Tuesday, April 3, 2007
Regular folk can get a skewed viewpoint of medical diagnostics if they were to presume that their care would mirror that of an elite athlete. This expectation can make for occasional tense moments in the doctor’s office.
Take the plight of the everyday person with low back pain. Backs are finicky things, and minor unexpected moves or twists can cause significant pain. But if there was no fall or car wreck or other trauma, the vertebrae are unlikely to be broken and plain X-rays are not needed. The injury to the muscles, ligaments or nerves in the back cannot be seen on plain films and their use is a waste of radiation. In fact, it is the rare circumstance when any test needs to be done. So the doc should take a good history and exam the patient. Unless some dire consequences are found, like the inability to control bowel or bladder function, then a conservative course of rest (usually less than 24 hours), some medications to control symptoms, exercises, physical therapy or chiropractic and return to activity as soon as possible.
Not in the alternative universe of sport. Being a devout sports fan, the patient knows that when his favorite player tweaks his back, an MRI is imminent. And being an egalitarian, the patient knows that what his pro gets is what he wants.
What the fan/patient forgets is that the elite athlete has a narrow window in which to perform. Depending on the sport, a career may last 4 years or less and an injury that would cause a mere mortal to be off work for 6-8 weeks, would be season ending. The pressure to return to the field of play is intense and the athlete often sacrifices long term pain and disability for the opportunity to play earlier than advisable. The athlete and the team need to be able to push rehab and recovery and they gather as much information as quickly as possible to determine if return to play is a possibility. If the answer is no, then the damaged goods athlete is thrown on the scrap heap.
We try hard not to throw John Q. Public away. It is the exact opposite philosophy that is provided in the real world, where we make certain that an injury is well cared for. We invest in clinical decision making and invest time up front so that injuries can heal completely before sending the patient back to the workplace or home front.
Technology is cool stuff and should be used to stomp out injury and illness, but technology needs to be used wisely. Before demanding a test or agreeing to have one done, ask how an abnormal result will affect your care. Just as importantly, ask what a normal test will mean. Know that, most of the time, your doctor should have a good idea of the diagnosis after completing a history and physical exam. When the hands come off your body a good time to ask what might be going on.