The Harm of Labels

The medical community goes to great lengths to place patients in neat little cubby holes by labeling each person with a diagnosis. A recently published study by Buitenhuis et al (Spine, 2008, Volume 33, Number 22, p 2427-2433) demonstrated that specifically believing that one’s neck pain was due to a “whiplash” injury contributed to a poor prognosis. Just the “whiplash” label alone was enough to slow the recovery process. In an editorial about this study (Spine, 2008, Volume 33, Number 22, p 2434), Dr. Kwan stated, “the treatment industry should be aware that the way we discuss with and teach patients about their pain (often indirectly by the application of labels) may affect the outcomes”. He went on to caution readers against the labels of fibromyalgia, chronic fatigue syndrome, and repetitive strain injury.

Often times, I am hesitant to give someone a label because I know that the diagnosis becomes part of a patient’s identity. The assigned meaning of a diagnosis becomes the basis on which a patient operates. From the moment someone is labeled, that diagnosis affects the way he/she plans for the future, speaks to other people, and makes decisions. On a similar note, the assigned meaning of the pain is a source of suffering. “This means I cannot go back to work”. “This means I cannot play ball”. “This means that I will end up in a wheelchair like my grandmother”. To stop this avalanche of negative thought, it is thus equally important to provided education and discussion along with the diagnosis. What is the expected recovery time? What does this diagnosis mean? What types of myths are associated with the diagnosis? It takes time to answer these questions. But, we can no longer afford to practice healthcare without health education. For centuries, education has been the key to stopping epidemics. Chronic pain is an epidemic that is not being solved with the mere application of labels. In fact, these empty labels may be causing more harm than good.

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Back and Neck, Healthcare by drlasich