[powercf]

> I counseled Will on the difference between subjective complaints of pain, which cannot be proven and are often magnified, and objective signs found only on careful clinical examination by an experienced physician

If a patient has a pain in his foot, but the doctor cannot understand the pain, then, according to Basil Besh, the patient doesn't have a pain in his foot.

This seems to advocate minimizing the importance of the patient's reporting of pain. Patients are experts in how they feel, and while they may not always be accurate, what a patient tells his doctor, should be fundamental in diagnosis & treatment.

[loceng]

"If a patient has a pain in his foot, but the doctor cannot understand the pain, then, according to Basil Besh, the patient doesn't have a pain in his foot."

Sorry, where does he say this or are you misunderstanding and making an huge assumption that the doctor's objective examination wouldn't include ultrasound, x-ray, and/or MRI diagnostics - which would all be part of determining objective cause? For example, if pain exists in an area - say in the feet - even if there's nothing visibly broken, fractured, or torn, an inflammatory process (which causes pain in itself) will show up as extra fluid in areas where there shouldn't be fluid noticeable.

[powercf]

> Sorry, where does he say this

He didn't state that. That's my interpertation of his well written and very reasonable (at face value) statement. His central messages are "the doctors know best, and we shouldn't listen to patients as they are work-shy and/or drug addicts", and "I won't talk about the whistleblower, Anna Watson, except to say that she's a trouble-maker, whom we had to fire, and is being investigated for malpractice".

I'm not a medical professional, but I don't agree that machines can always diagnose pain. If a patient says he's in pain, then the doctor should take his word for it. It becomes more complicated if the patient is potentially addicted to pain medication, but fundamentally the word of the patient needs to be central in medicine.

[loceng]

Okay, so I agree with everything you say except for the false assertion that he's being dismissive that just because the pain can't be "proven" - that it's to be dismissed. He doesn't seem to say that anywhere.

[_ea1k]

I'll agree that he is dismissive of some of the claims, but only because I have never heard of a doctor in these situations not being somewhat dismissive. Its an interesting environment with a lot of moral hazard at a lot of companies.

I know nothing specific to Tesla's environment.

[Aeolun]

Not saying it and not thinking it are two different things. If he didn’t have an opinion on the matter, I just cannot see why he would even bring it up.

In the best case, I feel like he intents to say that even though people claim to be in pain, there’s nothing medically wrong with them, and it’s fine to send them back to work.

[loceng]

This is why I asked. And really, that's your best case understanding or your most skeptical/negative case of the interpretation, and without allowing for any assumptions for the full context of the scenario? Honestly there isn't enough context with what the doctor said there as to what actions would be taken and under what types of circumstances - however then people like to make wild accusations/speculation based on not enough context; sure, you can get worry and emotional at the possibilities, and state those potential worries - however assuming that the doctor's ultimate intent is to sweep something under the rug and send an adequately injured worker back to work... that's less to not reasonable.

[Aeolun]

I’m just saying the mentality of dismissing primarily mental anguish lends itself extremely well to dismissing worker complaints and sending them back to work.

Whether or not that is actually the case, as you say, is hard to prove.

[mannykannot]

Powercf is making no such assumption. You, on the other hand, are assuming two things: firstly, that medical science is actually capable of identifying the physical cause of every pain (on the contrary, ideopathic pain is widely recognized as being a problem), and secondly that the medical staff at the facility has every device and diagnostic skill (up to MRIs, apparently) to make such a determination, and would, in fact, take the time to do so before deciding how to transport a patient off the facility.

[loceng]

Powercf did interpret/make an assumption of something that I believe was false.

It seems a lot of assumptions are being made by everyone - or context not being controlled for enough during responses - and it's too much effort to counter it all, some assumptions more or less reasonable than others; it's reasonable that they likely don't have an MRI, more likely they have x-ray and ultrasound - more likely reasonable to assume that based on the incident itself, what happened specifically, they can determine a reasonably safe course of action.

If there was an injury at work, and pain resulting from that, it's reasonable to assume that there was just an event that occurred to cause that injury/pain, right?

Basically missing from everyone's arguments are the specific contexts of different scenarios being argued around:

If someone hurts their hand and it visibly needs care, you send them to the hospital - that likely doesn't need to happen in an ambulance unless they're bleeding out and can't be stabilized.

If someone's just walking along or makes a twisting movement that that causes them immense back pain - and say, it wasn't from getting hit by any machinery moving quickly - then that sounds more like an inflammatory response the body does to stabilize an area that just had a nerve pinched than something more potentially devastating; a doctor should be able to based on the situation described by the person decide if they need to be mobilized and taken by ambulance or if taking a Lyft would be quicker getting them to full care. Likewise, that twisting movement should then be addressed to make sure their body can handle it or that their movement is proper for the task at end - that we could assume they're repeating often.

I've hurt my back before where I was walking like a hunchback 90 year old man, where I had to walk bent over a bit to stop the pain from getting worse; it was twisting from playing floor hockey after having just before done a hot yoga class, so my body was open and muscles weren't as tight/supportive - and it was only actually the next morning when the inflammatory reaction had kicked in/stabilized the area; I didn't go to the hospital, I did however call my chiropractor who I'd been seeing for other issues who could see and access me. She used heat and laser light to help reduce inflammation in the area (which helped), and told me to rest and not do yoga for a few weeks - and suggested anti-inflammatories if I wanted to take them. I half-jokingly pressed her to let me go after a week, to which I had a followup with her, went to the same hot yoga class 6 days later - and that heat, blood flow, stretching/strengthening - completely cleared whatever inflammation/pain process was happening in my spine and I felt 100% better afterward.

If someone was hit by machinery, say in the head, your decision making process will be different then if they're just walking and sprained an ankle. We can assume that if the on-site doctors are trained well then they're making good judgement calls based on the information presented to them, based on whatever diagnostics they may have available; the fail-safe to this is however why there are organizations like OSHA, to hopefully make sure good/acceptable decisions are being made.

My biggest concern in all of this would every doctor's ability for critical thinking, including having strong situational awareness, however that would come with proper/adequate training - and that would be required for any on-site doctors, ambulance attendants, or doctors working at hospitals.

EDIT: Just to point out - there was also an assumption made that my response was talking about this doctor's response/behaviour if he was at the Tesla facility and in the context of a worker coming to them on-site at Tesla, when in fact the context was never set and I wasn't specifically referencing what diagnostic tools they may have at Tesla.

[mannykannot]

A description of how things should be, no matter how correct (or long), is not evidence that the specific allegations, of things being otherwise, are wrong.

[mistercow]

Are you claiming that in all cases, pain can be attributed to some specific and observable physiological cause? Because that is not true at all, as many people with chronic pain can attest.

[loceng]

I have chronic pain that I have been problem solving for years, and succeeding in healing with stem cell treatments. I've had central sensitization and/or chronic pain syndrome (a few other terms are used as well). I'm very familiar with pain and perception of pain.

No, I'm not saying that in all cases pain can be attributed to something observable. There are different causes that can be from an immediate larger injury, to repetitive stress injuries - and likewise not excluding holistic influences, whether it being a source of pressure on nerves in the spine or even a diet that causes high inflammation in the body; different medications can certainly cause people problems too, whether increasing the sensation of pain and/or allowing them to cope until a minor injury becomes worse.

The person commenting above made a general statement that was actually wrong - they made a false assertion, saying that because it can't be objectively found (in the foot) it must mean the doctor doesn't believe it's there - when in fact the doctor simply said it can't be proven: that doesn't state whether the doctor believes the pain is there, nor what action for care would happen or recommend. If there's pain in the foot and nothing shows up on ultrasound, X-Ray (or motion X-ray), MRI - then you'd need to move up the body to see where else pain may be coming from - the spine being a stronger possibility as pain can radiate down. Likewise, as you said, many people with chronic pain can attest to there not perhaps being a physical cause - and we know that emotional pain/stress can manifest into the physical body; and because of plant medicines, higher use of psychedelics and their ability to help people reconnect and process repressed/suppressed emotions, people often report physical pain (arthritic type pain on all their joints, "heart pains", etc) going away often after one or a few Ayahuasca ceremonies, etc.

From my own experience doctors and the medical system have a really terrible understanding of pain, perception of pain. Luckily regenerative medicine (with stem cells et al) is giving options for people in pain to "experiment" - and with great success in many cases, assuming the process/protocol followed is from a research/evidence-based process (e.g. you're not getting treated by someone who only kind of knows what they are doing).