practically a doctor a day

This has been a doctor week. Yesterday, I saw an orthopedist whose specializes in hands, wrists, and elbows; today, an orthopedist who works on shoulders. Before them, a sleep specialist. I resist being the kind of person who runs to the doctor for every little thing, and I indeed considered canceling at least one of my appointments on that basis alone. But, the thing is, I don’t run to doctors for every little thing. I’ve had sleep problems for ten years, carpel tunnel for twenty, shoulder pains for eighteen months. I’ve put in my time studying—and sometimes trying—self-treatments and alternative treatments, yet I have only gotten worse.

I usually have a tentative diagnosis for a problem, and know everything medicine can do for it before I even see a doctor. I try to keep emotion out of doctor visits, because doctors are at their best when they feel they have something to offer, and few have much to offer in the way of emotional support.

The longer the appointment, the more of a challenge emotional neutrality becomes, and I might not know I’ve lost it until I realize I missed several sentences or failed to understand simple statements. Peggy and I try to go with one another to the doctor to compensate for such deficiencies.

I originally went with her—at her request—to offer moral support, and I usually didn’t ask her go with me because I didn’t think I needed moral support. I’ve discovered, though, that what I do need is another clear head in the room. She takes me with her for an additional reason. She is convinced that doctors—both male and female—treat her better when she’s with a man.

She and I both hold doctors in low esteem until they give us reason to think otherwise. Her nursing experiences have soured her, whereas I react more to the deference they expect and to the exorbitant fees they charge. They’re also typically rushed and, to many of them, medicine is simply a way to earn money. Then there are the limitations of medicine itself.

If a doctor comes into the room and says, “Mr. Thomas, I am Doctor Boneshaker,” he or she loses five points. If he shook hands as he said it, he only loses two points. If he gives his full name (giving me the option of what to call him), he gains five points.

I am often tempted to say, “I don’t do deference. I can call you Bill, or I can call you Mr. Boneshaker, or I can not call you anything. You choose.” I don’t say this because it might arouse hostility, and hostility would inhibit the doctor’s ability to help me. It’s one of those predicaments for which I can find no good solution.

I often run into more interesting problems with doctors. Both my hernia surgeon and the hand surgeon I saw yesterday (for carpel tunnel surgery) proposed the last surgical option that I had expected based upon my research. Every website I visited recommended endoscopic surgery over an open incision for hernia surgery, yet my doctor recommended an open incision based upon my thin build. The hand surgeon had even more treatment options—four in all—yet he chose one-hole endoscopic, the very surgery that has the highest failure rate.

How is a patient to respond? I fall back upon my overall impression of the doctor. Does he seem to care? Did he take the time to explain his reasoning? Is his resume impressive? The hand surgeon explained the discrepancy between my reading and his own approach this way. (1) Less qualified surgeons negatively skew the results. (2) Many websites lean toward conservatism because they are collectively produced across many disciplines, and because a wide range of surgical candidates look to them for advice. His patience in addressing my concern impressed me and that, along with his reasoning and his other qualifications, made me decide to go with his recommendation.

His description of the level of care my wrist I would need after surgery was far more optimistic than what I had read. For example, the Mayo Clinic advised that I not even lift a jug of milk for the first two weeks, whereas he told me to let my comfort level be my guide. When I asked about the discrepancy, he said that Mayo’s advice was based partly upon what he considered outmoded surgical techniques, and that tissue damage from a single puncture would be much less than that from a four-inch incision. That made sense. Whether it’s true, I don’t know. I could consult one or two more surgeons and go with the consensus, but I waited ten weeks to see this one, and this is an extremely common surgery, and it is also his bread and butter.

The amount of caution that is warranted in a surgical undertaking becomes much clearer in retrospect. My knee surgery was a mistake, but I undertook what I considered a prudent amount of research going into it, and I didn’t learn until later that the surgery plus physical therapy is no better than physical therapy alone. But that was two years ago, and I have come far in the amount of trouble I am willing to go to on my own behalf.

I can see how doctors would come to resent all the hours they spend explaining why they disagree with Web MD, but I should think that a patient would have to be pretty na├»ve to want to remain ignorant. Of course, I might be leaning too far in the other direction. I took complete control of my discussion with the hand surgeon yesterday, and, after I had gotten all of my questions answered and verified the Peggy had gotten all her questions answered, we left without either of us asking the surgeon if he had anything to say. In an ideal world, we wouldn’t need to ask, but I try to look at things from the doctor’s viewpoint.

Yesterday, for example, the doctor tried to take the initiative, but sensing that I knew where I wanted to go—and that I needed to feel in control—he backed off. I later wondered if he didn’t go so far as to stop thinking proactively, allowing himself to become simply a resource for answering questions. I quickly consoled myself with my observation that I have never found surgeons to be a timid species who readily allow themselves to be trodden upon.

My shoulder appointment this morning did not have a happy outcome. I thought I had lingering tendon inflammation from yoga exercises two years ago, but the x-rays showed jagged arthritic damage in both shoulders. The doctor advised that I avoid weight-bearing activities if I want the joints to last. When I asked how she was able to rule out soft tissue injuries, she said she wasn’t, but that there isn’t much she can do about them short of surgery, and I’m hardly ready for that. The best she could offer was an appointment with a physical therapist, and I took her up on it.