Monday, September 29, 2008
Diagnosis and treatment are the easy part of medicine. Listening to the patient often gives the diagnosis. Physical examination and few tests confirm it and treatment usually follows by routine or protocol. The hard part of medicine is predicting the future and telling patients when they will recover and be able to return to their regular activities. It’s much harder when the patient is an athlete and they want to be hit by a ton of football players.
The Al Harris saga continues. His injured spleen has kept him off the field but the coach says he may be back in three or four weeks. Pretty impressive stuff for an injury that once required emergency surgery. The approach mow is more conservative and spleens are allowed to heal on their own if possible, but the healing time is usually 6 weeks. But that’s for normal people and there aren’t any medical studies that look at when it’s safe to return to play football, hockey or any other contact sport.
Estimating when an illness resolves or an injury heals is educated guess work. Much depends on the underlying health of the patient and what the expectations are. College students who get infectious mononucleosis may lose a semester before being able to handle a full course load. The body uses its energy to fight the infection and there isn’t much left over. Roger Federer gets mono, continues to play tennis at world class level and his play suffers marginally to the point where he no longer dominates. Broken bones take forever to heal in older patients with osteoporsosis, yet relatively quickly in younger generations.
When infections are treated with antibiotics, the recovery time doesn’t necessarily equal the numbers of days to take the medication. Patients with strep throat feel better after a couple of days, with or without medicine, but the purpose of the antibiotic is to prevent hear valve infection or rheumatic fever and the patient needs to take the whole ten days. Patients with pneumonia may feel tired and wiped out for many days even after the infection has been treated.
There are many studies that give estimates of healing times but they need to be customized for the patient and their expectations. Pro athletes, whose careers are short, tend to return to play much more quickly that the general population. They are paid significant money to risk further injury. Regular patients tend not to take the risk of returning to work or play if that will cause damage or prolonged recovery.
When patients are admitted to the hospital from the emergency department, patients and their family want to know how long they will need to stay. It’s always hard to tell and the answer often is: I don’t know. It all depends on what the tests show and how well you respond to treatment. On the other hand, if I could predict the future, I would tell you next week’s lottery numbers and we both could retire.