So, Frank is a fitness guy, loves to run around and push his body to its limits, because he loves the feelings and is convinced physical activity is healthy. It's kind of reassuring to learn that sometimes, even somebody Frank will experience pain:
"Like most active people, I occasionally get injured... Most of the time I’m pain-free, but sometimes things get a little out of hand and I go in search of a specialist.
One particular instance stands out in my mind. I’d been suffering with a nagging pain in my shoulder, so I made an appointment with ... an orthopod. The good doc ran me through a basic physical exam and took the afflicted limb through all the standard tests. He checked my range of motion and did a host of biomechanical assessments. And because he was either detail-oriented or living in fear of litigation, he sent me down the hall for X-rays and an MRI.
When the results came back, we reviewed the images in his office. “Well,” he said, taking on his best bedside manner, “It doesn’t look like much. You’ve got a bit of an arthritic change in the joint, but it’s pretty subtle. You’ve got basic function and you can mange your pain with NSAIDs. Beyond that, there’s really not much I can do for you at this point. I’d recommend that you wait until it gets really bad and then come back and see me. Then I’ll be able to help you.” With that, he fired off a prescription for an over-the-counter NSAID and disappeared.
I am not making this up."
As you read through the blogpost you will note a river metaphor runs through it. We each are at an upstream moment, capable of many potential acts which will reverberate further downstream. The medical system is downstream, waiting for us. It can deliver us from all sorts of suffering, but only suffering it has equipped itself to deal with. Any suffering we encounter while still upstream, tough darts. We're pretty much on our own. He got better by the way.
More from Frank:
"To my way of thinking, this [medical encounter] episode symbolizes everything that’s wrong, not only with the medical and health care system, but with so many other systems in the modern world, from education to agriculture to economics to international relations. That is, we apply the majority of our attention and resources to late-stage downstream problems while ignoring what’s happening upstream, at the source. Across a wide range of professional and social programs, we practice a strange and troubling variation of the Hippocratic oath. Instead of “First, do no harm,” our strategy now appears to be “First, do nothing. Wait until the problem is monstrous in scale and scope, then implement some desperate counter-measures.” These counter-measures may or may not work, but they sure are lucrative."My bold. How true is that? Nuclear reactors in the earthquake/ tsunami belt.. Libya.. the status of women all over the world...
"So what are the origins of this downstream orientation, this habitual foot dragging, this bias against prevention? Can we trace it to its source? Perhaps there’s an influential force in intellectual history that gave rise to our “wait-till-the-last-minute” orientation. Or maybe it’s just a quirk of the human mind, a malfunction in our brain wiring that inclines us towards cognitive laziness and procrastination.
In all probability, it’s our evolutionary psychology at work: our brains are wired to maximize survival in the present moment. Staying alive is the prime directive; the future is an abstraction that may not even come to pass. Only with the invention of agriculture and industry did people have the opportunity to think of abstract upstream causes and future downstream consequences. When you’re living on the wild grassland, you hunt, gather and scavenge, and let the consequences fall where they may. If you’re still alive in the morning, you’ve succeeded."
Yeah... well... maybe. I don't know. Seems to me we have enough history around by now we shouldn't have to repeat it. However, because human primate political and social and religious systems have dammed up the river, it's pretty hard to get upstream. If you're on the downstream side, the dam is a barrier, and you might as well be a salmon. If you're on the upstream side, you have to swim around a whole lot in a huge artificial lake to even find the source of the creek.
Back to the medical angle on all this:
"Whatever the origins, today’s incentives are fundamentally perverse. There can be no getting around the fact that our prevailing downstream orientation keeps profits high. In fact, it keeps entire industries and professions afloat. Why should my doctor teach me how to keep my shoulder healthy when doing so would only hurt his bottom line? Even more to the point, why should medical and health insurance companies lift a finger to promote healthy living when doing so would destroy their gravy train of obesity, diabetes, heart disease and other lifestyle diseases? If we really started getting serious about upstream health and education, a lot of people would find their cash cows drying up; the profit party would be over."About human procrastination:
"It’s an old story of course, this tragedy of the commons. Like the village grazing pasture or the local river, the future is a commons, a very handy dumping ground for today’s challenges and inconveniences. Just as we casually dump carbon into the atmosphere and plastics into the oceans, so too do we dump today’s difficulties into the days, years and decades of our futures. This “solution” ultimately fails of course, as it leads to vicious cycles of embedded problems, desperate action, frantic fixes, half measures and escalating chaos. Procrastination, whether personal, professional or institutional, is a recipe for disaster."Couldn't agree more.
Solution in terms of health? fight from wherever your position is now. It could always be more downstream. Relative to where you could be, the present moment is upstream from there, and you still have a slight advantage.
"To the casual observer, a present-moment upstream action may not look like much. It might be something subtle, something having to do with attention, awareness or seemingly minor choices. It might be a simple change of language, a new choice of words. It might be a new orientation towards the body, with a fresh physical challenge. It might be eating, a little more real food and a little less refined carbohydrates. It might be spending a little more time with friends and family."Same solution in terms of anything, I think.
Thank you, Frank Forencich, for a fabulous blogpost.