Medical follow up

As I posted earlier, I had an initial visit with a physician here in Texas specializing in treatment of the hands. The initial consult was positive and on his recommendation I had two tests done: an Electromyography (EMG) test and a bone scan. The EMG test involves placing electrodes (pads, needles or both) at various points and testing nerve conduction pathways. The bone scan injects a dye and you go back four hours later for a low intensity, long duration scan. During that interval the dye accumulates in "problem" areas.

I had the follow up visit this week. It did not go well. In fact, it typified everything I loathe about the medical industry (note that I didn't say "profession").

The Eminent Physician (EP) arrived 35 minutes late. The upside is the Pile of Meat (PoM - me) got to read an article in a back issue of Smithsonian about the Apollo 11 flight and moon landing in its entirety while I waited.

After a perfunctory greeting (but no explanation or apology for the wait) the EP asked if I'd had any relief from the steroid injection in my thumb. I said no, and said "I forgot to ask last time, what is going on with my thumb?" The question clearly annoyed the EP who said I had arthritis. I commented that the onset was very sudden (like "instant") and I could feel something moving under the skin at the point of pain and my understanding was arthritis generally was progressive. This annoyed him further but he didn't respond and pulling up my x-ray would have been a waste of his valuable time: after all, he'd made his diagnosis and treatment and I likely wouldn't understand it anyway.

We moved on.

Without further comment to me, he began looking at the EMG results and making notes. Reading upside down, I saw that he circled several areas of the results and wrote things like "45ms" in his notes so I'm assuming at various points in the neural pathways in my arms/wrists there was a propagation delay of 45ms and that this isn't normal.

When he was done reading and making notes (as nearly as I could tell, he didn't look at the bone scan results) he said he wanted to give me a steroid injection in both wrists. When I asked why he looked offended and said I had abnormal findings in the EMG and this would help him determine whether it was my wrists or elbows. When I asked him what "abnormal" meant i.e., how bad it was he became annoyed and said it was irrelevant, that I had an abnormality and that he had proposed a treatment.

At that point, I tried to develop a "decision tree" i.e., if the injections help what does that tell you and what would the next steps be, if they don't help, what does that tell you and what would the next steps be. This clearly annoyed him further and finally he said "it doesn't matter to me whether you get the injections or not" (which was a real relief because after all, it's all about him).

It was glaringly apparent that my role as PoM was to be tested,report symptoms and accept treatment without question and, of course, pay the bill. Anything else was a waste of the EP's valuable time.

So what kind of ridiculous questions was I asking? Here's a sample:

• You asked if someone had driven me in because the injections would leave my hands numb. How long will this persist?
• So the EMG results are abnormal, can you give me an idea of how bad they are?
• Assuming the injections help, does this mean I'll be on a regular program of injections for the rest of my life?
• Assuming the injections help and nothing else changes i.e., I still do long distance cycling, how likely is this to reoccur?

On and on, blah, blah, blah. One inane question after another. No wonder he viewed it as a waste of his valuable time.

In the end, I decided to have the injections in the hope that they provide some relief to my hands but I won't be going back. I was strongly tempted to just get up and walk out but restrained myself since I'd already invested that much time with the EP.

I'd like to say this was an exception, that I caught an EP on a bad day (which really should be irrelevant to me as a patient but hey, we're all human), etc., but frankly this is exactly coincident with my 66 years of experience with the medical industry (there's that word again). In general, minds are made up - often before they even see you, whatever you have to say is for the most part irrelevant and their on the spot diagnosis is sacrosanct. Being by nature an optimist, I was hoping for a different outcome.

This whole episode is why it's entirely likely that if I ever develop a progressive disease e.g., cancer, I'll wait until it's essentially untreatable before consulting an EP despite the fact that unlike 33 million people in the country (and climbing) I have pretty good health insurance.

Oh, and my hands hurt.