wphamilton

I just want to rant about doctors, and I'm old enough to get away with it now. I think.

About 2 months ago I broke my collarbone, about 2 cm separation. The surgeon persuaded me in the "conservative" treatment - just let it heal. 85% of them will heal OK this way they said, and that matched with what I knew about it, but I was concerned that the separation and maybe a cm shortening (overlap) is borderline. But they told me that the real difference was only the first three weeks, where the pinning would allow you to be active, and after 6 weeks you wouldn't see a difference either way. So I was fine with the 85% chance.

So at the orthopedist for the evaluation followup they've overbooked and skip me, and I reschedule for a couple of days later. I call back the next day and find that I wasn't scheduled until the 3-month followup! I at least want an x-ray to see if it's at least approximately normal healing, so I fire that bunch and schedule with another. About 2 months since the accident and no, there isn't any union, no calcium bridging the two bone ends, so that's gotta impact the initial assessment, right? No you still get the same original spiel from a guy who didn't even look at the original x-rays. Except that he gets the percentage wrong (that they thought 10 years ago) and can't tell me details from the current x-ray right in front of him. So asking him what the chances are of this fracture healing, given the status after 2 months, he offers to hook me up with a specialist for a second opinion. But "He'll just tell you to get the ORIF surgery". What? You know that the specialist will disagree with you, but you can't give me any specific reasons why you're right and he's wrong? Yes, a second opinion sounds good please.

So maybe I'll be convinced to get a plate installed after all. But I am sick of one size fits all diagnostics that don't take the actual injury into account. What's the point of the visit and x-rays, if nothing matters? Pain med prescriptions? I don't take them, and that seems to be the only clinical diagnosing going on. You can deal with the pain, so everything is fine, even if you wind up with a malunion or non-union, but if someone's a wuss about it that's a whole different story on how it's healing? That chain of reasoning makes no sense to me.

no sweat

I sympathize, 120%. Medical care in the USA has become so incredibly unsatisfactory in so many respects. I will say that the one really positive experience I've had in the last few years happened to be with an orthopedist (a cyclist, it happens!) who was an absolute star.

wphamilton

I just don't get it. I have good insurance, my deductible is met and I can afford whatever we need to do. It's not like I'm a difficult patient. Three years ago, in the same original clinic, the surgeon said that he wished I could talk to his other patients, to set them straight. I was an ideal patient as far as they were concerned. So why this second-rate diagnostics, and blowing off appointments? Has our health care really sunk that low?

Wanderer

Maybe medical malpractice - maybe you should discuss that with him/her.

wphamilton

I don't know about that, they're telling me options and what they're saying is pretty standard. I'm frustrated with being charged hundreds for a visit that has no value, and not being able to trust an opinion.

Biker395 

It's my experience that in a lot of professions, 80% of the practitioners are competent at best and incompetent at worst. Look for the 20% ... ask friends and co-workers if need be. Don't accept anything less, and if what they tell you doesn't make sense with your researched opinion, challenge them.

Here is a (way too long) story of medical incompetence.

I had a growth in my upper jaw years ago. No one was sure what it was, so it wasn't clear whether I should go to an ENT or an oral surgeon. I went to an ENT. She had two offices, and GREAT educational credentials.

She scoped out the area with an apparatus that she disinfected with a Bic lighter (how do I know that? Because she told me that ), and pronounced to me that it was probably an ameloblastoma. A nasty, invasive tumor that comes about as close to cancer as it gets (it does not typically metastasize, but spreads easily and has to be taken out with large margins.

"We'll have to do a biopsy to confirm it, of course. The good news is that it is not cancer and is cureable. You'll have a lot of your upper jaw removed, and you'll have a hole between the roof of your mouth and your maxillary sinus, but that's no big deal ... no one will be able to see it.

No big deal?!?

Her "assistant" lost all my paperwork, scheduled me for blood tests on the wrong day, and had me take multiple tests when only one would have sufficed ... completely incompetent.

I went for a second opinion. This guy was recommended by a friend of mine who was a dentist, and was also an ENT. He looks at the film and opines it could be anything ... gotta do a biopsy. OK ... that is more comforting. I cancel the appointment with Dr. Bic.

Then he calls me a couple of days later, and tells me that he showed the film to a colleague, and they opined they thought it was cancer. He was referring me to an oncological head and neck surgeon of some renown (you actually might have read about this guy). Holy crap.

Crazy with fear, I finally got an appointment with this guy, who assured me that he never said it was cancer, just that it looked suspicious for it. He also told me that there appeared to be some healing in other scans I had in the interim, and that was indicative that it was NOT cancer. Nonetheless, he ordered a PET scan.

Holy crap ... PET scans are expensive ... they only order those when they have a strong suspicion of cancer. The insurance company refused to pay for that (something I actually found comforting).

So this H&N surgeon does the biopsy on New Years Eve and I spend the next couple of days in pretty severe pain. But after 2 weeks, the biopsy came back. After all that, it was just a dentigerous cyst! Harmless. Removal was almost trivial.

Surely and oncological H&N surgeon can do that surgery, right? They are the best of the best. Well, he did the surgery, and I had nasty, nasty pain for the next 3 weeks. Vicodin was useless, so I just suffered through it. My only respite from pain was sleeping, which I tried to do a lot of.

But finally, the pain subsided, and I thought I had it behind me.

Until a follow up scan showed that the cyst came back. I finally went to a professor of oral surgery at a local university with a teaching hospital. He did a biopsy in his office (painless, BTW), and found out that the earlier surgery was botched. The earlier surgeon had sewn together tissue that caused the new cyst. He also told me that the earlier surgeon had made a HUGE incision that was unnecessary, and the nerve damage for that was the reason for all the pain (which I still had bouts with).

He also told me that the first biopsy wasn't complete ... that there are a LOT of kinds of cysts, and since the sample wasn't sent to a place that specialized in this sort of thing, the earlier cyst may have been something else.

But this guy ... this oral surgeon ... knew his stuff. I had 2 more surgeries to clean up the mess, and at one point, went under anesthesia not knowing if I would wake up with 3-4 missing teeth (I didn't). But it didn't bother me because at least I had the confidence that this guy knew what he was doing.

So of all the docs I saw ... only ONE of the FOUR really knew what he was doing.

The first had no business diagnosing an ameloblastoma ... after educating myself on the subject I looked at the film and saw that it was missing features that are usually there with those kind of tumors. And what kind of doctor tells you something like that *without* a biopsy to be sure first?

The second had no business diagnosing cancer.

The third screwed up the surgery ... he should have referred me to a specialist ... an oral surgeon.

So the end up of all that is this. Don't take any docs word for anything until you have REASON to trust them. Do your own research and educate yourself. And get second opinions, even for the no-brainers. Insurance will gladly pay, and it might prevent a lot of heartache (although it didn't for me).

trackhub

I liked my previous PCP, who was also a cyclist, and rode to his office. He took time, and was very detailed oriented.
He believed he could learn a lot about a patient just by talking with them. Alas, he left the practice. My present PCP
is not that terrific. Not a cyclist, and really does not "get it". I told him I ride a fixie, and he just looked at me dumbfounded.
Never mind, just let it go, I keep telling myself.

What I find interesting: The so called "concierge practices". These are the ones you have to pay an exorbitant fee
just to join. The doctors limit the number patients they have. And for this you get: Same day appointments,
doctor takes your phone calls,,, In other words, the way doctors practiced, back in the 60s. I'm surprised
that MAD magazine hasn't got hold of this one.

I remember having a bad flu as a kid, and the doctor coming to the house. Wow. How far we've fallen.

FBinNY 

Diagnostics is the poor cousin of the medical trade. Think about how we approach a mechanical problem. Lot's of questions, and a process of winnowing and elimination until you form a theory. Then finding ways to test the theory to confirm or challenge it, then a new or confirmed theory and finally a proposed remedy.

90% of the work is the thankless prelude to the main act. Medicine is similar. It's much harder to figure out what needs to be done than it is to do it. But it's the doing that creates a billable event.

I wrote and deleted an anecdote because it was long and unnecessary.

Take the time to ask around to find the right guy. When I had a hand problem I asked some surgeons I knew who they'd go to if their hand were crushed in a car door, 3 out of 3 named the same guy, and that's who I saw. So find a doctor in the area who's a bit athletic, and ask who he'd go to if he broke his collarbone. Ask a few the same question and you'll find the same guy keeps cropping up, then go see him and explain that you need a 100% recovery so you can continue riding your bicycle. If you don't know any doctors, hang around where they do and ask.

BTW- being the perfect patient works against you, they treat you haphazardly because they can. Make NOISE, and insist they listen and explain.

Timtruro

When I was running I got the best results from drs. who ran or were at least active. Most think what works for them will work for you. Very difficult to find someone you would consistently put your trust in.

berner

I have a friend who is an MD and who I've known long before he was an MD. He has told me Drs. are idiots and I've come to agree.

MinnMan

I totally sympathize, particularly because your story has echoes of my experience with my broken hand last year. It took forever to heal and I had to rattle lots of cages to get them to pay attention to me.

Midway through my travails, my ortho retired. I hated him and thought him incompetent, so I wasn't so sorry. But then, when I got transferred to a new ortho, I was told that there was a 3 month wait to have an appointment with her because I was a "new patient". I went ballistic, of course.

Fortunately, there was an attending nurse at the practice who really had his act together AND who had given me his email address. So when the "3 months" roadblock came up, I emailed him and he arranged an appointment in 10 days. In fact, at several junctures in my experience, the intervention of this guy was critical. The docs are too busy to look after you and the people in the front office are no more than bots. The people who care and who can help are the nurses, PAs, etc. who know how to work the system from behind the front office.

There was a period of time where a non-union seemed like a real possibility. Something that was discovered only months after the initial break was that I was vitamin D deficient. Why they don't screen for this routinely when people (particularly older people) have fractures, I don't know. It makes a BIG difference to the healing time, but yet nobody thought to investigate until it was clear something wasn't going right.

So, best of luck to you, and get your calcium and vitamin D. Supplement absorption is not always so great, so drink as much milk as your GI system will tolerate

BobbyG

I was going to share my story, but yours covered all the bases concerning what my family encountered recently, from the aloofness, to the incompetence, to the time-tables to the insurance cluster-f. We also have "fired" whole teams who couldn't get it together. Occasionally we encounter dedicated, alert professionals and are thankful for them.

Mountain Mitch

On reading your tale I assumed you were in Canada and was pleasantly surprised to find you aren't! Only difference is here we don't have to pay (directly) for this kind of half-assed incompetence...and the wait times are longer (which is good in some ways as a lot of issues just work themselves out).

Phloom

Canada has a much cheaper healthcare system. The Canadian cost of healthcare is 10.4% of GDP and it covers everyone. The American healthcare system is 15% of GDP and it doesn't cover everyone. I work as an analyst in Canada's second largest emergency department. We are being overwhelmed with immigration into our province and an aging population. Also, meth-amphetamine has finally made its way here.

Mountain Mitch

Yeah, so there! Our incompetent health care is cheaper than yours!

...but all our consumer products are more. If you dare to complain you're told "yeah, but we have free healthcare"!

Phloom

After working in the emergency department for almost seven years, I am very proud of where I am working and what I am doing. Our mortality rate is very low, less than 200 a year with 120,000 patients.
People that are critically ill are looked after immediately, mean is less than 2 minutes. I see a lot of people coming in with self-inflicted ailments like obesity, drug abuse which includes smoking cigarettes and alcoholism. Everyone is cared for but the order they are looked at is determined by medical need. A heart attack patient is seen before someone with a broken arm. My experiences with the healthcare system have been very beneficial for me. And that was before I started to work for it.

I was recently in Austin Texas and I had an encounter the the US healthcare system. I forgot to bring a vial of insulin. In Canada, I could get one without a doctor's prescription. Not so in the US. I found a walk in clinic and they asked to see my insurance card. I explained I was from Canada and my insurance is a wallet stuffed with US dollars. No problem, I saw a doctor in about 10 minutes for $150 USD. The doctor was a real hockey fan and seeing I was Canadian, he thought I would know everything about hockey. I apologized, I know very little.

The real shocker was picking up my vial of insulin from the pharmacy, $350 USD. That would have cost $60 CDN here in Canada and I have a drug benefit insurance plan from my employer, so about $15. No wonder Americans come over to Canada in bus loads to buy their medications. My forgetting my insulin vial cost $500 USD or about $600 CDN. Being poor in the United States must really suck. In Canada, the poor get healthcare just like the rest of us.

70sSanO

I can sympathize with you. Last October I shattered my clavicle and was given the same 85% prognosis. The main difference was I had already talked to our daughter, who rides horses and knows people who have gone both ways. She really urged me to get a plate and not just let it heal.

I was almost 63 when the accident occurred and I was not a good candidate because I was not a professional athlete that depended on full use of my arm, it was left arm, and I was 63. Since I had made up my mind I was going to try and have surgery done, I basically asked him what would happen next time if I didn't have a plate put in, because there was going to be a next time. I ended up convincing them that surgery was the only option since I was going to continue to be active; which was really the only alternative, as it ended up that I had 4 or 5 pieces that had to be put together. Ended up with the longest plate available and 11 screws.

The surgery went fine, but I had an MRI a few weeks ago because I think I also bunged up my rotator cuff when I hit the ground. I get a clicking sound when I try to swim. I'll see the doctor on Wednesday to see what the next steps are.

One more thing, my 6 weeks turned out to be over 3 months off the bike and the area will probably be sensitive (sharp pain) to any bumps for a year. The only positive thing is that everything is in place even though the healing is still going on.

Hang in there.

John

berner

Earlier this year I read a book by a man who had hiked the 2200 miles of the Appalachian Trail. I have not hiked any real distance lately but hiked quite a bit just a few years ago so books about hikes are of considerable interest. It happened that his wife was misdiagnosed when a dark spot appeared on a mammogram. The Dr. thought it was just a calcium deposit even though the woman's mother died of breast cancer, as did this woman herself. I know personally of another similar misdiagnose which also resulted in death, this one in my family. There are individuals in the medial profession who are so incompetent as to border on stupidity and or criminal negligence. I would hope that the medical profession would clean up it's accreditation procedure but I think that is not going to happen. The alternative is to be very active in evaluating people charged with your health care.

Carbonfiberboy 

Another way to look at it is that the surgeon gave you a choice, and you chose wrongly. That's the low cost plan, and some HMOs are very concerned about each doctor's "unit costs."

When offered the choice, I chose surgery every time, and in my case that turned out very well. It's unfortunate that we have to be our own medical advocates, that that's how it is in many aspects of our lives. Yes, there are experts, but their choices or recommendations may stem from their needs, not ours.

wphamilton

Right, I don't begrudge the 85% chance conservative choice, since I'd choose it again given the same odds. So it's not really choosing wrongly from that perspective. I'm scheduling the ORIF surgery this week.

The specialist I saw today, my second opinion from the second ortho clinic, was perplexed that there were only the original x-rays and the current ones after 2 months. Getting to the bottom of it, they've never seen a fully functional patient with that much separation after two months. And not needing pain meds, so the natural conservative reaction is leave it alone. Evidently a normal patient in that condition is non-functional and pestering for prescripts and that's the diagnostic trigger.

But with no discernible calcium growth and a low probability of an eventual good union, I'm opting to install the plate. The first clinic couldn't competently schedule a followup to even check, and the subsequent surgeon after them was too dogmatic to adjust to that.

tigat

The doc who fixed my broken femur-hip a few years back knew, without my saying so, that I wanted a partner in constructing a safe but aggressive rehab plan. He wasn't a rider himself, but definitely got it.

I've found, with my more recent couple of ER visits, that conservative options are pushed pretty hard for folks our age, who don't depend on riding our bikes for a living. I guess I'm not that much of a grown up yet.

wphamilton

I'm getting bolted up next Wednesday which gives me a week of not-healing. Kind of a free do-over period since he's got to cut the ends, the cartilage, and re-position things anyway and I don't need to be as limited about keeping the bones steady and not pulling or jarring them. Within some limits of course, I don't need those ends moving around and cutting things. Since I'm taking vacation time anyway I'm tempted to get a good bit of riding in before then, which seems weird being still broken but logically why not?

FBinNY 

You might find the jarring of potholes passed up though the bars and arms pretty painful. As you point out, there's not much to lose medically, but why ride if it doesn't feel good. Of course you can't know until you try, and you'll know soon enough.

wphamilton

I've been commuting all this time, and had a nice 42 mile ride Sunday, which only hurt out of the saddle on hills. Longer distances, maybe, pain isn't really the issue seriously. It just sounds kind of amusing: broken bone, increase the miles!

MinnMan

OK. you are tough