain demanding that “something has to be done”. They don’t realise that when a doctor has competently assessed you and has ruled out “red flags”, which could indicate a serious underlying issue, that the risk will not compound. It doesn’t matter if you’ve had the back pain for a day or a year. If the clinical scenario has not changed then the risk is still a “simple risk” and will not “compound”.
Yes, physiotherapy and lifestyle change is still the way forward.
*Usually men and women alike tend to think that they have metastatic cancer if they have lower back pain. They fail to realise that they have developed the pain because their body is trying to signal to them that they have poor muscle development (usually due to being overweight and inactive).