full article 700 words
Medical training is better than the competition, but family doctors lack the skills and knowledge to treat most common aches, pains and injury problem, especially stubborn cases. Even the best general practitioners of medicine are poor substitutes for specialists,1 physical therapists, and some exceptional chiropractors and massage therapists. Most doctors are well aware of this, but some seem to be disconcertingly oblivious. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton:
Undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.
Please cut doctors some slack on this. It’s not an insult to physicians.2 Doctors have to work with an astonishing array of conditions, and pain is often too subjective, slippery, and minor compared to other pathologies — it doesn’t get on their radar. Musculoskeletal pain is a bit of a backwater, simply because medicine had bigger fish to fry (e.g. curing major infectious diseases and so on).3
Nevertheless, the severity and importance of a lot of body pain was also underestimated — or even disbelieved — by too many doctors for too long. Medicine should now be taking pain more seriously.4
Medical researchers have done many studies showing that most doctors still do not understand aches and pains or heed expert recommendations. At the 2014 World Congress on Pain, Dr Andreas Kopf presented “3 Sad Realities”:
A paper in Archives of Internal Medicine showed that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al. “90% of postgraduate physicians report no adequate training in pain.”More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.”5
Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.”6 In 2006, Stockard et al found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.7
So that pretty much tears it. Medicine gives itself a failing grade in this area.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
From the abstract: “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.”BACK TO TEXT
From the abstract: “… training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs.”BACK TO TEXT
From the abstract: “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”BACK TO TEXT