The title of this blog is taken directly from the front page of this week’s British Medical Journal. (BMJ 2018; 360:k1670). (I added the exclamation mark).
I read the headline at the weekend and straightaway got it.
Mild – moderate – severe is such a common system for allocating symptoms and extent of disease in healthcare that when I came to read the article this evening, it was along the lines I had anticipated.
I had not expected the patient to have Multiple Sclerosis – in my imagination, the patient might have had asthma or arthritis; mild MS – seems an oxymoron, or an impossible relative (get it..?) – a little bit wet; slightly dead. Gentle chemotherapy.
The article took me to thoughts of Victor Frankl – I have talked about him before; he is the Jewish-Austrian Neurologist/Psychiatrist who developed a psychotherapeutic theory following his experiences in Auschwitz – Logotherapy; essentially, meaning therapy.
And, for those of you who have red his book, Man’s Search for Meaning*, you will recall the section describing the impossible relativity of suffering.
Here is an example;
Moira’s suffering is less than Keith’s as Moira only lost five pounds and Keith ten. What does this mean? Is it of any value? If Moira is a millionaire the comparisons are moot; if Moira has profound anxiety, the comparison is also not meaningful, or, say, Keith loses the money but doesn’t realise (or care).
There are endless permutations.
Every individual’s suffering and experience is unique and personal.
I most often encounter this sense of relativity when speaking with patients who have functional illness; this is people with real symptoms but without discernable physiological change; most diseases have these types of pairings – dysfunctional breathing and asthma (breathlessness), non-epileptic attack disorder and epilepsy (seizure), irritable bowel syndrome and inflammatory bowel disease (diarrhoea/abdominal pain) – some of these conditions are better understood than others, some we have a clearer grasp of the pathology, yet, the individual whose life is overwhelmed because of an eczematous rash doesn’t really care whether the rash is caused by stress or antibodies – the person wants the same as everyone – treatment and understanding.
The pain of functional sciatica is just as severe as someone with a bulging disc.
I have written over the years about my fixation with the use of language in healthcare – how we refer to folk – the asthmatic or person with asthma, that kind of thing; here is an area I hadn’t considered.
I can’t see an immediate way around this other than trying our best to be careful when we talk with patients; clearly it is in the patient’s interests for one doctor to say to another, ‘Morag over there has acute, severe, life-threatening asthma,’ you don’t want to get caught-up in the niceties of language on such occasions.
Yet, perhaps when things are less intense, advising the patient – you have heart disease, rather than attaching an adjective is the best approach; no one ever died from mild asthma – even this is a misnomer; of the people who die every year from an attack of asthma, most are classified as being either mild or moderate (60% – see here).
‘I’m breathless, it’ll sort itself out, it is only mild,’ followed by collapse.
I don’t think we can banish these terms (unlike sufferer, which yes, should be binned), instead, perhaps apply the same level of sensitivity and, person-centredness that should be directed towards each and every clinical encounter.
If you want to read the article, you can go here.
PS Upon reading this, I noticed that I have earned myself half an hour of continuous personal development (CPD) points; it is likely, if you follow the link, and, with my blog, you have earned a whole point – congratulations!
*If you haven’t read his book, please buy yourself a copy now. From Amazon or Waterstones.