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Friday, August 5, 2011

Sometimes Doing Nothing is the Hardest Thing to Do for Patient Too

This was a great post by Dr. Westby Fisher.  Read it first.

When I catch a cold, I routinely treat the symptoms, rest, and as to doctors, do nothing.  For my kids, I do the same, with watchful waiting to see if it gets worse.  If it does, then I make the call.  I don't need to see a doctor to have them tell me, yep, it's a cold.

As a patient, I'm happy to hear that time will likely cure my problem.  Not to long ago I was diagnosed with Cervicular Radiculopathy.  I used the diagnosis as an experiment in being an engaged patient.  At that time, my symptoms were consistent with C5 compression.  The treatment was a course of oral steroids and a month of PT, with a few backup plans.  After the PT it went away.

It's back, and now I have symptoms of both C4 and C5 compression (more fingers are tingly).  I learned quite a bit from PT and am following the course of exercises that my therapist suggested, as well as going back to sleeping on my back.  There is no pain this time, just a bit of tingling at the beginning and/or end of the day.  What should I do?  Do I call my doctor and make another appointment, or do I deal with this the way I think he would tell me to anyway?  Do I need the steroids again, or are OTC anti-inflammatory drugs sufficient.  I'll learn the answers to these questions when I seem in a few weeks for a follow-up from something else.  But it is hard not to be worried.  If I call, they'll probably want to make another appointment for me sooner, and that just isn't convenient, nor do I think that there is much other than watchful waiting that will happen as a result.  So, I'll wait and watch.  If things get worse, I'll make a call.

My wife has a bum knee (Arthritis).  We paid over $3000 dollars for that diagnosis via MRI, which was what the doctor already told her it likely was to begin with.  Next time I know the right questions to ask about diagnostic testing.  What could this test tell you that you don't already know, and how could it change the treatment, and how likely is it that it is worth the expense?  She's also in PT.  After a month of PT we got our bill.  She discovered we were paying $45 dollars a visit (X four weeks) for Ice pack treatment in addition to the other therapy.  She stopped those and now puts an ice pack on at home after the PT visit.

My doctor told me that my EKG in the office showed a possibly enlarged left ventricle.  I'm already under observation because I'm mildly hypertensive.  He wants an ultrasound.  I'll ask him the same questions I should have asked about the MRI when I see him again.  My wife had a similar experience and even though the ultrasound results came back, no change in treatment occurred.  Is it worth the money?

I too am learning to do nothing.  I wish it were easier, and that I understood what the ramifications were.  I really cannot wait until my doctor gets his patient portal.  Then I'll be able to send him some of these easy to answer questions, and not have to worry so much while I do nothing.

   -- Keith

P.S.  As I think about the business case for doing nothing, it should be easier for doctors to do nothing.  By making more patients happier in less time, they should be able to treat more patients.  I guess it goes back to the adage that an empty bed gets filled as does a void in ones schedule.  Ideally, that would also mean that the patient one is treating are those that are more serious and need more treatment, and therefore generate more revenue.

2 comments:

  1. Westby Fisher's blog was an interesting read for me as a former UK GP. In the NHS health care system the economic drivers are somewhat different, since there are few direct fee-per-service activities.

    There is however in the clinician's mind, still a very definite need to 'do something' - give an antibiotic, refer to a specialist etc even where it actually involves more work for no monetary gain.

    I think it is partly just a human need to respond to a request for help, and to the well documented phenomenon that 'errors of commission' are seen as less culpable than 'errors of omission'.

    So while money ,as always, is a driver it is by no means the only thing going on.

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  2. My experience is that most things will resolve on their own, and that engaging the medical profession is almost bound to lead to activity of one sort or another. Good luck!

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