"Painless"

I had a chance to watch the episode of House, M.D. today, titled “Painless”.*

The gist of the episode is that as a favor to Cameron for completing some of his paperwork House agrees to take on the case of a chronic pain patient who has recently attempted suicide.  This attempt has stemmed from a long time frustration at not having found a diagnosis nor relief from his debilitating pain.  That part alone was difficult to watch.  Living w/ daily chronic pain is not something easy to manage, and I found it even more difficult to watch at times.  House’s team launches into differential mode, ruling out fibromyalgia b/c of the type of pain, and a few other things.  Enter the ever so smug Dr. Taub, a character whom I can not stand since he is always fiercely judgmental and rude to his patients.  There are times that I find House a comforting bedside manner in comparison to Taub’s harshness.

Today Dr. Taub is convinced that this pain must be psychosomatic, and has labeled the man a selfish ass hole for his suicide attempts.  In Dr. Taub’s mind only a selfish person would attempt such a thing, and no sane person would ever attempt suicide.  Pretty easy thing to claim for person not living in constant chronic pain.

Pain will drive people to desperate measures.  Severe pain w/o relief, in my experience, will make a person desperate for it to stop.  When you have suffered for years, tried whatever drugs are thrown at you, are still w/o a reason for the pain and are still finding no relief your world turns a little bleak.  Even the most level headed person would want to find a way to not exist in such a state.  Wanting to end chronic pain and the accompanying misery doesn’t make a person mentally troubled.  In a way I find them the rational people.  A reasonable person doesn’t want to keep suffering.  When medicine fails them it is an easy leap to want to find another way out.  As selfish as it seems to the person (or doctor) on the outside who isn’t experiencing the pain or the person not being believed about said pain is in no position to make the judgement of the state of mind of the person who is.

But Dr. Taub is so focused that this must be mental illness.  Since this man’s doctors haven’t found a reason or a cure yet the man must surely be making it all up in his head, especially since clever Dr. Taub has his special pain questionnaire.  His multiple choice questions surely solve everything.  Now, two things about this assumption pissed me off while watching:

1) If this patient was in fact experiencing pain as a psychosomatic symptom it sure as hell doesn’t make his pain any less real.  Real life doctors dismiss this all the time, assuming that the pain isn’t that bad b/c it is all in your head.  Instead of trying a med regiment that will help both the mind and the pain they insist that anti-depressants, despite sometimes making people suicidal and not working for everyone w/ a slew of side effects added in for fun.  While I have had success w/ ADs when I needed them I found them unhelpful for pain, even at recommended dosages.  I find this course of treatment a way for doctors to shrug out of their duty to heal and protect their patients.  Just because it is in fact “all in your head” doesn’t mean that your head isn’t telling you that you are in pain.  Doctors are too quick to give up and just decide that someone is merely depressed (merely!) and that the ADs are the quick solution.  Some doctors will shuffle you off to mental health for further treatment w/o waiting to see if the pain actually subsides.  They also fail to fully investigate the side effects in each individual patient.  ADs come w/ a slew of side effects, including suicidal thoughts, sexual side effects (failure to achieve orgasm, something I am writing a piece on right now), sleep problems, night sweats, fatigue, and many other things, each unique to each unique patient.  These things are quickly dismissed by doctors, and any complaint often gets you a backlashing of “if you want to get better you will suck it up”.  As someone very wise once told me, medicine is like shoes.  Some people can wear a spiked heel and walk around everywhere and never think twice about it.  They like spiked heeled shoes, those shoes work for them.  Other people need a flip flop, something comfortable and non-intrusive.  Something that molds to your foot instead of forcing the foot to conform.  Shoes are not one size fits all, and neither is medicine.

2)  Sometimes, a lot of the time, more than smug doctors like TV Dr. Taub (you would be surprised how much like TV doctors some real doctors can be) are willing to acknowledge, the pain is not only real, but actually causing the depression.  Even Dr. House, in this episode, in a moment of relating to the patient, says “He’s not in pain because he is depressed, he is depressed because he is in pain”.  Doctors are sometimes so unwilling to admit this if the physical answer is not obvious or provable w/ a blood test or scan.  Instead they will often insist upon and resort to the treatments of point 1.  Often the pain has nothing to do w/ your head (except for the blearing headaches), and all the ADs in the world are not going to help this.  Sometimes traditional pain remedies don’t work, and sometimes people are so sick of the side effects of pain meds only add to the misery.  Constantly prescribing ibuprofen or acetaminophen won’t help most chronic pain patients.  Treating chronic pain patients like drug seekers won’t help.  Not believing a patient who is suffering won’t help.  Being snarky and rude to your patient won’t help.

Chronic pain patients are sometimes afraid of their doctors b/c they know they won’t be believed or treated properly.  It is always easily dismissed as being in your head or you are told if you could only lose weight it would magically go away (even if the weight set in b/c you can’t move as much as you used to and wasn’t there when the pain started).  Even more horrible is the fact that doctors like the imaginary and smug Dr. Taub really exist.  They allow their judgement to inhibit their patient care and fail to use the one skill that is important that medical school can’t teach.

Compassion.

*My critique is based on the procedural aspect of the show, which is the type of show that House, M.D. is, featuring patient care and the individual care of individual patients.  For an insightful breakdown of the same episode from a story arc perspective, please see these posts by mzbitca of What a Crazy Random Happenstance.  All of her points I noticed as well.  I think plenty has been said on the treatment of Cuddy since becoming a mother and on Dr. Hadley’s (AKA “Thirteen”) being manipulated by Forman.  What I don’t see enough of are people criticizing the way patient care seems to be handled by some of the doctors, and that is why I chose this aspect for my critique.