[phobosanomaly]

I will push back a little bit, because I'm curious to see if anyone has a good argument for why I'm wrong on this.

I would say that it's the equivalent of having the HR person mail their computer in, swapping out the motherboard, and mailing it back. This is, from my experience, what most IT departments actually do in this sort of situation. Maybe I'm wrong. I'm not an IT guy.

The surgeons proposed to directly fix the problem. I don't see a good alternative proposal for their team to make, given imperfect information about every patient.

What is a plausible mechanism for a real-world physician to intricately investigate every moment of every patient's personal life to get to the elemental root cause of every single illness? Someone would have to follow them around 24/7 with a video camera.

[tdrp]

Thank for this discussion, it is really interesting to me!

The surgeon proposed what was probably the algorithmic way to fix the problem.

Given that the OP was having issues because of their heels, odds are that the surgery wouldn't have entirely fixed it and now the ligaments would have been unnecessarily tampered with by a surgeon whose thought was "we should totally reroute those ligaments that'll do it". OP mentioned she was a marathon runner, athletic and in her early thirties - what? did her ligaments suddenly get into a state where they needed rerouting? OK sure but why, why now, etc. I feel like even a non-medical professional could have gotten closer after talking to her for twenty minutes.

I am not a doctor obviously, but I have been to some good doctors and the "imperfect information" can significantly be improved if they actually make a more clever, targeted effort to inquire, rather than just casually prescribing surgery or heavy medication. Good doctors will talk to you, actually tell you what the "algorithm" prescribes and often tell you why they think it is not the case here. The best way I can describe the difference is like talking to a customer support bot vs talking to a customer support person.

I realize this is probably extinct now here in the US because of litigation and insurance requirements but it's still that way in many countries. I am certain that good, fluid doctors there beat the algorithmic approach hands down, whereas good doctors here may be capped and severely restrained by it.

[phobosanomaly]

I agree with you, one-size-fits-all is a ridiculous approach in this situation.

I would love for us to be doing a better job here.

[medntech]

Can you give an example of an algorithm?

[phobosanomaly]

I found this from the European Association of Urology.

https://uroweb.org/wp-content/uploads/26-Chronic-Pelvic-Pain...

There's a rough algorithm for non-gender-specific chronic pelvic pain on p.24.

But, yeah, there's over 100 pages in there on chronic pelvic pain in this document alone. Definitely a problem that's above my pay grade.

"The algorithm for diagnosing and treating CPP (Algorithm 1) has been developed to guide a physician through the process from diagnosis to management. A physician should follow the lines by answering the appropriate questions with yes or no. By doing this the clinician will end up at a box that refers to the chapter in this guideline that contains all the information needed.

Because CPP is pain perceived in structures related to the pelvis, it is necessary to approach a patient diagnosed with CPP as a chronic pain patient. Confining the diagnosis to a specific organ may overlook multisystem functional abnormalities requiring individual treatment and general aspects of pain in planning investigation and treatment. This idea is easily recognised in the algorithm where the division in specific disease associated pain is made on one hand and pelvic pain syndrome on the other.

The algorithm also illustrates that the authors advocate early involvement of a multidisciplinary pain team. In practice, this should mean that well-known diseases, e.g. ‘true’ cystitis and endometriosis, will be diagnosed and treated early. If treating such conditions does not reduce symptoms, or such well-defined conditions are not found, then further investigation may be necessary, depending on where the pain is localised."