When the experts are not so expert after all

I'm not sure if this forum is appropriate for my question, but you have been very helpful in the past.

I have met many doctors and surgeons in the last two years. I am a university lecturer specialising in the area of applied intuitionistic logic. All the doctors I have met very average or poor problem solving skills -- a typical expectation of a layperson. I would unlikely attribute a higher grade than a basic pass to all of them in my under-graduate course. This is unfortunate, but a reality I have come to accept.

This seemingly immutable fact has cost me a lot of money and trauma in dealing with the result of a sporting injury in July 2007 (and six subsequent surgical procedures). All surgeons I have met have extremely good surgical skills with very average or poor diagnostic skills.

I would like to renew my athletic endeavours if it ever becomes possible, but I am afraid of having a sporting injury, since I know I will have to study extremely hard to diagnose myself again (as I have done).

However, this was not the biggest hurdle, after having correctly diagnosed my pathologies (I did it four times with zero errors). On all four occasions, I had an enormous struggle to convince doctors that I was correct so that they would take action. Admittedly, these pathologies were difficult to diagnose (i.e. not indicating on radiograph, but still very serious problems). I would like to enact a mitigation strategy should this arise again.

Is it possible, by travelling internationally, paying money to the appropriate people (i.e. turns out cheaper in the long run) or by some other unforeseen means, to allow myself to tell a surgeon what the diagnosis is and request the appropriate treatment, without having to deal with potential incompetence and treatment being held hostage by self-appointed authority?

Thanks for any advice. I realise how dangerous it is to circumvent self-appointed experts, but the danger posed by their incompetence is far more serious (full story due for release after formal governmental complaint is dealt with).

Hi, dibblego. I can really understand your frustration. It is galling when you've a pretty good idea what's amiss and doctors won't take your word for it! I come up against that myself from time to time, having been nursing in orthopaedic surgery for 50+ years and lectured on the topic. But one has to realise that these surgeons (or doctors) have a professional limitation in that they cannot just accept a patient's point of view and act upon it without verifying it for themselves. I doubt that, if a court case ensued, neither the judge nor their professional body would be very understanding!! So it behoves them to make their own investigations and come to their own conclusion as to a diagnosis. That's what you pay them the big bucks for! That they sometimes lack good communication skills is a sad but true fact of life.

Having said that, it seem good practice (one would think) for them to enter into a collaborative with their patients as many, I have found, actually have a pretty good idea what's going on or, at the very least, what caused it. I also get pretty rattled when they don't seem to be listening to me in the least.

What I did was to hunt around for a doctor who was prepared to discuss things with me rather than issue their own edicts. And I found that a degree of intentional diffidence at the beginning of the relationship could reap benefits in the long term, if you get what I mean! Well, it works for me! http://i21.photobucket.com/albums/b2...ies/wink-1.gif

Thanks Josephine,
I have found a doctor who will listen to me, but this does nothing to help. He is a surgeon of the foot/ankle and lives 1000km (600 miles) away.

Consider this one anecdote (I have hundreds). I had an inversion sprain to my right ankle and had five orthopaedic procedures. By August 2009 I could not walk and was in extreme pain, because the original complaint had not been dealt with; only made worse. Thankfully, by this time, I had a full understanding of anatomy, diagnoses, clinical indicators, etc. of the lower extremity.

I had a trapped peroneal nerve so I set about finding it. I eventually did using various data points. I published an essay titled, The Case for Entrapment Neuropathy of the Superficial Peroneal Nerve. I presented it to a foot/ankle orthopaedic surgeon with citations (text books, journals). Having some gained credibility with him, he injected the suspected entrapment site. There was a major positive indication.

I asked for surgical decompression, but he was reluctant, for a sixth time. Instead, he asked for a second opinion. I visited a Neurosurgeon, who told me that:
a) The injury is in my interest because I ride motorcycles and the injury prevents this
b) I am delusional for believing that my in-depth understanding of a particular area of medicine is normal
c) My partner (a nurse) is also delusional for thinking same
d) Surgery is not in my interest because some other guy, for which he has much respect, thinks that I am psychiatrically ill due to an episode (which has now been discovered to be drug poisoning (serotonin toxicity)).
e) When pressured, he finally admitted that I cannot have the pathology I think I do, because he has never heard of it.

This list goes on. Further, I have many similar stories. I cannot have these people determine what is in my interest, yet at the same time, I may need to seek medical assistance.

I've had the nerve decompressed and I am back to motorcycling (and mountain climbing, etc.), but I still have pretty bad evertor weakness. Hopefully will improve over time.

I need some method of resolving this contention between extreme incompetence of medical practitioners and access to the benefits of medical science. Thanks for your help ;)

Well, I have a similar situation - my sister has had extreme pain for several years. More recently she has had both knees and a hip replaced, each time with a flair-up of the pain which is in areas other than the operation site. No-one would listen to her or me about this and ended up telling her she was a) a drama queen and/or b) had a drug habit. It's been a nightmare.

Recently I learned about a condition called RSD. Never heard of it before but it came up on another forum. I did a lot of hunting around on the internet (as one does!) and realised with some shock, that these symptoms were exactly what my sister is suffering from. I was prepared to consider that the lack of care from her doctors during her three surgeries (five if you count the two pre-TKR arthroscopies) as being due to a lack of knowledge of the condition on their part. Only now, just a few days ago, I have discovered they are perfectly well aware of it, just had never considered it as a possibility! I am speechless! When I asked them if they thought it possible, they just lifted their shoulders and responded 'quite possibly' and that was it! http://i21.photobucket.com/albums/b2...milies/doh.gif I think they are not prepared to go forward with it because I suggested it! If they'd thought of it themselves would be a whole different scenario.

But as you say, we know they are sometimes unwilling to be the recipient of this information and even less willing to act on the information when it is presented. Yet we still need to get treatment from them.
It's tough .....

Hi Josephine,
I was "diagnosed" with RSD. It was wrong though and I knew it. It sounds like your sister is in a lot of pain. I think you should consider continued investigation into the underlying cause of your sister's problem.

As you note, medical doctors are not particularly enthused about solving problems. You only have two choices
1) concede and suffer the consequences
2) solve the problem yourself with a thorough investigation

The preferred option of having an expert solve the problem is simply not available, as much as you and I may wish otherwise.

Hope you get to the bottom of it!

Yeah - the only option we end up having, eh? - keep on keeping on! http://i21.photobucket.com/albums/b2...ies/wink-1.gif

Hi, after reading all of this and agreeing with both of you.. I think the problem underlies on how society thinks so much of doctors so they started to think that they know everything.... its weird cuz in Chile physios joke around and say instead of doctors ... diostor which is like saying god..back to what you were saying it seems like doctors have no wishes of solving problems (most of them not all of them) and probably have gone into the medical carreer to make money .. which is sad and bad for society.

I think it would be good for you to even try and seek an expert some where else even if it is far and your def sure on what type of treatment you need.

Hi dibblego,

First off I can't believe a surgeon had never heard of a peroneal nerve entrapment!

Secondly, like you said surgeons typically have good surgical skills but poor diagnostic skills. I'm not sure if your aware but doctors are split into two groups - physicians and surgeons. Physicians diagnose and surgeons cut!

In future if you have an injury your best bet is to go to a sports physician as they have the musculoskeletal knowledge and diagnostic abilitiy to correctly diagnose you.

Quote:

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Physicians diagnose and surgeons cut!

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Oooh, that was out of the dark ages! http://i21.photobucket.com/albums/b2...ies/heehee.gif And part of a much longer list - must look it up!

No one's perfect as the saying goes... Everyone has it's defectiveness. :D

Hi

because the accuracy of diagnodis is about 20%, and docs physicians only people, please before being cut double check it, question, be doubful, learn about your condition, go to another practicioner, maybe physio, or Chineese doctor etc.
Im a physio and manual therapist (sort of european osteopath) and helped people with hernited disc with a referal to get it operated etc.
please be vigilent and shop around.

thanks
Yaro

Dibblego, i have just caught your thread and im finding the responses interesting. I have to agree with ATTIreland - most surgeons are into end stage intervention - that is, they get to see all the patients who fail with physio, physicians, alternate therapists, fringe therapies. Therefore pretty much all the patients they see usually need surgery in some way - that is their underlying perception of medical pathologies. Their top end clinical diagnostic skills are actually pretty ordinary as they rely on 'gold' standard imaging or arthroscopies to confirm their diagnosis. This makes them clinically lazy (and to really throw fuel into the fire - i see your thread is from Australia - most Oz surgeons make 90% of their money from surgery - they have to see people like you in their clinic to fill their surgical lists. For this pleasure they sting you about $160 for 15 minutes. Believe me, you are COSTING them money by being seen in a consult room he has to pay rent on. He would much prefer to be performing high dollar return surgery - or out playing golf). So don't be surprised by this attitude of specialists.

If you tell me where you are from (city) i may know of some clever sports doctors who may be more responsive to your needs.

Hi Dibleggo and others who have commented on the posts so far...,

i am kind of in both camps. I certainly understand your frustration Dibblego and i too feel that things are often simplistic with doctors...but they sub-specialise these days and really just prefer to do what they are comfy doing.

They have worked hard and studied hard and it costs LOTS of money and time to do all this training and they are up with the latest research in their special areas and can quote their statistics and others statistics...

...but when it comes to something out of the box/different/complex/etc, most don't want to know about it because it ruins the rhythm they are in.

How does that help the average punter?

I think finding the right doctor/surgeon/physician for the right patient is the first step. I try to match the patient and their personality and expectations with the surgeon. I know good surgeons with terrible communication - they tend to be good for the older people who expect doctors to be like that and NEED surgery (bone on bone knee OA which needs TKR etc). Then there are the other doctors who can do complex diagnosis etc.

Another problem i find is that doctors seem to practice diagnosis by exclusion - and this is to some degree what i do as a physio - list of possible diagnoses and eliminate them with more info etc...but some are so unsophisticated it becomes a joke.

Whilst reading your story, i was wondering if your intelligence and knowledge comes across as threatening to the doctors?

I have found i have changed many a doctors' minds by simply communicating all the info like you have described but in such a way as they still feel in charge, they make the decisions and the patient gets better.

I have tried the blunt approach before without much success but when i changed strategies, i found most doctors to be receptive.

Should we have to be like that to get a good result - i don't think so...but i think we NEED to be to get a good result. We shouldn't have to grovel or make someone be god so they will listen to us...but a bit of patient respect and careful phrasing has served me well over the years...but then there are those who will never listen - i don't deal with them!!

What are your current symptoms at the moment and what do you consider your problem to be - i like to think that i have fairly good diagnostic skills and would like to chat - even to learn what it is that you do.

Cheers