Injury Rehabilitation Principles: The Looking Good Syndrome

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The “Looking Good” Syndrome: Confusion created right at the start of treatment

Many patients present to my office with a difficult problem and a pattern of treatment I would consider sub par. This sub par treatment may be performed by top physicians and physical therapists, and others in the health care system, all with good intentions. I am amazed at times at the treatment given, and I must think that the health care providers must have been burnt out when treating the patient. Why were these good clinicians giving patients such inadequate treatment? It took me awhile to see a pattern in these patients. I call this syndrome of inadequate care The Looking Good Syndrome, although I still grasp for a better title.


Yesterday I saw Helen for the first time. Helen matches the profile of this syndrome well, and I even told her so. She has had a significant ankle problem for several years, and very inadequate treatment. The injury to her ankle is very disabling and she is only 21 years old!! Helen is cheerful, very positive in nature, bubbling in personality, walked into the office without limping, and good looking by any definition (when you read this Helen please don’t blush). After examining her ankle, even though it was obvious she needed x rays and a MRI, I had to force the words that she needed these tests out of my mouth. There is a psychological block (and I sure hope some psychologist reading this can explain in the comment section) to spend the money, time, effort, etc. to order these tests since the patient is “Looking Good”.

The patient is too healthy looking to have a serious injury. Does that make sense? No!! Anyone can get a serious injury. But, no health care provider actually wants anyone to have a bad injury, and the reasons at any one moment can be numerous. A bad injury denotes possible diagnostic dilemmas, possible difficulties in treatment reflecting poorly on the provider, possible requirements of effort that a burnt out doctor, therapist, etc. may not want to expend, and the list goes on. But, for the average clinician, a serious injury to an otherwise healthy looking patient is just too sad on a human level, and so easily dismissed as something that the patient will recover from with ease. Should health care providers be allowed to be human in the 21st century? I hope so.

What are the components of Looking Good which affect this syndrome? First of all, it is the physical nature of the patient. Secondly, and probably the most important, it is the positive personality of the patient. This positive personality, when the health care provider is collecting initial impressions, may steer the course of treatment away from a potentially negative diagnosis. How is a negative diagnosis avoided? The proper tests to make that diagnosis are never done. If done, the results of the tests may be minimized. If you match the positive personality of the patient (glass is half full), with an otherwise negative (glass is half empty) doctor, trouble brews in setting the course correctly in developing a great treatment plan.

What does all this really mean? Patients who feel that they may have a serious injury need to push these health care providers along gently (they are not machines). Assume that they are human and actually don’t want to learn any bad news about you. You, on the other hand, want your body to work correctly for many years to come and need their help to make things right again. How are things made right again? First step is always in ordering the right tests, and then moving the treatment through the roadblocks, over the plateaus, and up to Grandma’s House (always a great place)!