What not to do? The Question Less Asked.

Recently, a client asked me “Ok. So what shouldn’t I do now?” And it struck me how infrequently we get such questions. As professionals we are often asked them by our clients, “What should I do?” in the belief that something ‘more’ is the solution to their problems; that they are missing out on something that they should be doing. This is true for most fields and healthcare is no exception.

xSolutions to a problem can often be found from many directions though we often prefer something from the side of complexity – the ‘more’ side. In healthcare, that could mean more ‘tests’, ‘scans’, ‘drugs’ or ‘treatments’. The ‘less’ side is less explored, no pun intended.

In the case of musculoskeletal conditions, a small minority of conditions have their roots in the person’s genetic code; meaning that they were born with it. Most have external causes – lifestyle, diet, occupational conditions or movement habits. For example low back pain from poor posture, wrist repetitive strain injury from poor ergonomic workplace setup and sports injury from overtraining.

When faced with such musculoskeletal injuries, humans don’t seem to be geared up to accept simple answers. We prefer complex solutions (read machines with lots of blinking lights) over simpler ones (read manual therapy or exercises using body weight). We see this across many different situations.

The most common situation is, ‘what sort of machine test will you do?’ We have learnt to equate the more expensive and more complex the machine scanning us to better results. We wrote about this about a year ago, “Diagnose First, Scan Second” where a recent study found that the routine use of radiography (X-ray), MRI, or CT scans in patients with low-back pain but no indication of a serious underlying condition does not improve clinical outcomes. Combine this no-improvement outcome with the more recent reports on radiation overdoses from CT scan and it is worrying.

Another situation is the use of impressive looking machines for treatments. Will a more expensive looking exercise machine work better for me than a simple home-based type device? In the fitness industry, there is a growing trend of people moving away from machine-based exercises towards simpler functional movement-based devices like the TRX Suspension Training. Not only is it several hundred dollars cheaper if not thousands, it can be more versatile and challenging.

Surprisingly, sometimes even when it comes to treating a specific condition, the best answer may be to do nothing. In the case of whiplash, one of the recommended treatment protocols during the early stage of whiplash is to “Act As Usual”. It can be quite unsettling when visiting a doctor for whiplash treatment and to be told to act normally, to do nothing different.

Of course it does not mean that the most appropriate treatment is always to do nothing or to do something less. However, it does mean that not every appropriate treatment must do something or to do something more.

Perhaps a simple rule of thumb to help you learn to do less to achieve more with your health, for every ‘what can I do?’ question, ask ‘what shouldn’t I do?”.

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