[Health Column] Do Doctors Diagnose Pain Differently?

[Asia Economy] Until now, no doctor has directly seen the patient's pain. Instead, doctors look for indirect evidence of the disease through various tests. They find herniated lumbar discs using MRI, detect abnormal nerves through nerve conduction studies, and identify narrowed blood vessels with angiography. However, the diagnoses made by doctors interpreting these indirect pieces of evidence can differ.

Upon reviewing the test results, one doctor may recommend surgery, while another prescribes procedures, medication, physical therapy, or exercise therapy. Some doctors even diagnose that the condition will improve simply by resting. One might wonder, "Huh? That's strange. The patient complained of pain and objective results were obtained from the testing machines, so why do treatment opinions differ?"

There are several reasons why doctors have different treatment opinions. It may depend on whether the doctor has acquired the latest knowledge or on the breadth and depth of their clinical experience.

Treatment opinions can also vary depending on the characteristics of the patient group seeking a specialist or considerations of the patient's socioeconomic status. Nevertheless, above all, the biggest reason may be the differing interpretations of the test results by doctors. From the patient's perspective, this can be frustrating.

Since opinions differ depending on the medical institution and each specialist, patients sometimes seek out large hospitals, but even there, doctors' interpretations of the results tend to vary. So why do pain specialists' opinions not align on objective test results? Why are there doctors who trust and explain the results as they are, and others who do not? The reason lies in whether or not they recognize the errors inherent in the tests. Accepting the results as they are means risking falling into error.

The first error is hastily deciding that an abnormal test result is the direct cause of the pain. For example, even though it has been revealed that the degree of lumbar pain does not correlate with the extent of disc herniation, some still recommend disc surgery simply because it seems plausible.

The second error occurs when no abnormalities appear on the tests. If no abnormalities are found, does that mean the patient's pain does not exist? In such cases, patients seek out hospitals with good equipment to find the cause. Nevertheless, many end up wandering without answers and eventually find the cause through the skilled hands of a local doctor. Although the test equipment shows normal results, abnormalities are revealed through the direct examination by the doctor’s hands.

While testing machines, the pinnacle of modern science, cannot reveal the cause of every disease, they do not make major errors. The ones who err are the doctors interpreting the results. The fact that doctors must study throughout their lives and accumulate experience means, in some ways, they are less likely to make the error of mechanically interpreting test results. What doctors need is knowledge in their specialty, but more importantly, wisdom to apply that knowledge.
Park Yongseok, Director of Haengbok Anesthesia and Pain Medicine Clinic