Why the Healthcare System Doesn't Handle RSIs Very Well

Part 1 in a Series

Medical Education

The Affordable Care Act (ACA) contains some major new components that will mean a sea change in how healthcare will be delivered in this country. They represent an once-in-a-century opportunity for you to influence how the healthcare system gets reshaped. Experts have been dissecting, discussing, and deciding how healthcare should be delivered in the information age. Central to their ideas are words like "patient engagement" and "pay-for-performance", as the ACA mandates better patient outcomes. That means you are an important piece in this new health-care system. It's a wonderful time to get your voice heard.

Experts warn that, while you are likely to live longer as a result of all our medical wizardry, you will likely be doing so with a chronic disease. This may be an acceptable set of circumstances for theorists, but it's a cold slap in the face for the rest of us. The average American lacks the education, finances, and resources to handle a chronic disease. At the very least, they will mean major lifestyle changes for all of us.

Lack of education, when it comes to patients, is a prickly issue in all this. "The culture of the health professions is rooted in their education," says Dr. William W. Stead of Vanderbilt University Medical Center in his paper Healthcare Culture in the United States. Challenges from those lower in the hierarchy, patients being the lowest, have historically not been acceptable. “Google happy” patients are not welcome and some practitioners are moving to control the information. WebMD, for example, has a strict peer-review process for what goes on their site, credibility being a big part of their brand. Others, however, are leaning into more knowledgeable patients. You can find out which camp your doctor falls into by inquiring what types of patient education programs he or she has in place.

When it comes to something like repetitive strain injury (RSI), where medical science understands little about the underlying mechanisms of injury, a well-educated patient population can help develop more effective treatments more quickly than has been achieved thus far. The traditional mechanisms of research, conclude, publish, and disseminate to practitioners has a number of logjams. We’ll take up the last issue in this post.

In medical school, doctors learn the scientific method and the basis for disease. Some would like to see the four-year course of study be cut to three to ease student loan burden on young doctors. Yet there has been such an explosion of biomedical knowledge and technology, others argue medical school should be longer. While researching my book, for example, I discovered that nearly half of the medical schools in the United States do not require a musculoskeletal course. As we shall see, this would be a good reason why there are so many poor outcomes at the primary care level.

It's really only during internship and residency that doctors learn to apply their knowledge in real-life settings. Specialization developed to cope with the exponential increase in information. Unfortunately, according to Dr. Stead, the results have been "some are learning more and more about less and less, while the rest are learning less and less about more and more." For instance, only rheumatologists, anesthesiologists, and physiatrists study pain, and during residency not medical school. Pain, it would seem, should be included as the basis for disease.

The lack of knowledge exacerbates when we reach the third level of education: clinical experience and continued reading. A doctor is free to select which topics he or she wants to stay abreast of, relying on a system of peer-reviewed journals that present the latest research findings. Here's where conflicts and competition play out to the detriment of patients. The Journal on Neurology, for example, claims the nerves for its own. None of the other journals are supposed to write about nerves. This means that even though many injuries and illnesses affect the nerves, unless the practicing physician subscribes to the Journal on Neurology, they will learn very little of the recent discoveries regarding nerves. Add to that the exponential increase in knowledge, and all the available journals, and you can see how very little your doctor may know about what ails you.

This problem is about to get worse as the ACA redirects healthcare delivery through the primary care physician (PCP). Said physician has not had any of the education on pain, likely not a class on the musculoskeletal system, and most likely very little continuing education on any of the recent scientific discoveries on either topic. If they only subscribe to the Journal of Family Practice, which cannot write about those subjects, or perhaps only one article once a year, very little pertinent information will have reached them. This is who will be your front line defense. Because medical science doesn’t agree whether RSIs are musculoskeletal or neuromuscular, there is little wonder that he or she will have little success in treating your carpal tunnel syndrome or gamers’ thumb or tendonitis.

So many RSI sufferers I talk to go to their PCP, receive inadequate answers or treatment, and are told to go home and rest it, the current first response treatment guideline. They wind up believing their wrists or thumbs or elbows will always hurt, unless they stop doing what it is they suspect is causing it, and in the case of work, that's often just not possible. Its way too easy for that patient to wind up with a systemic, lifestyle threatening, chronic illness they thought was just carpal tunnel syndrome. That's what happened to me.

This is why I write regularly about the latest RSI research. To arm sufferers with the information I suspect their doctors do not possess. With the ACA, it is likely now more than ever, that your doctor is just a little bit more willing to listen to you than he or she has been in the past. I try to provide you with peer-reviewed research from reputable organizations to facilitate your doctor's education on RSIs. But you might be sensitive to how you approach them on the subject, now that you have a better understanding of their own perspective.

The next blog in the series addresses Clinical Data Sourcing, another way you can help solve the mystery of RSI.

@JillGambaro