Treating People like Nails

“When you have a hammer, everything seems like a nail.”

People usually join their religion to fulfill their very simple needs (see a list here). But once they become a committed believer, they are given a hammer and shown how to use their religion on all the nails in their lives.  Soon, even their friends start looking like nails.

Acupuncturists, Chiropractors, Homeopaths often do the same: they treat people who are not getting better over and over with their favorite ‘therapy’ because they only have one tool and they are invested in it.

My son went to a Physical Therapist recently for ankle pain (growth plate issue).  He was given therapy exercises that only caused him worse ankle pain. When I read the exercise sheet he was given, I noticed that it was a generic ankle exercise program given to everyone for ankle pain. I had the same situation a year ago with my shoulder pain: the exercises I was given only made my shoulder worse.  I have seen the same with other friends who are treated with Physical Therapy. Physical Therapy is often used like placebo medicine.

But this hammer-nail blindness happens in all walks of life. I work in medicine and repeatedly see surgeons who perform unnecessary surgery, pediatricians who give unnecessary antibiotics and more.

Vested interests in our own tools often make us overextend their use. The less effective your tool, the more obvious this universal crime. I’ve done it lots of times. I just got riled again seeing it done to my kid.

Moral: Beware, the smiley face in front of you may be envisioning you as a nail!

Question to readers: Have you ever turned another person into a nail?


Filed under Philosophy & Religion

13 responses to “Treating People like Nails

  1. No. I am an objectivist, not a sales person for objectivism. That would be hypocritical, I think.

  2. In the acupuncture world, it’s very common to tell any new patient to give it 5 to 10 treatments to see if their condition responds well. Generally a new patient will call and either say they’ve already decided to try acupuncture, their friend or healthcare provider recommended it, or they ask if I think acupuncture will help them. There are some tricky moral decisions to make here. I try to be honest with prospective patients, especially those who want to quit smoking or treat hot flashes, that the research doesn’t support acupuncture as very effective. For people with general back or neck pain, especially if they’ve been checked over by an MD (ruling out bone cancers, etc.), I’ll encourage them to try acupuncture for 5 treatments. I’m comfortable saying that back and neck pain are the conditions acupuncture has been shown to be the best for… In the past, I would have been very happy to hammer those nails into anyone as long as they wanted. Now I’m more concerned with plausibility, evidence levels, and indirect harm.
    Sabio, what kind of medicine do you practice now?

  3. @ ancientwaykevin,

    I like your approach — you, like me, has seen people rope people in for the long treatments. Chiropractors sometimes tell people to come back for routine “adjustments” — arghhhh.

    I am presently doing Urology. I have done Family Practice, Trauma Surgery, Pediatric Dermatology, ER, Ortho, Occupational Health, and Prison medicine. That is the beauty of being a Physician Assistant–horizontal mobility.

    Even in Urology, we may call people back for regular exams that are either not essential or could be done by other people. But insurance pays. Consumer beware ! I sometimes let people know they have options — sometimes, people rather not know the options (oddly enough).

    I am curious how your studies into effective of treatments will continue to effect our practice. I will watch your blog unfold.

  4. Sabio, I’m putting that first paragraph of yours into my quote file. You said it brilliantly!

    I remember a visit to my infant daughter’s pediatrician for treatment for a cold that had turned into a lingering cough. The doctor gave us a prescription, but said that she thought our daughter had a bit of asthma that was causing her to wheeze. We thought that was odd, since my daughter had never before (or in the 17 years since) had any kind of breathing problems. Turns out this doctor was an asthma specialist!

  5. @ ubi,
    Wow, thanks. Glad you enjoyed it. I had to look back and re-read it. I enjoyed it myself!🙂

    Your story about the asthma specialist is perfect! That is exactly what happens. You’ve probably been a good watch-dog for your kids. There are lots of hammer-freaks out there.

  6. As a Christian, everyone was a nail to me. Everyone. It’s as simple as that. It has been quite an adjustment to see people as people.

  7. Wow, nicely said, MichaelB, for me too. People were no longer needing salvation or improving. I could just enjoy people.

  8. CRL

    Mario! Do your kids play?

    At any rate, when I cared deeply about religion, I was very good at hiding it—no one wants to talk to someone who obsesses over one subject area, unless that subject happens to be one of the few that is socially acceptable for small talk. When religion came up in conversation, though, I was quite eager to expound my every opinion. I suppose you can say that the few Christians I hung out with at the time got the nail treatment (and the atheist majority had the nails they wanted to hammer hammered in for them.) Surprisingly, I’m still good friends with most of them, probably because I saw them more as people to debate more than people to convert.

  9. Earnest

    As a mental health patient, I feel like I have a default nail definition. I am being made by medication into something I was not originally, to fit my social roles better and blend in with society. Until my situation is commanded to be revealed by the bylaws of my employer. Then I truly become the nail I was born to be. Or maybe that’s just breakthrough neurosis, I guess my meds should be increased!

    I should say however that people in general seem to be carrying smaller metaphorical hammers as time goes by.

    Despite (or perhaps because) of this, I have the urge to wield hammers on other people. There is a great article that I will look for, that describes alternatives to evidence-based medicine. My favorites are vehemence-based medicine, where the person who shouts loudest in case conference gets their way, and eminence-based medicine, where you never question the one on the team with the most white hair.

  10. Psychiatry is ripe ground for both vehemence-based medicine and eminence-based medicine.

  11. @crl,
    Yep, everyone can play the hammer-nail game.

  12. Dexter

    The hammer nail game starts early on. When your a kid your told what to do by your parent’s because they know best. Medical professionals went to school.. so they know best. The man wears a robe.. so they know best.
    It never ends.
    But maybe its more complicated. As there are different types of hammers (jackhammers vs soft faced mallet), there is certainly different methods for shaping behavior. Do you ask the robber the kindly put down his gun or throw your kid across the room for not making his bed?
    Maybe the problem is with the nail? Maybe the nail is too thin or frail for the jackhammer. Each of us have weakeness, vulnaribilities, sensitivities that can easily get crushed in the wrong circumstance.
    I have no answers, only further questions as I sort my toolbox.

  13. I love the thin nail analogy. Analogies are weak and invite other analogies. This one was fun. Thanx.

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