Lessons in defensive medicine
by Jerry Frost
Scene One: In the late 1930s my younger sister, Judy, employing all the wisdom of a six-year-old, pushed a pebble up her nose. My mother, try as she might, could not extract the pebble. Our newest family member, Janet, and I watched carefully, and for the most part silently. I might have said something like how dumb it was to put a pebble up your nose, but even then I knew that comment would not be helpful.
We lived on Long Island. My mother bundled up the three of us, stuck us in the car, and drove to the doctor. The doctor took one look at Judy's nose, went to a cabinet, returned with something in his hand, and said, "Here, Judy, sniff this." Soon she sneezed, and out came the pebble. Pepper was the miracle drug of the day. (Penicillin had not yet been discovered.)
Scene Two: Ten years ago, I experienced pain in my right foot while playing tennis. I went to see an orthopedic surgeon at St. Joe's who specialized in sports medicine. He took one look at my foot and said, "You have a 'hammertoe.'"
"Great," I thought. "There are a lot of other labels that could be worse." Then he explained that the end joint of the toe was permanently bent down in an extreme position.
"What's the cure, if there is a cure?" I asked. "Because it hurts."
His reply: "We cut the tendon that controls the end of the toe."
I've noticed that surgeons really like to cut. It's kind of like the old saying: "If the only tool you have is a hammer, everything tends to look like a nail."
He asked: "Shall we take care of it now?"
I'm game for most anything, so I said "Sure." We walked into another room, I hopped up on the table, and he gave me a shot of local anesthetic.
After fifteen minutes, he returned with a nurse and began. Before long, he said: "OK. Try not to walk
on it too much for a few days." I think the nurse needed fresh air, because she gave me a wheelchair ride all the way to my car.
Scene Three: Fast forward to a couple of years ago. Again, my foot hurt while playing tennis; this time it was the other foot. After a thorough self-exam, I confirmed it was definitely a hammertoe.
I called to make an appointment. No, I was told, I could not see the doctor who had recently done hand surgery for me; I would have to schedule a visit with their foot surgeon.
On my initial visit, they took Xrays of my foot. And this time I wasn't going to just hop onto a table and get local anesthetic. "Nowadays we do this procedure in surgery," she explained and outlined the blood work that would be necessary prior to general anesthesia. I quickly stated that I was quite sure that a "local" would be satisfactory--and that was that, except I had to fill out one more form.
The new millennium has brought us defensive medicine; which is also expensive medicine.
I arrived for the procedure and was told to disrobe, put on a gown, and climb on a gurney. Nurse One gave me instructions and took my vitals. After a while Nurse Two arrived to tell me, "It won't be much longer now."
She was wrong. Later I asked to call my wife so she could cancel a meeting I had scheduled. The procedure was taking longer than I had expected--and it hadn't even started yet.
The doctor stopped by and made an X with a marker on the correct toe. Nurse Three arrived, and I was wheeled into the operating room to meet Nurses Four and Five.
One advantage to local anesthesia is that you get to watch what goes on. Just like on TV, the surgeon put out her arms and Nurse Four covered her with a gown. Then the doctor installed her face shield. I felt compelled to ask if she had to wear safety shoes as well. The answer was, "Not today."
The procedure went well. The four of us had a grand conversation about Cozumel, Hawaii, and hurricanes. They applied two Band Aids. I was then dismissed. No one offered me a wheelchair ride.
Commentary: Can you imagine if Judy got a pebble up her nose today? Instead of a handful of pepper, she would have been subjected to Xrays, MRIs, brightly lit operating rooms, and who knows what else.
We have become a country filled with fear: not fear of harm, but fear of litigation. As for me, I'll take the pepper treatment--or just hop up on a table.
[Originally published in September, 2013.]