Don’t treat me, I’m a doctor

“Tennis elbow”, also known as lateral epicondylitis, is a common condition causing pain over the outside of the elbow, where the muscles to the wrist and fingers attach. I’ve got it, and I am doing absolutely nothing about it. Doctors often do not seek treatment, even treatments that they themselves recommend to others. What do these doctors know that makes them avoid treatment?

There are many enlightening articles written about why doctors don’t get treated themselves. Often, it is because they are aware of the true effectiveness (less than commonly believed) and the true risks and harms (greater than commonly believed). Possibly also because they have seen the treatments and know the data – and are therefore in a good position to weigh up the effect of the risks and benefits on their quality of life. For end of life care, they also realise that everybody has to die, and sometimes how you die (quality of life) is more important than how many extra days you can sneak in before you go (length of life). Funnily enough, we know from research (mentioned elsewhere in this blog) that doctors tend to overestimate the effectiveness and underestimate the harms of medicine – yet they still often refuse treatments. What does that say about the true effectiveness of some of these treatments?

Some entertaining links to media articles are given here: what doctors won’t do, why doctors would rather die than endure painful treatments, doctors don’t follow their own advice, doctors don’t use the treatments they recommend, some admittedly ‘out there’ quotes on chemotherapy, why doctors don’t want treatment when they are dying.

For me, my tennis elbow is painful. I frequently have trouble lifting things or doing heavy work and it wakes me occasionally at night. However, I am not ‘bothered’ by it. I know that it is a condition of uncertain origin, that the myriad of treatments (including injections, ultrasound, surgery, medications and splints) are largely ineffective, and that the condition is self-limiting – it gets better by itself, eventually.

Tennis elbow is a classic example of medicalisation, overdiagnosis and overtreatment. The lack of a clear cause does not stop people from making up causes and therefore diagnoses on which they base treatments that have little or no effect beyond placebo.

The apparent effectiveness of treatments for conditions that are self-limiting is what drives sales and continued treatment. Fear is another driver, promoted by doctors that use the knowledge difference between them and their patients. Unexplained, spontaneous moderate elbow pain can be distressing, and that can easily drive full blown medicalisation with all its tests, labels and treatments. And for many doctors, treating people is just a case of going through the motions. We think that patients expect treatment, so why not just give them everything?

It doesn’t have to be that way. I am telling myself exactly what I tell my patients: you have a common condition that causes elbow pain and some functional limitation but gradually gets better over time and for which, treatments are largely a waste of time. With that advice, the condition becomes a minor annoyance and doesn’t ‘bother’ me.

The bottom line

How much something bothers you, and how much you seek treatment, are subjective and depend on your beliefs and fears; we need to manage them as doctors and provide accurate information and reassurance, not just reflexively order tests and treatments for every complaint.