My patient has pain in the right hand, which my EMG/NCV last week showed was simply carpal tunnel syndrome. I've scheduled him to see a hand surgeon in a few days.
I understand the MRI of his neck had a few disk bulges and all, which might cause hand pain. But, as is documented in the report and your own note, all those abnormalities are on the left. His symptoms are all on the right.
When he told me that you were insisting he have left-sided "laser neck surgery" for the right hand pain, I figured he'd simply misunderstood what you said, or maybe you'd read the MRI wrong. I do that myself here and there, and have to double check. Hell, I think everyone does.
But when he brought in your printed instructions, with some sort of bogus "referred dermatomal crossing" bullshit about how a pinched nerve on the left can cause "sympathetic allodynic crossover pain" and affect only the right... I told him to run away from you.
I also liked how your note specifically advised him against seeing me to discuss this, and instead recommended a neurologist you have "an affiliation" with. How much of the cut is he getting for being your partner in fraud? I can only assume you've been burned before by other outside docs (like me) telling patients the truth. The part of your note suggesting he not have an EMG/NCV "because it will only delay your pain relief" is a real piece of work. Heaven forbid someone should make the correct diagnosis and rob you of a case.
Your threat about not referring patients to me isn't particularly intimidating. You never have. Now I know why. I have nothing against surgeons. I refer patients to them (when needed) routinely. But I don't take that decision lightly, and keep a short list of surgeons I trust.
So, I don't feel particularly bad that I deprived you of a case. In fact, I hope I have the opportunity to do so again.
Yours truly,
Ibee Grumpy, M.D.
15 comments:
You go Grumpy!
I love it when pain patients refuse to go to neuro...how in the heck will you get a good idea of what's wrong without neuro? (DUH!)
I tell patients the following as a nurse:
1. You have a right to a second (and even third) opinion.
2. The answer to all problems for a surgeon is to cut.
3. If they wouldn't do this surgery on their family member (I do ask and review their rationale), I wouldn't let them do it on me.
It also helps to talk to his/her nurses. They provide a wealth of information in the review (or lack thereof).
If any or all send up a red flag, review your options and just say no if needed.
Just my $0.02...
Thank you for allowing me to consult on this interesting and challenging case.
This reminds me of a commercial for union plumbers that depicts a non-union plumber telling his customer he needed a new "flam shooter".
Scammers exist no matter what the profession. Your patient is so lucky to have you as his advocate.
If you didn't (or haven't in the past) reported this fellow to your state medical board, you are being remiss.
Measure twice, cut once.
I agree with Brent ~ the "doc" must have graduated from the "Arse-holes 'R' Us" school of medicine, and needs to be investigated and shut down.
I love your blog but you make me afraid to see any doc. It's like that Forrest Gump thing with the chocolates, you never know what you're gonna get. And your patients, mercy, who are these people?
Second the notion of cc: medical board.
"3. If they wouldn't do this surgery on their family member (I do ask and review their rationale), I wouldn't let them do it on me."
You shouldn't ask, and they shouldn't answer that. What they would do or wouldn't do has nothing to do with your decision.
Grumpy, I hope you reported this shitsipper to your friendly neighborhood medical board.
Thanks Dr. Grumpy. Your response gives me faith in human beings.
RehabRN wrote:
"2. The answer to all problems for a surgeon is to cut."
That's simply incorrect. I'm sure Dr Grumpy wouldn't refer patients to a surgeon if that were the case.
-MD, not a surgeon.
The surgical solution is to cut -- 'tis true. Except in limited situations, if there is no surgical option, then there is no need for the patient to be there, or to continue with that doctor. The patient will go back to his/her non-surgical doctor for treatment. Visits with a surgeon have generally to do with - surgery. It's more than just "When you're a hammer, everything looks like a nail."
This is one reason I read your blog. Way to go, Dr. G!!!!!
Congratulations Doctor!Yes, refer him to the board.
Another quack doctor.I know one who "treated" a stage 4 cancerous brain tumor with... an MRI
I had a neurologist send me to a surgeon to see about decompressing a nerve in my elbow. The surgeon said absolutely not and sent me to physical therapy for 8 weeks. So no, the surgeon's answer is not always to cut, and if it is, then they aren't a good surgeon. Elbow isn't perfect, it still flares up but I no longer want to cut off my arm so I can sleep.
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