Nocebo

She is 85-years of age and has not been ambulatory for 4 years. While she was being pushed in her wheelchair last week, the chair accidentally tipped forward; the woman fell out and fractured her left humerus.

One week later, I was called in by the orthopedist to complete active range of motion activities with the left shoulder. Setting aside (for a moment) the difficulties one might have encouraging an individual with a fractured arm to actively elevate the same arm overhead, I commenced my examination. When I tried to establish goals with the patient, she confessed, “Why bother, it isn’t going to help. The doctor already told me so.”

Later in the visit, the son shared with me this story:

‘The doctor was a dick. He could have been more positive with her; she is 85-years-old for cryin’ out loud. But no. He just walked in the room and said, “You have 3 choices and none of them are good. You can try therapy (but you won’t be able to move your arm well after), I could try to screw it back together (but you won’t be able to move your arm well after), or we could do a shoulder replacement (but, again, you won’t be able to move your arm well after). So, the best thing to do is therapy and hope for the best.”‘

Thanks, doc.

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