Dear Men – Why I might refuse to give you treatment

The month of Movember is important to me, as it reminds me what my most important role as an osteopath is. Osteopaths and other Allied Health Professionals undertake years of rigorous training to learn their craft and serve their patients’ needs for diagnosis and treatment. However, I feel that the single most important part of my training is to judge when NOT TO TREAT a patient, because I suspect that their symptoms may be caused by something that falls outside my area of expertise.


A great example of this is a consultation I had with an active, fit man in his mid 50s just the other day. He was complaining of a long history of back pain, which in recent months had changed in character and intensity. Based on his age alone, I was already alert to the fact that he was in the broad risk group for prostate cancer. Because of this, I lined up my questions to screen for any signs that his complaint could be of a sinister cause. Before I could get into questioning him, he told me that he had recently been diagnosed with early stage prostate cancer.


Now my job was made a little easier. Instead of thinking ‘could this guy have cancer’, I was then thinking ‘what has caused the pain behaviour to change recently’? I followed his declaration with a string of screening and diagnostic questions. From his answers, I was satisfied that his pain was due to a recent change in his work circumstances and that the pain behaviour was consistent with musculoskeletal pain. I relayed that conclusion to him, but followed with, “Mr X, my treatment is going to make your back feel a lot better, and I’m going to guide you as to how to look after your spine so a new normal is established for how your back feels. I want you to have awareness of what your new normal is, because in the future, should there be a marked change in the pain behaviour of your back, I want you to get it checked out immediately.”


“Why do you say that?” he asked.


I explained, “Well, because of your cancer diagnosis. You are going to want to make sure that there is no spread to the spine.”


“Now that’s what I was worried about!” he admitted. The room felt lighter because he had got something off his chest that he’d not had the opportunity to discuss with anyone else before. His worry was not about his back pain – he had admitted to a long history and no curtailing of usual activities, including sport. His concern was whether or not his back pain was linked to his cancer.


Often, people consult Dr. Google for something like back pain. Once you confirm you are a male in your 50’s, you are confronted with the horror of different cancers and other scary illnesses. Diagnosis is never that straight forward. Context is everything. Being able to quickly differentiate a pattern of symptoms quickly means you can put your patient’s mind at ease or direct him to seek investigation from another specialist.


My Dad died 6 years ago due to a very aggressive form of prostate cancer. He was definitely in that generation of men who put up with or ignore early signs and seek help when it’s too late. He was also diabetic, so the symptom of increased urination had not been differentiated and investigated. Sadly, he did not confide in me either. Maybe I should have known, because he’d refused several invitations to spend time with me in London, preferring to stay in his home in the Midlands. Another clue to differentiating symptom progressions is to ask what else is changing your life. Are you avoiding an activity you used to love or take for granted?


So to all you men, young and old, don’t rely on Dr. Google. If you have symptoms that are not disappearing on their own by taking reasonable self-care measures, get expert advice from someone skilled to differentiate symptoms. Often, it is nothing sinister, but do you want to risk not knowing?


#alliedhealthprofessionals #osteopath #prostatecancer #movember #bowelcancer

#menshealth #wellman