Sunday, December 5, 2010
Hand Surgery
Was anyone else terrified by the author's story about his hand? I feel like the story of Anne Dodge was really unfortunate, and I felt terrible that she had lived with a misdiagnosed condition for so long, but the author's story scared me on a whole new level. When he recounted his visits with the first few doctors who became so eager to operate, and operate aggressively, I was astonished. One doctor just made up a condition, and the next doctor wanted to do three unnecessary surgeries. I understand that patients may exert a lot of pressure and may demand a treatment/cure, or even just a diagnosis to comfort them, but the thought of a doctor just making up a diagnosis or performing an unnecessary surgery makes me cringe.
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Yeah, I have heard of this issue that was mentioned in the book with fusion procedures for your back. That a lot of doctors go this route, I have a couple friends that did this, and the results are all over the place. I guess that is a good reason to do your homework on the doctor you visit. I would want to know if they plan to find something before it starts, especially something as serious as back fusion. Similar to Groopman's hands issues, I am reminded of sleep apnea. I have some trouble sleeping, and I know it doesn't have anything to do with apnea, at least I pretty sure. I had a doctor suggest a sleep study, for that reason. I asked him how often the study doesn't find apnea. He didn't know, and I'm not sure he liked the question. I guess who is hurt by an incorrect apnea diagnosis? Except CPAPs and studies cost money, and I can't believe sleeping with one is easy to start. Don't get me wrong, I know people with apnea that swear by the CPAP, and the diagnosis was correct, but I honestly have never heard of anyone not getting diagnosed with it following a study.
ReplyDeleteI spent this past summer doing medication reconciliation in our surgery admit unit, and I saw a tremendous number of spinal fusions. During my down time I liked looking up articles about some of the more common procedures to do a little self learning, and I stumbled on quite a bit of literature that did not support these procedures. It really made me wonder how insurance companies keep paying for them if there is a lack of clear, convincing evidence of their efficacy. I understand that the doctors may recommend them because they believe in them, or maybe just because they know they are lucrative, but I would think that the insurance companies would be reluctant to foot the bill in these circumstances. Not only are these surgeries dangerous for patients (anesthesia alone has many risks, not to mention infections, etc.), but they are expensive. Patients may even know this, but opt to have the procedures anyway since their insurance covers it, but eventually we all end up paying for procedures like this through higher premiums.
ReplyDeleteIt sounds like Jason and Shelly both would agree with me that surgery has become more apart of early treatment vs. what used to be (and should be) the last option. I feel that the general public's opinion of surgery is skewed from hearing about professional athletes undergoing the knife. Obviously some surgeries are needed, but our general culture believes surgery is the quick fix when rest and physical therapy may be all that is needed.
ReplyDeleteYeah Will, everyone wants a quick fix. It's one thing if you are Sidney Rice and need hip surgery (which he should have had in off season) or me, I don't have much of a future in the NFL. But I wouldn't be surprised that a surgeon could look at the same hip and recommend surgery for someone when rest and rehab is just as good. When insurance companies cover it who is hurt? oh, I guess all of us. And I agree with a point Shelly made about wondering why insurance companies continue to pay for procedures (fusions, specifically) that have conflicting data. Usually, nobody utilizes data better to make decisions than insurance companies.
ReplyDeleteAfter reading this book, I wonder how the average patient would be able to get enough information to be an advocate for themselves. Sometimes a physician is wrong, but who wants to pay another co-pay for a visit or wants to prove their doctor wrong? Who knows if an insurance company will cover multiple visits for the same thing? Also, when an insurance company will pay for a surgery but won't pay for physical therapy, I can see why someone would take the risk as an answer to their pain, especially if they weren't truly informed about the procedure.
ReplyDeleteTwo years ago I had an EP study performed on the off chance that I had an abnormal rhythm since a monitor was inconclusive. I was 22 at the time and I knew my brother had it done when he was 17 so I figured I would be fine. Looking back now, I just agreed to a procedure where electrodes are inserted into your femoral arteries and fed into your heart all while under heavy sedation because the doctor thought it was the best way to find an accurate diagnosis. The problem I have with it now was that there was no point in really performing the procedure in the first place. It wasn't interfering with my normal life and I had no aspirations to be a triathlete so the stress on my heart was n/a. Turns out that I have a sensitivity to my body's production of adrenaline so now I can take a beta blocker before exercise... which who would ever do that since all it does is make you feel tired? Moral of the story is, it's difficult to question a physicians view because you trust their expertise. As pharmacists we can encourage our patients to ask questions and take a more active role in their healthcare.
ReplyDeleteI agree that these kind of stories are troubling. Sometimes I wonder if some doctors are really like that. Are they so confident in their ability to make the right diagnosis in the space of a few minutes or are they just so egotistical that they are willing to make a mistaken diagnosis and hope no one is the wiser. But what gives us, the general public hope is that for every Dr. C, there are many more Dr. Ds who have to take on the role of undoing all the damage doctors like Dr. C cause. As I was reading the chapter on the author’s hand problem, the one that comes across again and again is that doctors who are humble, without being arrogant and who listen to the patient are so much better prepared to be doctors. I also liked what Dr. Light said “the perfect is the enemy of the good” which is a good way to set realistic expectations for both the patient and the doctor.
ReplyDeleteThis past summer, I met a doctor who makes it a point to go to all his patient's funerals. It's not a common practice but according to him, it keeps him tuned in to the individual patient and their families and the families are really appreciative of his presencec even though they have just lost someone they love who was in his care.
In this chapter, the term of "commission bias" stood out to me. According to the book, commission bias is the "tendency toward action rather than inaction." This is terrifying to know that rather than stepping back and making a rational decision, some doctors who lack confidence would desperately give in to "do something." This can occur due to pressure from the patient to find a solution for their problem. Sometimes inaction is best, even though it is not what the patient expected.
ReplyDeleteThe other day at work, I had a patient ask me for a recommendation on an OTC product for his child's illness. The father explained the symptoms to me (which were minimal) and I told him, I think the best thing for your child is to continue your current treatment and not add medications. The father seemed surprised by my comment, but I didn't want to suggest something to him, when I didn't think anything would be helpful.