Wednesday, December 26, 2012

What's Good For The Goose

I never said I didn't like the guy.  In fact, the opposite was true.  I respected Thomas for his career choice.  Instead of residency or fellowship, he went to business school.  Instead of hanging up a shingle, he worked towards a masters in public health.

Far be it from me to criticize his expertise.  We need people like Thomas.  The kind who expose the waste and absence of thrift.  Maybe I rolled my eyes occasionally when he threw around Berwickian acronyms or sang the praises of the patient centered medical home.  We are all entitled to our opinions; to use our knowledge to make a living.

So when Thomas limped into my office wincing in pain, I looked forward to interacting with this engaged and empowered patient.  After taking a history and performing a physical exam, I felt fairly certain that he was suffering from a herniated disk.  I sat at my desk across from the examining table and began to discuss the options.  Seconds into my explanation, Thomas interrupted me.

I want an MRI!

I tried to explain that in absence of worrisome signs and symptoms, we could hold off on such testing until we got to the point of considering injections or surgery.  I thought a man of his knowledge and outspoken views on parsimony would surely understand.  There were a number of simple treatments to try first.  Thomas wasted no time in responding.

I don't want surgery, but let's do the MRI just in case.

Would it surprise you to know that I spent the next twenty minutes trying to dissuade him?  The MRI showed a herniated disk as expected.  After a steroid dose pack and a few sessions of physical therapy, he was feeling better.

He strode into my office effortlessly two weeks later.  His pain was gone.  I gently chided, and asked if the MRI had been ultimately necessary.  His smile barely quivered as he skirted the question, and reasserted his glorious improvement.

Apparently physical and emotional distress can alter one's beliefs about appropriateness.

Apparently what's good for the goose is not always good for the gander.


Jim Saliwtz said...

By far the fastest PET approval I ever saw (5 minutes) was to evaluate a 5mm (sub-PET detection size) in the VP of a health insurance company.

Anonymous said...

Medical treatment is not a constitutional right, unless it is me that needs it.