I’ve been hard on American medicine. Americans are over-tested, over-diagnosed and over-treated, I’ve argued, because physicians and hospitals in our capitalist culture care more about profits than patients. But two recent events have forced me to reconsider my criticism. First, the pharmaceutical industry, which I have accused of greed and dishonesty, created safe, effective vaccines for COVID-19 with unprecedented speed. I felt overwhelming gratitude when I got my second Moderna shot in March. Then, on Memorial Day, I underwent emergency surgery on my right elbow. Here’s the story of my elbow.
I play hockey every winter on ponds in Cold Spring, New York, where I used to live. Although I wear a helmet and knee pads, I don’t wear elbow pads. My teammates tell me I’m stupid; I tell them I don’t need elbow pads because I never fall down. Then I fell down and banged my right elbow, and it became sore and swollen. In March an orthopedic surgeon here in Hoboken, whom I’ll call Orthopedist #1, diagnosed bursitis, inflammation of a fluid-filled sack called the bursa. He drained my elbow and gave me a cortisone shot.
My elbow felt and looked better for a couple of weeks, then it swelled again. My girlfriend, a Manhattan snob, bugged me to get a second opinion from a doctor in New York. On May 10, I saw Orthopedist #2 in Manhattan. She said my elbow was infected and recommended a bursectomy, surgical removal of the bursa. I’d never had surgery before, and I didn’t want to start now, so I sought another opinion.
Over the next week I saw three more Manhattan specialists: Orthopedist #3 (recommended by a friend of my girlfriend); Wound Specialist (to whom #3 referred me); and Orthopedist #4 (to whom Wound Specialist referred me). None liked the look of my elbow, which was now oozing fluid; all recommended surgery. But they said I could treat the bursitis with antibiotics and get surgery later if my elbow got worse. I chose that option.
On May 29, after two days of fever and chills, I walked to the emergency room of Hoboken University Medical Center. Blood tests revealed a low white blood cell count and elevated liver enzymes; these results, plus my fever and chills, were consistent with sepsis. The emergency-room doctor put me on intravenous antibiotics and checked me into a room. I ended up spending three nights in the hospital.
On Memorial Day, Orthopedic Surgeon #5 operated on my elbow while I was under anesthesis. He removed the infected bursa and surrounding tissue and shaved a bone spur off the tip of my elbow. I left the hospital on June 1 with a five-inch incision held together by 40 metal staples. By late June, Orthopedist #5 had pulled out the staples, and my elbow was feeling fine.
What did I learn from this ordeal? I learned that I should give doctors more credit. I have asserted that Americans are over-tested, over-diagnosed and over-treated. If anything, I was under-tested, under-diagnosed, under-treated, but that was my fault. I told all the physicians I saw in Manhattan that I wanted to avoid surgery, and so they didn’t push for it. They said staying on antibiotics was an option, at least temporarily.
I have accused physicians of being profit-driven. But if Orthopedist #1 had been greedy, he would have pushed for surgery, but he didn’t. The Wound Specialist saw me on his day off and spent a half-hour meticulously cleaning the hole in my elbow and packing it with antiseptic gauze; he never even billed me or my insurance company. All of the physicians I saw were good at their jobs. So was everyone at Hoboken University Medical Center. The hospital has rough online reviews, but the care I got there from physicians and nurses was superb.
So when should we doubt experts? When should we trust them? I’ve been wrestling with this immensely important question throughout my career. Second-guessing experts, you might say, is my job description. There is no sure-fire formula, no algorithm, that can resolve the question for us. We must analyze cases as best we can one by one, never forgetting our own fallibility.
I stand by my critiques of American medicine. The U.S. spends far more on health care per capita than any other country while ranking below dozens of countries in longevity and other health measures. American medicine needs fixing. But I have more respect for medical experts now than I once did. If three specialists in a row tell me I need surgery, I’ll get surgery. I also have more respect for the wisdom of my hockey buddies. When I hit the ice this winter, I’ll be wearing elbow pads.
John Horgan directs the Center for Science Writings at Stevens. This column is adapted from one originally published in Scientific American.
Scientific Curmudgeon is an Opinion column written by CAL Professor and Director of the Stevens Center for Science Writings, John Horgan. Columns are adapted from ones originally published on ScientificAmerican.com.
Be First to Comment