Female physicians are to blame...

[mags]

I'm a female physician in the US. I would love to get some feedback and maybe even specific examples of the apathy and indifference of physicians. I've been out of med school for about 5 years so I guess I'm part of the younger generation of physicians.

I certainly do not want my patients to remain uneducated and just do what I say. I have yet to meet another physician with this attitude. I have plenty of patients who are educated about their medical issues and ask questions frequently. I have no problem explaining the reasoning behind my recommendations and I find that this improves adherence to treatment.

However, I also struggle with apathy among patients. I have patients who would rather take a pill than make lifestyle changes then turn around and complain about the side effects of pills. I have patients who are in every couple of months with "a cold that won't go away" convinced they have pneumonia or sinus infection and get offended when I tell them they have a chronic smoker's cough and it won't go away unless they quit smoking. I've run into situations where a patient has had a symptom for months then comes in two days before their vacation wanting me to "fix it" so they will have a good vacation. These people get MAD at me when I explain that they will need further testing and/or a specialist appointment and that it isn't an easy "fix." Apparently, I am ruining their vacation. This situation has happened more than once.

browngrl posted above that wait lists aren't so bad because some medical issues improve with time. Is a doctor apathetic if he/she believes a problem is self-limited and believes the best course of action is watchful waiting?

Can my patients ALWAYS get a message to me? No, not if it is after clinic hours and I'm not on call or if I just have a few days off of work. But a patient CAN always get in touch with a physician from my clinic. Doctors are people with families and responsibilities outside of work. We can't always be available. It is a stressful lifestyle and historically this career has had a high rate of suicide. If a physician wants to limit work hours to something reasonable, I don't see that as apathetic.

So, I would really like to know what exactly "apathy" among physicians is?

[Brainsample]

Look, I have an idea. Why doesn't whoever the "thinking" housewife quoted and she organize a big convention and invite all the women doctors, they can get them saved, and then they can kill them.

Oh, wait. That's not my original idea. That's the Spanish Inquisition! I didn't expect the Spanish Inquisition! (Cursed Michael Palin!)

Then, when all of the fundie women get sick with anything requiring a man to look at their womanly parts, they can die because they are sinful and brought the illness on themselves, but we can make sure that they are saved before they die (anointing of the sick/last rites).

(Hmmm. Having Word of Faith flashbacks. Hmmm. Faith as a work, and divine health is merited through sinlessness and being full of the truth and the Spirit.)

Or the can just kill off the extra women who are not good for breeding stock or servitude, and then there will be less sin in the world, and it will be, ever so much a better, better, happy place. :P

Do they not get that they sound like the Spanish Inquisition, complete with the superstition?

[3 is enough]

I've lived in both the US and Canada, and used both systems. The Canadian system is not perfect, but, IMO vastly preferable to the US system.

The stories of people dying while waiting for treatment in Canada are vastly exaggerated. My father had multiple hip and knee replacements, and never waited more than 6 weeks for surgery. I know this can vary from province to province, but that was his experience. He died of cancer 4 years ago, and had excellent care. He had a rare abdominal cancer, and it wasn't diagnosed until it had spread to his liver and was at stage 4- simply because he had no symptoms up to that point. Even though he was diagnosed as terminal, he was still offered the option of chemotherapy. When he died, after 5 months of doctor visits, tests, and hospitalization, my mother had a bill for $22 for the phone in his room.

I have a very interesting comparison of the two systems. I like to think of it as "A tale of Two Broken Bones"

My Canadian niece fell from a jungle gym, badly breaking her arm. This was Saturday evening on a long holiday weekend. My brother rushed her to the local ER, where she was x-rayed, and it was determined that she needed pins to set the break. She had the surgery, and was home in her bed by 3 am. Total time from accident to recovery: 7 hours. Cost to my brother: $0.

My son fell in gym class on a Friday afternoon, breaking his thumb. I took him to Urgent care, where he was x-rayed and put in a sling. I was given the name of a pediatric orthopedic surgeon to call on Monday morning, because ERs in our state do not do casts- it's a liability issue. I called the doctor on Monday morning, and they refused to see him because they didn't take our insurance. I offered to pay cash, but they refused. I didn't even get a referral for another doctor. I finally found a doctor who would see him, and got an appointment for Wednesday. He got his cast 5 days after the break, and we paid at least $500 in deductibles and co-pays. Luckily it was a clean break and didn't need to be reset.

In this case there is no question as to which system is better.

My daughter is starting medical school in August. During her interview, she was asked how to fix healthcare. She replied that she felt a universal healthcare system was the answer. Obviously her answer did not harm her chances of admission. A lot medical professionals hate the insurance industry with a passion, but they are a very powerful lobby, and that's why nothing will change anytime soon.

[browngrl]

Look, I have an idea. Why doesn't whoever the "thinking" housewife quoted and she organize a big convention and invite all the women doctors, they can get them saved, and then they can kill them.

Oh, wait. That's not my original idea. That's the Spanish Inquisition! I didn't expect the Spanish Inquisition! (Cursed Michael Palin!)

Nobody expects the spanish inquisition!!!

[JesusFightClub]

UK here. I love the NHS.

I have a mental illness which would send doctors' bills through the roof, plus I smashed up a limb last year in an accident, said limb now has serious metal to hold it together. Not a penny did I pay for my two weeks' stay in hospital which required not only surgery on the limb but med stabilisation for mania and hallucinations due to the meds I was on. Or the physio after. Or the community psychiatric services I've made use of.

My dad was very ill as a baby. My gran praised the NHS all her life because they couldn't have ever paid for all the treatment my dad got. He's now got cancer and has more prescriptions than you can shake a stick at, and doesn't pay for any of them.

Are there problems, yeah, sure. Wait times for elective surgery. It's a bureaucracy so sometimes you get all the "friendliness" you'd expect. Hospital food leaves something to be desired very often (though this is due to privatisation of that service). Would I swap it for the US system, you have to be kidding me.

[acheronbeach]

FYI, can't say much about medical policy, but I'm a Canadian and the longest I've waited at a clinic or hospital is 3 hours - and I've never had a serious injury that required attention quickly.

My mother's waited 4-5 months for non-emergency specialist's appointments. My father has waited 6 weeks on average to schedule appointments with a joint specialist. The only specialist I've seen is a dermatologist and that was a 7 day wait in a rural city in Ontario.

I have heard that wait times can be much longer outside of Ontario, but my experiences have been excellent.

[emmiedahl]

My sister in law and her Canadian husband sold their farm and moved to the States a few years ago in part because of medical drama. I don't know if they had a typical experience, but they were very unhappy with the care they received there and prefer the care here even though they have to pay out of pocket for insurance. I guess its a YMMV thing.

[kb2]

I don't understand complaints about wait times. If there are so many people who need joint replacements that it will take six months for you to get one on a first-come-first-serve basis, how many people are you shoving out of the way to get one in a few weeks with your private insurance/out of pocket payment? The argument never held water for me--it basically means, "I want to keep this completely unfair system because I'll get mine."

Medicare/medicaid reimbursements are a mess though.

I can't comment on TTH because she drives me too crazy.

[Brainsample]

My husband says that he has a solution. Someone needs to start an Medical society of eunuchs. Fundy physician men can volunteer to become eunuchs so that they wont be tempted when they care for women.

Even though it's a fertility cult, dh says that "You have to give a little to get a little."

[watchdog]

So, I would really like to know what exactly "apathy" among physicians is?

I could write a book but don't want to do it here. PM me if you'd like examples.

I will say this though. As a physician, you will likely never experience the apathy of which I speak. Example... my mother went to a cardiologist recommended by our PCP. She had blockage in the arteries in both legs. This doctor began to perform a leg angioplasty on one leg but had to stop when she had a bad reaction to medication... a drug which should have been listed among her allergies on her chart but was not due to the negligence of the nursing staff. (That's another story.) He was confident afterwards that he could treat her leg successfully and rescheduled the procedure for about a month later. For some reason he got cold feet but waited until the evening before the procedure to call and then hemmed and hawed around before admitting he didn't want to do it. What changed in the previous month I don't know. It wasn't a personality conflict as my mother is a very polite, unassuming person, and neither of us had any issues with him.

A few weeks later our PCP experienced chest pain one night and went to the ER. He was told nothing was wrong but demanded a copy of his EKG. He took it to this cardiologist who said it was abnormal, diagnosed him with extensive blockage in one of his coronary arteries, and performed angioplasty a day or two later.

Two patients, one doctor, entirely different outcomes. This is not my family's worst experience by any means. My mother had to go to three more doctors before finding one willing to treat her. The doctor who finally treated her was very professional (at first), treating one leg and then the other a couple months later. She had no problems after the first procedure, but the second has been a different matter. She developed all the symptoms of a blood clot about 6 weeks later, but the doctor's office refused to give her an appointment. Her PCP saw her immediately upon hearing her symptoms and sent her straight to the imaging center for an ultrasound. Fortunately there was no clot (the technician thought there was, too), but she's still experiencing severe pain, swelling, and redness in her leg, and the doctor's office will not give her an appointment until August. I don't know that the doctor even knows what's going on, but the attitude from his office staff is very apathetic.

I could write a book on my experiences with apathetic and incompetent doctors. We can talk about what I had to go through to get needed knee surgery. Or Armour Thyroid for thyroid resistance... or for that matter the correct tests to diagnose it. We can talk about the hell several doctors put my dad through in the hospital in the weeks before he died. And on and on and on. I mean no offense, but as "one of them," you likely will always receive "professional courtesies" that we non-doctors will never get.

[bananacat]

My husband says that he has a solution. Someone needs to start an Medical society of eunuchs. Fundy physician men can volunteer to become eunuchs so that they wont be tempted when they care for women.

Even though it's a fertility cult, dh says that "You have to give a little to get a little."

Lol, if they did this they could bring back polygyny. Jim Bob could get himself another wife to keep the family growing, and then some young boy who is missing out could just become a eunuch for the cause, and even potentially treat JB's wives and daughters.

[Brainsample]

Lol, if they did this they could bring back polygyny. Jim Bob could get himself another wife to keep the family growing, and then some young boy who is missing out could just become a eunuch for the cause, and even potentially treat JB's wives and daughters.

If his kids build on-site to live after they're married, JB could procure his own eunuch for the household and extended family.

Which makes me wonder... I often wonder if Michelle has issues with urinary continence? Does anyone else wonder that but me? If they hire a general surgeon eunuch, he could potentially also do Michelle's bladder surgery, should she ever need it.

[Childless]

The whole "Americans don't have to wait as long to see specialists" is a bunch of bull shit. My son has an issue that requires orthotics to fix. His pediatrican referred us to a specialist. We had to wait 3 months to get an appointment with said specialist. After which, I got a bill for hundreds of dollars. I'd take the Canadian system over the American system in a heartbeat.

I had to have abdominal surgery recently. I waited 2 weeks to get an appointment to see the surgeon. I then waited a month and a half to get the surgery. Once I got to the hospital on the day of the surgery, it was pushed back 4 hours because a critical case had come in and my surgeon, understandably, kicked my surgery aside to help that patient. This whole myth that Americans don't have to wait for specialists/surgeries/etc. is ridiculous. That's just a lie put out there by the powerful insurance industry that stands to loose a lot if univeral healthcare ever becomes a reality.

[Artemis]

English here. If I call my doctor at 8.30 am, they will guarantee to see me the same day. I've had to ring in difficulties at lunchtime and say 'I need to see a doctor' it's urgent and related to . . .' and they've given me an appointment withing three hours.

If you have a problem out of hours, there's NHS direct. OK, they're not brilliant, but they're OK. Or A&E at the local hospital (Accident and Emergency.) You may wait six hours, but that's only if you're triaged as non-urgent. Waited four hours one Boxing Day with my elderly mother, who dropped a hot glass dish on her leg. (The dish broke - blood everywhere.) We steri-stripped it and drove in. She was just about to be seen when a very little still white baby came in and they saw the baby first, of course, as we would expect. They always see emergencies and children first.

I have two friends with children with serious medical problems involving trips to Great Ormond Street Hospital for Sick Children in London, where all the really rare and serious cases go. Neither of them has paid a penny. I imagine in the US it would have cost what - thousands? (We're talking multiple ops and re-construction work after birth defects here.)

The three grandparents I knew are dead now. All of them had major cancer treatment, with high quality drugs/palliative care etc, over many months, for nothing.

Our system is not perfect, and there are issues. But I wouldn't trade it for yours for anything. The thought of what you have to pay is truly terrifying. What happens to down and outs who need treatment? What do they do?

[FlorenceHamilton]

This is a wonderful discussion. And so close to my heart. In the US, the majority of medical students are now female as well. The handwriting is on the wall, so to speak. If a person's motivation to become physicial is for power, money and prestige and to "fix" broken stuff, then medicine will NOT be a good choice for you. If your motovation is to teach, heal, work as a team with your patient as a voting member, and to make more out of less, then this is the field for you.

In other words, the way the practice of medicine is changing, it does not appeal to traditional Patriarchal thinking.

Health care resources are not unlimited.

Let me say this again.

Health care resources are not unlimited.

We need to look around us and understand that this is true no matter where you live. In developed countries like the United States, Canada, UK and many others, there are far more resources than thert are in developing countries and we need to be gateful that is true.

Waiting times exist in all countries. Limited availability of physicians and technology, nursing and other caregivers affects every kind of system.

In the United States several large companies which we call the Insurance Industry controls the way resources are used. These companies operate like banks. They hold our insurance premiums and invest them to make money for themselves in return for the promise that if you get sick or injured, they will pay for a part of the costs if no disqualifying reason is invloved. (Warm and fuzzy, ain't it?) These Insurance Company banks will do every possible thing to not need to pay. They are in the business of investment banking.

The government currently controls the health care access of the very poor and elderly in Medicare. (Unless the Teabaggers take it away.) When the medicare act was passed.in 1965, many people screamed about "socialism" and the "end of the American way for life."

Let me quote Ronald Reagan from 2005, " Reagan "criticized Social Security for supplanting private savings and warned that subsidized medicine would curtail Americans' freedom" and that "pretty soon your son won't decide when he's in school, where he will go or what he will do for a living. He will wait for the government to tell him." and Reagan warns that if his listeners do not stop the proposed medical program, "behind it will come other government programs that will invade every area of freedom as we have known it in this country until one day as Norman Thomas said we will wake to find that we have socialism." Under this scenario, Reagan says, "We are going to spend our sunset years telling our children and our children's children, what it once was like in America when men were free."

And those, my friends, were words uttered by one of of most revered leaders from before 1965.

Making basic Health care government entitlement is not a cure all for the problem of ensuring health care. It is a way to make basic (and usually more than basic) health care to everyone in the United States regardless of ability to pay. It is a way to channel the funds into a system that is simpler and easier to navigate and monitor (yes this means for the public to monitor.) for the patients and the caregivers. There are going to be waiting times in every system. There are going to be situations that limit access to the most specialized care.

Who would you like to make the rules? Bank of America? Your State government? Your Federal government? Who do you want to have control of that money?

[mags]

Two patients, one doctor, entirely different outcomes.

Two patients with entirely different medical issues are going to have entirely different outcomes. I don't think you can compare the two scenarios you discuss. The fact that your mother had to go to 2-3 specialists before one would agree to do the procedure tells me that she is either high risk or has a complex issue. It is unfortunate that she had to see so many doctors but a physician who knows his/her limits is actually a GOOD thing. I wouldn't call that apathetic.

You say that as a physician I will likely never have to deal with these issues. I would counter that as a physician I know the limits of what medicine can offer and I have a different set of expectations.

[Brainsample]

Two patients with entirely different medical issues are going to have entirely different outcomes. I don't think you can compare the two scenarios you discuss. The fact that your mother had to go to 2-3 specialists before one would agree to do the procedure tells me that she is either high risk or has a complex issue. It is unfortunate that she had to see so many doctors but a physician who knows his/her limits is actually a GOOD thing. I wouldn't call that apathetic.

You say that as a physician I will likely never have to deal with these issues. I would counter that as a physician I know the limits of what medicine can offer and I have a different set of expectations.

Ah, introducing another contributing factor -- the idea in the US and elsewhere that doctors can fix EVERYTHING. And that patients have a RIGHT to perfect health which doctors have the ability to give them but are all just holding back. That is a fantasy.

That doesn't diminish the great resources that are available in healthcare today, new pharmaceuticals every day, or the good and vital work that doctors do. But as mags says here, specialists are specialists because they don't treat everything and realize their limitations. For some problems, there are no good solutions. That is not apathy, that is the limitation of humanity -- of the physician and of the patient.

"A different set of expectations" is a pregnant phrase, so true, and a huge part of the discussion.

[FlorenceHamilton]

The issue of expectations is very important. I stated before that patients have to become full members of their own health care team. Doctors simply cannot fix every ill. And we cetainly cannot help you if your agenda and set of expectations is not realistic to the situation.

It is true that your upper respiratory infection makes you feel miserable. You are achey, congested. Your head feels full and throbs. It is not a fun thing. Sometimes you come to the doctor and the doctors says s/he cannot do anything to change the course of your illness. S/he can give advice on things you can do for yourself to make the illness more tolerable until it passes. We can give you a note for your boss acknowledging that you are truly ill. We can tell you things to look for that would indicate that medical intervention would be advised. Patients need to take an active role in the reality.

Grandma is very sick. She has had diabeties for years, but she sure does like to eat. She is morbidly obese, but she did quit smoking after she had the stents put in her heart. Eating has been her only joy. She can in with a big belly ache. It turns out that she had a clogged bloodvessel going to her intestines and she had a bowel infarction. Infection had begun to set in even thought the surgeon got there very quickly. She got very strong antibiotics. Even though she has heart disease and diabetes, we got her through the surgery. It was a really risky surgery, too and we were not sure that she would survive the first 24 hours after that. Problem is, that now he kidneys are shuttling down and efforts to get them to function are only partly affective. Grandma is clear that she does not want dialysis. Family is very upset. Grandma is awake and alert, but she is miserable. She is all swollen. The nurses struggle to lift her to care for her private parts and she complains that they handle her like a sack of potatoes. The staff at the hospital looks at the family and gestures that this is all they can do. Her foley catheter is leaking because her tissue swelling keeps fluctuating. She has tubes in her belly bacause of the colostomy, but she is also passing stool rectally, The nurses have to work in twos to get her cleaned up and repostioned. Grandma complains that she is exhausted from being moved around like that. Family is getting frustrated with the doctors who cannot seem to agree or to give a straight answer about what is going to happen next for grandma. Everyone is feelng bad about the predicament, but the staff is getting frustrated with the family who wants grandma to get "better care". PCP explains that the prognosis remains very poor, but that granma has already beaten the odds. There are no straight answers. We probably are looking at long term care, or in the event that her kidneys get no better, then Hospice. Family is not happy.

Id this apathy on the part of the caregivers? Is this poor health care? Is this just the sad reality of life? What can we do better in this situation?

[watchdog]

The fact that your mother had to go to 2-3 specialists before one would agree to do the procedure tells me that she is either high risk or has a complex issue. It is unfortunate that she had to see so many doctors but a physician who knows his/her limits is actually a GOOD thing. I wouldn't call that apathetic.

Nope, not true. The well was poisoned by the first one who concluded, in spite of a long history to the contrary, that she is allergic to contrast dye. The 3rd one wanted to do both legs at the same time which to me was NOT knowing his limits. The 4th became apathetic only after she experienced side effects after the second procedure. (Nothing to do with the dye which she's still not allergic to.) I agree knowing one's limits is always a good thing.

As for Florence's example, it sounds like grandma is her own worst enemy. With the growing epidemic of obesity in the US and elsewhere, I'm sure there will be many more like grandma in the future. My mother never smoked or drank and is slender and in very good health for her age. Obviously higher risk than a 30-year-old just by virtue of her age, but not because of unhealthy lifestyle choices.

It's been interesting hearing about the experiences of those in countries with socialized medicine. As almost everyone has said, no system is perfect. Thanks for sharing your stories.

[watchdog]

You say that as a physician I will likely never have to deal with these issues. I would counter that as a physician I know the limits of what medicine can offer and I have a different set of expectations.

I said nothing about expectations. What I meant was that as a fellow physician, you'll likely always receive preferential treatment and be shown more concern by your colleagues. That's just the way it is.

[FlorenceHamilton]

Watchdog,

Granma comes from a different generation. She grew up learning that being well padded was a sign of health. By the way, her children appear to be slender and fit. But they still (and they should) love their mother dearly. It is still about expectaions. The family expects grandma's health needs to come first and it is hard for them so see that there are other patients are also on the unit who have families (or Not) but need care. They are looking for inconsistencies that they can point to as reasons why grandma is not getting better. Remember, resources are not unlimited.

Blaming grandma for her obestiy is convenient, but does not roslve the problems. Do you feel that the health care she is getting is apathetic? Do you think that the nursing staff is overwhelmed by caring for this lady and may be avoiding additional interaction with the family because they have no aswers? Was it cold and heartless of me to tell the family that they are reaching an impasse. Was it blowing them off to tell them that palliative care and comfort are all that we can offer?

[emmiedahl]

My good doctor, we had the same issue with my grandma. She was not a smoker, but she was proud to be well-padded (she grew up in a third world where it was a status symbol on par with owning an authentic Louis Vuitton handbag for every outfit in your closet) and very uncooperative with medical staff. Her death, once she accepted it, was peaceful thanks to compassionate care.

I have never known a truly apathetic doctor. Maybe I am lucky.

[watchdog]

Do you feel that the health care she is getting is apathetic? Do you think that the nursing staff is overwhelmed by caring for this lady and may be avoiding additional interaction with the family because they have no aswers? Was it cold and heartless of me to tell the family that they are reaching an impasse. Was it blowing them off to tell them that palliative care and comfort are all that we can offer?

Obviously I don't know enough about the situation to know whether the care she's receiving is apathetic or not. It does sound as if the staff is overwhelmed, but I don't think avoiding the family just because they don't have any more to offer is right. (Again, I'm assuming the family isn't wearing on your last nerve with constant, unrealistic demands.) I think if you've exhausted all the options you were right to level with the family, and if she's capable of understanding, the patient as well. I always appreciate the honest approach more than the silent treatment which I generally interpret as... well... apathy.

[FlorenceHamilton]

This is one of many thousands of human beings who are interfacing with the Health care sytem in the United States (and everywhere). My point is that the American public does not have a good understanding of the realities we are facing. In the situation that I discussed, the family is actually very nice. However, in the throes of the emotion of watching Grandma slipping away, they are becoming difficult to communicate with.

I live in a very conservative part of the country. People believe that the American HEalth system is a the best in the world. Sometimes, their beilief in this crosses into the supernatural. If we are not making Grandma better, we must be witholding something. If Grandma's son/daughter was a doctor, her care would be bettter/different. The slight differences in presntation and opinion between health care providers begin to seem like looming gaps in care that if avoided or corrected, would make all the difference

By the way, just as an aside, Grandma is a hoot! She is funny and charming and clever. She told me that she was bitchy sometimes and she just cannot help it. I assured her that she had earned the right to be bitchy sometimes. We all giggled. This is a really nice lady with a realy nice family. The stress of the situation makes everyone a bit "bitchy" sometimes.

My point is that what appears to be apathy may be exhaustion, lack of control, a self preserving behavior to allow the health care giver to be able to have energy for the next person. It could be frustration at something else entirely. Perhaps the EMR system is not working correctly, making it difficult to obtain and share information. Maybe one of the insurance companies is on the floor doing a chart audit that is making some information difficult to obtain. Maybe the adminstrators are getting tough about using too many paper supplies for each patient. Maybe there is an inspector timing the handwashing of caregivers on the floor. Maybe the doctor's own mother is also sick, or their child was just deployed to the Middle East.

Health care is an important issue. I am showing you all some of the stressor we deal with every day. There are lots of female docs reading this thread. We need to hear what your impressions are about the subject.

[watchdog]

I said I wasn't going to do this, but since others have told their experiences, I'll tell one of mine. As a veteran of two knee surgeries (same knee) with internal hardware and the scars to show for it, I couldn't help but have a feeling of dread when walking normally a couple years ago I felt a sharp pain in my knee and couldn't walk it off. My knee quickly began to swell, and within a few hours I could hardly walk on it at all. Knowing I hadn't twisted or done anything to injure it, I limped around for a couple of weeks hoping it would spontaneously get better before finally going to see an orthopedist. He took x-rays and did a good exam and said he suspected it might be the meniscus. That's what I was thinking, too. He sent me for an MRI, and there was a list of about 8 abnormalities they found, including a statement that the lateral meniscus had been previously removed. He offered no treatment except physical therapy, which, if the meniscus was torn, was probably only going to make matters worse.

Now, it had been 20 years since my last knee surgery, but I had gotten a copy of the op report for my records which had long since been lost or discarded, but I distinctly remembered it saying that the lateral meniscus was intact. This was somewhat surprising considering the violent, crushing nature of the injury necessitating that surgery. Having moved to a different state since then, I contacted my old orthopedist's office to get my records. They had long since destroyed them, but I was able to get the op report from the hospital where I had the surgery. They were in the process of destroying records from 1989, so it was a miracle they still had it. A few weeks later and they wouldn't have.

They sent me a copy, and sure enough, just as I remembered, it said the meniscus was intact. I called the imaging center and spoke with the radiologist who'd read it and read him the op report from 20 years earlier. He laughed and said, "In that case, it's torn to smithereens." (I didn't think it was that funny.)

I went to a different orthopedist in the same group who took one look at the radiologist's supplemental report and said, "I can scope it as early as next week." He went on to say that 99% of his patients wouldn't have been so diligent and that had I not gotten that old op report he wouldn't have been willing to do anything either. Well, what choice did I have? And how many patients bother to get copies of their records? If I hadn't been so diligent I guess I'd still be hobbling around on it today.

Oh, yeah. I had the surgery a week later. The surgeon came out and told my family, "She sure called that one right." He told me later he really didn't think it was anything more serious than a small tear, but the farther in he went the worse it looked. He said practically the whole lateral meniscus was destroyed. "It looked like crabmeat."

The first doctor, other than doing a good exam, was apathetic. I don't think my expectations of being able to straighten my knee (there was about 20 degrees of permanent flexion beyond which I couldn't straighten it) or walk without excruciating pain were unrealistic. He said the x-rays had shown no sign of osteoarthritis. He even stated he suspected from his exam that it was the meniscus, but he didn't trust his instincts. I think that's part of the problem in medicine today. Doctors rely too much on sophisticated, expensive tests whereas their older counterparts had to go on experience and their guts.

Actually, this was one time a doctor seemed to appreciate an informed, involved patient. At least until he did the surgery and got paid. Unfortunately, when I went back to him for post-op follow-ups and was still having pain in the medial side of the knee he dismissed my concerns. (I'd complained about this before the surgery, but he apparently didn't check that side nor would he address it later even after the physical therapist brought it to his attention.) I would always wait 2-3 hours to see him, and he'd spend 10 seconds in the room and say come back in 2 weeks. After about 3 of these "visits" I wondered why I was bothering. On my way in I'd always see him standing in the hallway animatedly chatting with his young, male jock patients while he'd barely acknowledge me. So yeah, I definitely saw a difference in how some doctors treat different patients. Even my PCP acknowledged that I wasn't imagining things. He said orthopedists who treat a lot of jocks (like this one) like young athletic patients because they figure they'll continue to injure themselves and come back again and again. I wasn't as likely to reinjure myself and bring him any return business, so he was through with me.