Earlier this year my mom was in a terrible care accident. She miraculously survived with multiple fractures. Were this to have happened to most women her age they would have been a pile of bone dust.
In the hospital after the accident they set what bones they could and attached an external fixater on her leg. The staff at the hospital said that in a few weeks they would remove the fixator and surgically install a plate in that leg. The hospital experience was terrible and dangerous. I had to constantly monitor staff to assure they didn’t give my diabetic mom and IV drip with sucrose in it – which happened no less than three times. After a few days my mom was moved to a rehab facility. In transition, the hospital forgot to write a prescription for blood thinners (a standard of care for bed ridden patients) and mistakenly documented her status as weight bearing. She couldn’t even sit up or role over.
About ten days later my mother’s legs were filled with clots. This is extremely dangerous. If a clot breaks free it can cause a stroke or a heart attack. So they dosed her up with a lot of blood thinners, I prayed and made sure the staff at the facility would watch her like a hawk anytime I couldn’t be there.
So the day arrived for the appointment when she was to have the plate placed in her leg. My brother was here visiting from Indonesia, so he rode with my mom in the ambulance while I drove so I would be able to pick my son up from school after the appointment. When the young physician entered the room and asked how we were doing my mother said “great all things considered, just here to get the plate put in.” He asked “are you having problems with the fixator?” We responded by letting him know that this is just we had been told in the hospital. My brother and mother immediately began rationalizing how and why a plate would be better. It might “strengthen and fortify the bone.” The doctor responded with a hedging “I don’t know, maybe, but if that is what you want to do, we can schedule your for surgery.”
Because of what I do (advocate for cancer patients), I’m very sensitive to how dangerous and destructive making “more is better” blanket assumptions can be in respect to healthcare, and especially in situations that might feel acute. So I say, “wait a minute, let’s really think about this. You will have to stop taking blood thinners prior to surgery – and your clots have just cleared up, spend another night in the hospital and we know that can be dangerous, undergo anesthesia, also dangerous, and sustain injury – because there is injury imposed during surgery, and this will inevitably prolong your healing. So if there is not in fact a benefit to having this done, I don’t think you should do it.”
The doctor excused himself for about five minutes returning with a recommendation against surgery due to my mother’s status as having diabetes, high blood pressure, and having been a smoker until just prior to the accident.
A few weeks later at her next follow-up appointment my mother was complaining about the fixator and lamenting that she hadn’t opted for the plate. On this day we were seeing a very seasoned doctor with much more experience than the last. He informed us that removing the fixator was the absolute worst thing that could’ve been done. The bone had broken clean at the top and the bottom of her shin, and shattered like a windshield in between the two breaks. By some miracle no bone had separated from the shattered break, and to open up her leg and start playing around with that might have left her crippled and in even more pain than she will be in for the rest of her life.
The lesson – ask questions and be educated and informed. Doctors hedge at a patient directing his or her own care as they fear litigation if they say no over what on the surface may appear to be choice. All too often they are only enabling a fearful reaction to a situation that the average lay person is just not used to.
This comedy of errors I think is more illustrative of healthcare today than most of us would like to believe. Overtreatment and inappropriate treatment is probably epidemic in respect to a lot of health related situations. However, undertreatment too can be a problem. We have got to be able to trust our doctors to weigh the long-term data and marry that with their clinical expertise while we strive to be informed educated advocates for our own care. If we fail to do so, the results could be catastrophic.