Is physical pain worse than psychological pain?
I think we are living in a very privileged time and the standard of living for most people is very high.
Food and shelter and basic human needs are catered for and most people are able to live with a good standard of health.
When I look at the health care needs of our society I really think we have got a huge unmet need for the provision and acceptance of our psychological well-being and mental health.
I was talking recently about the stigma attached with cervical screening and I can completely understand how people may feel embarrassed about going to the doctor and these stigmas really need to be challenged.
There is still a huge stigma associated with mental health
– it is not something that is openly discussed in the work place and I can understand how people are embarrassed about it and do not really feel comfortable going to the doctor to talk about it, which can only exacerbate the problem.
In the same way that there are tragedies surrounding undiagnosed cervical cancer that could have been treated sooner, there are also tragedies surrounding mental health and it is a huge cause of morbidity and mortality in our community and often affects young people.
I have a patient who is due to have a breast reduction and her work place has told her she will not be eligible to have sick leave.
This is something I have discussed before and comes up time and time again.
Both her GP and myself have written to her HR manager to explain that this is a necessary medical procedure to relieve the significant pain and discomfort that she is constantly suffering from, but as well as this, it can also have a tremendous psychological benefit as can many breast re-shaping operations and other forms of surgery which is too often deemed to be ‘cosmetic’.
However, we are encouraged to focus on the functional symptoms that it improves because this is deemed somehow more worthy than if we were to say that surgery was going to cause a tremendous improvement in self-esteem and psychological well-being.
I understand the need for rationing and it may be that we cannot afford to pay for sick leave for everybody if they are choosing to have surgery, but there are many operations that people choose to have which might improve their physical pain or problem which would never be questioned, so why is it then that an operation to improve psychological well-being is?
It is not only that they are questioned, but they are just outright declined.
I am reading a book at the moment which are the memoirs of a brain surgeon. I find it quite painful to read because there are parallels in his practice that I can strongly relate to and it can be a heavy burden to carry when operating on a patient when we must constantly reflect on whether we are doing the right thing.
Because it is neurosurgery, no-one would question whether it was needed.
I am sure his patients had no problem obtaining sick leave from work.
However, many of the operations have limited clinical value, dubious success rates and uncertain outcomes.
Cosmetic surgery on the other hand has very good success rates with well documented improvement in quality of life postoperatively and yet it is treated as some kind of pariah.
I am not for a moment suggesting that neurosurgery isn’t worthy and I am sure that in many cases quality of life can be significantly improved but it is not always necessary and it is often performed because of the patient’s choice, yet it is not held to the same standard as a patient choosing to have a breast reduction or other cosmetic procedure.
I know that I am one small voice amongst a sea of media that shows pictures of out of proportion and excessive figures that is labelled as cosmetic surgery, but this is not something that most plastic surgeons recognise and certainly nothing that we see on a day-to-day basis.
The aim of any surgery is to improve quality of life and plastic surgeons do this every day with extremely good and predictable results.
We are not trying to create Barbie dolls, we are trying to restore and reconstruct form and function and we are treating self-esteem and making people feel better about themselves.
Look next to you on the bus and that is our average patient.
It is for normal people who are unhappy about some feature that could be improved with surgery.
If you have surgery and are unable to work because of the surgery, then I think you should be treated just like anybody else rather than having a value judgment being imposed by your HR department who decide that your surgery is not worthwhile or eligible to warrant sick leave.
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