Self-limiting Conditions: A Holistic Approach
After a thorough assessment of my husband's back and shoulder and a review of the scans and reports, the specialist described what he called a “unique solution.”
I noted the “look” on my husband's face; the specialist lost him at “drill a hole in the spine,” and the procedure was finally rejected at the mention of paralysis. An awkward silence ensued. Despite a previsit commitment to my husband that I would not “interfere” or “ask too many questions,” I could not resist. “Doctor,” I queried, “What would happen if my husband waited and chose not to have the intervention? Could this condition resolve on its own?” “Of course!” the doctor replied, unhesitatingly.
A voice echoed in my head, “Many conditions are self-limiting and may need some management but not dramatic intervention.” It was the voice of a close colleague, a rheumatologist, who looks at and listens to his patients and who considers the most conservative course of action, a standard palliative intervention, support, and follow-up posttreatment. “Let's wait and see; I will call you,” and he did to discuss with my husband the state of his pain. I believe that the posttreatment calls were just as important as the intervention. Within 2 weeks, my husband's pain began to resolve and eventually disappeared.
In another era, my husband may have viewed the specialist's suggestion as the definitive treatment instead of as an option. Fortunately, my husband's problem with pain turned out to be self-limiting, as are many pain-related episodes. Niesel and Herzog1 point to the widespread experience of pain among Americans, 1 in every 3, as well as its self-limiting nature. They also assert that self-limiting, acute pain can be caused by cell receptors that are activated in response to, in my husband's case, stretching. Although the pain was intense, particularly at night, my husband's condition was a relatively minor ailment, successfully treated by a provider who listened, reassured, and projected an evidence-based, positive outcome and who “waited” for the body to heal itself. In a study of 299 patients presenting with minor ailments to general practitioners, Fassaert et al2 confirmed the importance of reassurance, evidence-based speculation for a positive prognosis, and attention to the mood of the patient as key elements in successful intervention.
In 1859, Nightingale brought attention to nature's reparative processes. She believed that the essence of good care was to “...put the patient in the best condition for nature to act upon him”3(p75); adjust the environment, treat the patient with dignity, and give the body time to heal itself. That is what the rheumatologist did for my husband. And that is the approach that all practitioners should take in caring for patients with self-limiting conditions.
This editorial is dedicated to my good colleague Dr Vincent Zarro, Drexel University, College of Medicine.