A recent thread over at Molly on Money got me thinking about how we make decisions based on past experience vs. current data. When to step outside the norm, to experiment with alternate approaches, and when to rely on the tried, true and tested.
Photo Credit: Flikr: Just Some Dust
Not to pick on the medical profession, but I’ve had a couple of cases where a physician prescribed a remedy consistent with knowledge and training, and which turned out to be either wrong or completely unnecessary.
About fifteen years ago, I noticed a gradual loss of feeling and strength in my left hand. I would pick up something like a glass of water, and have it slip from my hand. The pinkie and ring finger would also get cold and tingle for hours on end, and then stop.
Our family doctor referred me to a specialist to get a conductivity test done on my arm. I don’t how these tests are conducted these days, but at the time, it was a perfectly ghastly procedure.
The specialist, a Dr. Gupta (I still remember his name – you’ll see why) started the procedure by sticking what looked like a knitting needle about an inch into the meaty part of my palm (Yaaaa-oooOOW!!). There were wires connected to one of the needle, ending in alligator clips. These were in turn attached to my shoulder area, completing the circuit.
The good doctor then advised me, “this might shock a little”. I was still stunned by how much the damn needle had hurt, that all I had time to say was “huh?” Not waiting for any further input, Dr. Mengele Gupta flipped a switch, sending what felt like a massive surge of electricity up and down my arm. I swear that the lights flickered and sparks flew from my dental fillings.
Thankfully, Torquemada Dr. Gupta only needed one test run, so after extracting the knitting needle and a few alcohol swabs, I was cheerfully released, faint wisps of smoke curling up from the top of my head.
A few days later after the test results were in, I consulted again with our family doctor. It turned out that I had compression in a major nerve that runs up from the wrist, and into a boney channel or “sleeve” at the bottom inside of the elbow. This channel had been compressed, squeezing the nerve and causing the loss of feeling and tingling. The doctor’s solution was to operate and re-route the nerve around the boney channel, and so relieve the compression.
Even though I was assured that Dr. Gupta would be nowhere near the operating room, I declined the opportunity.
I looked instead at my daily routines for the possible causes of this compression. Turns out, how I had set up my computer workstation at work was not the best ergonomically correct solution. I sat at the inside corner of two desks, and rested my elbows on the desk surface. I also drove with bottom of the elbow resting on the car window sill on that precise spot, on the compressed nerve. I decided to change my work posture by resting the left elbow on a small pillow, and on my lap when driving the car. Within a month, the symptoms had all but gone away, except for some residual damage which leaves some occasional and minor tingling in the two fingers.
Maybe the operation would have fixed it 100%, but I some minor tingling I can live with.
The point is that the doctor was operating on what he knew, based on the education and training and knowledge he had accumulated to that point in time. I don’t fault him for his recommendation. The situation was non-critical enough that I could step back, analyze, and experiment with a different path.
Other times, orthodoxy and established procedure are the only safe path.
Case in point: Mrs. 101 was recently hospitalized briefly for acute chest pains. One fine evening after she complained of pain high in her chest, I rushed her to the St. Johns urgent care center not more than 2 blocks away. After checking all vitals and administering nitroglycerin, the duty doctor advised going to the ER by ambulance. In the ER, the staff went through a series of diagnoses and incremental steps. Administer 4mg of morphine, wait for results, try another dose, and so on in PERT chart fashion. Eventually, as the pains did not recede, she was admitted overnight for cardiac monitoring and heart stress testing. All turned out fine, the pain went away overnight, and it was surmised that it was probably acid reflux, which can mimic heart attack symptoms.
Some takeaways from these two stories:
Short-term, high-impact situations, rely on historical knowledge and practices.
If I’m in a car accident, and end up in the ER with a steering column through my spleen, I don’t want the doctor to talk about alternative medicine and meditation. I want drugs, serious drugs, and the best operating room surgeon in town. Same goes for chest pains.
Long-term, low-impact, seek new approaches.
I can afford to experiment with my gardening, because I don’t depend on it to make a living. Were I a farmer, I expect that I’d be much more risk-averse.
On investments: Educate myself on long-term trends and invest accordingly with a smaller portion of our capital in high-risk, high-reward areas such as penny mining stocks natural resource companies.
Track and measure.
You only know what you know. I’ll be starting a gardening journal this year. I’m thinking that whatever written data and observation I can record will give good guidance for the 2012 season.
Get a second opinion *before* getting an electrical conductivity test.
And stay the hell away from anyone called Dr. Gupta.
LOL, I didn’t know there was such a thing. Seems like a pretty crazy test to perform. I agree with everything you said in the post. It’s good to seek out second opinions, but under duress and with life potentially at stake you want the fix and you want it now.
I once dropped a plank of wood on my big toe and the nail turned black. I had a huge callous and the nail was growing very weirdly and maybe it was mildly infected or there was some kind of growth on it… sounds disgusting, I know, and it was. After seeing the doc he recommended to do an operation and basically slice off part of my toe, but in the end I did a bit of reading, declined and decided to “solve” the problem another way, using some good old bodily fluids (didn’t say this wasn’t going to be disgusting). I could always have gone for the operation if the situation didn’t improve, but it did. Within a few weeks my toe was completely healed and the nail eventually returned to normal once the mangled portion had been pushed out enough and trimmed.
Invest It Wisely recently posted..The “Tiger Mom” Approach is Not the Only Chinese Way
Bloody hell! The prospect of getting part of a big toe sliced off more than justifies second thoughts!
The mental picture is only mildly disgusting, but even so, I’m glad I’ve just finished with dinner.
In Jan. I just completed two years and 5 mammograms and ultra sounds to prove to the doctors that the masses that I had in my breast were the same ones from 10 years ago (which had been biopsied and found to be just fine). I didn’t have the medical records from that biopsy or the records to show the size of the masses. One doctor aggressively tried to push me into a radiation therapy to track the masses for 1 yr. She was so emotional and not great about answering my questions I switched doctors immediately. I found a compromise that would not compromise my health.
I now take responsibility for my own medical records and I feel stronger than ever about asking as many questions as I feel I need to from my doctor.
Molly On Money recently posted..Getting Off Your Ass- The First Step to Building a Budget
From speaking with friends and colleagues who are cancer survivors, it seems that the ones who make it are the ones who ask the most questions and are genuine pains in the ass. I’m with you, I don’t like doctors who play God, issuing edicts down to us mere mortals. I’m sorry to hear about the 5 (!!) mammograms. Mrs. 101 absolutely detests them!
This is a very interesting point. The level of risk you are willing to assume ultimately depends on your dependency on something. I do think it is important to evaluate current data too, but sometimes it doesn’t meet the same level of evidence as the tried and proven. It’s a balance issue for me; notwithstanding life and death situations (I hope).
Roshawn @ Watson Inc recently posted..Surprising Trend In Mortgage Defaults
Hi Shawn. Trial-and-error eventually leads to traditions, which are just fine for the 80%.
Good for you for realizing that doctors aren’t the super intelligent god like people that the movie and media make them out to be!
Good think you didn’t follow suite like most people!
There’s a reason why they call it “practicing medicine”, as they say. Good call not letting them practice it on you. My mom always says, “well, doctors die too.” For the most part they do a good job, but they are just following common protocol, as in some ways are we all.
I really enjoyed reading about your incident. I am really glad it was just a false alarm for your wife. That must have been really scary. I’m guessing it wasn’t the same Doctor Gupta of CNN fame. lol.
… and they smoke and are just as stressed out and overweight as the rest of us. Your Mom’s got it right.
No, it wasn’t CNN Gupta. Not that camera-friendly.
People put medical practictioners up on a pedestal and think they are all knowing. The reality is that they are just like every other career..you have the A players, the B players and the C players. There are some that are outstanding, some that are competant, and some that are incompetant.
Many physicians are not very open minded and quite a few don’t listen at all. I’m glad you have more common sense than these guys.
First Gen American recently posted..Favorites- the Landlord edition
Sandy, I agree.
Mrs. 101 used to have an abundant trust in doctors. A couple of missed diagnoses tempered that opinion. I think that these days, rushed as they are, doctors don’t generally ask enough questions and area a little too quick with that drug prescription.
Oh man, the nightmare stories I have about doctors! Plus, I do a lot of research that coincides with medical research in various ways and the stuff they do is just BAD, and on top of that, many doctors don’t even seem to pay attention to best practice, even for things we know about. One of my friends is on the pre-med committee for her college and she is always telling me horror stories about some of the idiot undergrads who get into med school and end up practicing. You don’t have to be all that smart to be a doctor, just good at memorizing. I could go on because I have long rants on this topic.
Anyhow, I have very little trust in doctors.
Nicole recently posted..DRIPping
Hi Nicole, thanks for stopping by and leaving some feedback. It wasn’t my intention for the post to be anti-medical profession, but I know exactly what you’re saying, and I like your comment about doctors not needing to be all that smart, just good at memorizing. The admitting doctor that transitioned us from the ER to the hospital proper was unquestionably socially retarded. I tried several times to crack a few jokes (and I can turn on the charm when I need to), and every single time I got…. nothing. Just an empty bovine stare. He chewed the cud for a while, and went back to asking questions off a form. The ER doctor herself now, was a different story, just an absolute crackersnap, fast on her feet and full of personality. Maybe it was the operating environment. The type of character associated with a fast-paced varied environment like an emergency room (TV shows aside) perhaps doesn’t allow for cow-slow intellect.
Wow! I had exactly the same experience! Only my doctor wasn’t called Gupta! This guy went ahead and even prescribed an anti-depressant! I refused and found some exercises on the web, changed my work position and the numbness went away. Took almost a year though!
Glad you didn’t opt for surgery!
Moneycone recently posted..Buying Stocks Neglect This Metric At Your Own Peril!
Gotta love those anti-depressants! Maybe your physician had a hot medical sales rep that he was trying to get on the good side of. I saw one once in a waiting room with her bag of tricks. Sailed right in to see Doc, while the rest of us went back to Redbook and CNN Headline News. Good that it turned out OK for you.
But what about Dr. Sanjay Gupta of CNN fame?
I trust the medical profession more less and less each year I get older. I am kind of the opposite of my parents, who took the doctor’s word as gold.
Many doctor’s just go with a set standard that is in their head and don’t think outside of the box. Your Dr. Gupta obviously just got his training from the medevil period… (I actually have no idea, maybe that is a great way of diagnosing your nerve issues. Sounds awful to me.)
I have a post coming up on this so I won’t go on too long, but we recently ended up in the ER because this idiot doctor wouldn’t do a damn throat swab on my daughter because he was convinced she had something real serious. Idiot.
I gotta go calm down and have a glass of wine now. I am glad your situation had an easy remedy.
Everyday Tips recently posted..10 Tips to Radically Improve Productivity in the Home Office
LOL! Quite possible that my Dr. Gupta moonlighted as a medieval barber.
[...] 101 Centavos shares an interesting story about his experience with the medical profession. His post highlights that thinking outside the box is necessary, instead of just following the same path every time. [...]
[...] You Only Know What You Know (101 Centavos) [...]