The Mad Hatter’s Healthcare Party!!

May 15, 2019

A very happy UnBirthday to you!!!

Unless it is your birthday, in which case, you have my condolences.

If you’re thinking “this does not make sense” then you would probably be right.

The Mad Hatter’s tea party, for me, is the perfect analogy for the worst kind of health care experience, which remains a very common occurrence for people in pain or injured.

The person running the show makes short, harsh comments, interrupts the listener and speaks in nonsensical language without paying any attention to the person in front of them, who leaves thoroughly confused.

If they do spend any time trying to help, they spend all their time and effort on things the person does not want or need, in the end making it worse.

So the person comes expecting a cup of tea, or needing directions to the castle, but leaves with their alarm clock filled with jam and smashed with a hammer.

Much of what occurs as standard, or first line healthcare, does not make sense.

It’s as if we have got the pyramid analogy (where you start at the bottom with the most effective, easily accessible, cheapest and least risky treatments and go up) and flipped it.

The 2 best examples of this are the 2 things we do a lot of, and are 2 things that could be done a huge amount better – Persistent pain and Athletic rehab.

Overall, with severe or persistent pain, we tend to massively overtreat things that get better for many non-specific reasons, focus much attention and funds on things we can’t change or that have very little impact on actual outcomes, and whether with the best intentions or not, can do more harm than good.

Severe pain without a large, traumatic incident immediately preceding it, or pain that sticks around for a long time are things that we are unsure how best to manage.

While extremely troubling for the person feeling it, it is highly likely to be a result of many, individual factors and in nearly all cases, will resolve well, with time, advice, positive environments and increasing physical capacity.

Obviously there are some nasty things that need to be ruled out, but these are, fortunately, not common.

Bulging discs and all the big words you hear on an MRI report are not as nasty as we once thought. They exist in people who have NEVER had pain, as do “pinched nerves”, arthritis and all the other things you have heard are wrong with you.

This is not ignoring them, it is just trying to understand them in the correct context. Your context.

It also means that, while this can be hard to hear when you are in a lot of pain, throwing expensive interventions at most things is not a good idea.

Surgery for neck pain can’t be first.

Implanting things on your spinal cord for back pain can’t be first.

Ketamine, Codeine, Lyrica, Endone can’t be first.

If they were magic, that would be ok, but they are not.

Interventions like that may have a place, but in a very small amount of cases. And after everything else has failed, not before trying the simple things.

Over time the health and medical professions have increasingly thrown money, time, resources and treatments at problems like this and they have gotten WORSE.

Just think that over for a second.

Neck and Back pain, for example, have increased as a global health issue as we have treated it.

That seems a bit topsy-turvy.

Every profession is guilty. Instead of good advice, reassurance and following evidence based guidelines to frame treatment pathways, we are fast tracking them to expensive and ineffective treatments, and then saying, “oh well there is nothing else that can be done”

Like taking someone to the Mad Hatter’s tea party and bailing before shit gets crazy, then suggesting it’s their fault for getting involved.


But what about Athletic Rehab, after things like ankle sprains, hamstring tears, ACL reconstructions and shoulder dislocations?

Things where there HAS been a traumatic incident, even the need for surgery to retain the architecture of a structure?

This is an area we seem to gigantically UNDER emphasise.

One of the biggest risk factors for an injury, any injury, is that you have done it before.

Once you have done something, statistically, you will do it again.

There are, of course, many reasons for this.

One of them is woefully inadequate initial management and/or rehabilitation.

Again, this is something all professions are guilty of.

“It’s just a sprain”, “It’s not broken, see how you go for 6 weeks”

“It doesn’t hurt, so it must be ready to play”

Many injuries have fantastic rehab plans, outcome measures and clinical decision making frameworks to give people accurate expectations of what they need to be able to do, and what is safe, before contemplating a return to athletic activity.

It is always, ALWAYS more than what you think.

If you sustained an injury at a certain level, it makes sense to get better than before, to decrease your risk, right?

As a health professional, this is really the point of rehab. This is what we need to outline to people at the START, and develop the pathway for people to achieve it.


We can’t PREVENT or CURE pain and injury. It will always happen, it is a normal part of life.

What we are doing is really trying to decrease the amount of time that an individual spends not being able to live the life that they want.

Health care should be decreasing the BURDEN of pain and injury on people, not increasing their problems, or leaving them open for recurring problems.

Currently, despite huge amounts of research into recommendations, guidelines and advancements in what we know about treatment and rehabilitation, I feel that we have this upside down.

Or if not upside down, then convoluted, inconsistent and, from the outside, often looking like a bunch of people chasing a dormouse around to put jam on his nose and shove him in a teapot.