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The Patients Have Spoken and I Am (or am not) Listening!!!

I feel like I’m having a Sacha Baron Cohen moment (actor of “Borat” and “Dictator” fame). On the one hand I am smiling and nodding in agreement, and on the other, I am probably doing EXACTLY the opposite of what everyone has advised.

Let me start by sincerely thanking all of you for responding and sharing VERY SOLID advice with me about how to address my MD dilemma from last month.

For those of you who missed my post which I blogged about on April 12th, a young 14 year old girl presented to our office with a complaint of knee pain. She was seen by an orthopedist who after finding NOTHING on MRI decided the young girl should have surgery. The debate isn’t whether orthopedic surgery is or is not a proper option; the debate is whether surgery, an irreversible, highly invasive procedure, should be the NEXT option for a 14 year old girl. Remember, the MRI…a HIGHLY sensitive test that would have revealed most any derangement of the knee, was negative.

So after considering the numerous words, and the very well-thought advice from all of you, and again, I sincerely appreciate the time many of you took to answer my request for help, I have decided to do the following:

Tell the orthopedic surgeon SHAME ON YOU and shine a light on abject ignorance!! (I wanted to tell him to go *$@^* himself but my mother advised me against using bad language.)

My decision is based on three factors:

1. The current research is glaringly obvious and doesn’t just suggest a proper course of care in the case of the 14 year old girl and the hundreds of patients like her…it clearly STATES IT, SO SHAME ON THE DOCTOR FOR NOT BEING CURRENT IN THE RESEARCH AND PRESCRIBING AN APPROACH FROM THE 70’s!

(A special note to further illuminate my point: In the 70’s I was diagnosed with Osgood Schlatter’s Disease. A gruesome sounding disease, which when translated simply means TENDINITIS OF THE KNEE IN CHILDREN. My parents responsibly took me to an orthopedic surgeon who was one of the leading surgeons in the state of Connecticut. His treatment was to put me in a full length cast for 8 weeks. Yes, it was stupid then, but it was the recognized treatment of choice in those days. If a doctor did that today, he might risk losing his license for blatant incompetency. My point is, we as doctors have a responsibility to stay current and evolve our treatment approaches, not make recommendations that didn’t work 10 or 20 years ago.)

2. I have been in this field now for some 18 years (jeez I’m getting old) and there is a BIG difference between the doctors we work with who evolve and look to stay current in the research and those who don’t. And frankly, it is LATE IN THE DAY AND I’M TIRED OF TREATING STUPID OPINIONS EQUALLY WITH THE WELL THOUGHT, CRITICALLY BASED INFORMATION. And I realize that many of you may think I’m being a little too harsh here, but am I? How would any of you feel if after putting your 14 year old daughter through a surgical procedure, she came out of surgery feeling no better? And what if you later found out, there may have been a non-surgical option READILY AVAILABLE and your doctor didn’t even look to explore it? Would you be as frustrated as I am?

3. Although we have referred patients to this doctor in the past, he hasn’t returned the favor in kind, so how can I lose a relationship I don’t already have? (I just threw this one in, even though it doesn’t change the way I think we should address this issue.)

To be clear, I’m not picking on this doctor, I’m picking on everyone who propagates ill-founded or unfounded opinions and information, and passes it along as if it were truth. This goes for surgeons, chiropractors, politicians, teachers, or any “so called” expect or person of authority. You know who I mean, those among us who regard facts, data and research as inconvenient things that get in the way of their story, narrative or random jibberish. Don’t get me started. I see why George Carlin was so grizzled and cynical towards the end.

So I have put together a list of questions YOU MUST ask your surgeon before orthopedic surgery. By the way, feel free to ask these questions of your chiropractor, physical therapist or anyone else giving you advice about YOUR body or YOUR KID’S body:

1. Are there other options?
2. What do we do if the surgery doesn’t fix the problem?
3. Is this what you would recommend for Michael Jordan?
4. Is this what you would recommend for YOUR daughter? or, Would you have the surgery if the MRI were negative?

These questions will prove to be enlightening. I’m done ranting, but always remember, stay informed, if you aren’t informed, seek out those who may have real information, and look to a variety of experts who have experience dealing with similar cases as yours.


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