Sx – stands for Symptoms (in this case you can include Signs), as in you go the doctor and tell them your story. In our culture you don’t go until you have a story, and that story is usually a sad one. We have talked at length here about the story (and natural history – which means recurrent story) of those with back pain. When you tell your story you have expectation about what it means to the doctor; when the doctor hears your story they make all kinds of judgements about you and your story as well as their own situation (employer), your insurance coverage, their values and your values, etc.
Ex – stands for Examination. After you have interviewed your doctor and they have asked questions to better understand your story, they are supposed to do an examination. I will spend another entire Blog Post on the thought processes inherent in that some other day. At this point the point is the entire health care system you are accessing has a pre-determined mental picture embodied in the formula Sx + Ex = Dx -> Tx. It’s the model that modern medicine was founded on: the war against disease. Filled with presuppositions and assumptions, this model is partly what got us where we are. Ask yourself, who benefits from things being just the way they are; is an accident?
Xr – this just stands for any testing done to assist the doctor in determining what the Diagnosis is. I used Xr for X-ray because we can all relate. (When you contemplate this element of the formula, think MONEY and motivation.)
Dx – This is the big ticket item. The major goal of the all earlier efforts. This is such a big deal that all insurance reimbursement hinges on it (well, not really, but I am trying to make a point – contemplate how crucial the “diagnosis” is to both doctor and patient. Forget for a minute that in the realm of back pain (and many if not most other conditions) an accurate diagnosis that actually means anything is a very rare thing – of course if you wait until the condition develops into it’s later stages, well.. “If your symptoms persist, then come back.” (Don’t take my word for any of this, check into…)
Tx – This stands for Treatment. Treatment is a loaded word. Historically our health care system is build on the fantasy that with the “right” diagnosis there should be a preferred, highly predictable, infallible in fact, treatment that offers a solution. Science was supposed to give us that perfect treatment choice. So much for that.
One could talk all day about each of the components of the above formula, so I think I will let what I’ve written so far sink in, and Post on each component separately so that this doesn’t turn into a novel-length Post. Ask yourself what you know about each of those as they relate to your health care experience. Think in terms of your insurance coverage, your employer’s point of view in selecting the options that you then select from. If you have any concept of the terms Medically Necessary, ask yourself where that fits it.