Monday, August 17, 2009

farmdoc's blog post number 484

Recently I’ve learned of medical feedback about three people I’ve assessed in my work:

1. A man was treated with a peripheral regional field stimulator – a very expensive device that’s implanted under the skin and which should only be used to treat people with severe end-stage pain. Before the PRFS was inserted, this man wasn’t taking any painkiller at all, so his pain couldn’t have been severe let alone end-stage.

2. A woman aged under 40 years who sustained a hip fracture in a car accident, was treated with total hip replacement surgery. THR surgery should only occur if hip pain’s intolerable. And the older the person is at the time of surgery the better because hip prostheses wear out, and each re-do operation’s technically harder. Preoperatively this woman was taking painkillers and coping reasonably well. And she was 10-20 years too young for THR surgery.

3. A woman whose work was physically light, claimed a back injury rendered her able to work part-time but not full-time. I and three other specialists found her normal on physical examination. Yet her claim was apparently settled for a large financial quantum.

In each of these three cases my medical advice wasn’t heeded. I was peeved. I wondered why my advice was sought if it wasn’t taken. Then Sweetheart Vivienne told me I was over-enmeshed. That I shouldn’t care. That I was paid for my work, and if my advice – no matter how sound – was ignored, then what the hell. She’s right. Of course. As usual. Over-enmeshment never did anyone any good. Me included.

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