I took Renee to the right shoulder specialist. Boy, was I disappointed! The Doc is not really a right shoulder specialist, he can diagnosis either shoulder. What he can’t do is anything else. Renee also has pain in her wrist and asked her doc’s opinion. “I can only do shoulder work. I’m not trained in wrist,” stated the specialist.
I called him the “right” specialist because all the reviews and recommendations from friends and neighbors said he was the “RIGHT” doc for Renee. As it turns out, he was the wrong doc. In my day, there was a doc referred to as an orthopedist. As a resident, you’re trained in general orthopedics and then do a fellowship in a specific area of the body (like the shoulder), giving the right to claim a specialty.
My point is the following: The doc either has the knowledge necessary to diagnose and treat wrist pain and was in too much of a hurry to assess Renee’s wrist or, for whatever reason, had a crappy residency and really can’t show competency if any other joint other than the shoulder.
We are still not certain where Renee’s shoulder pain is coming from. Although doubtful that the wrist pain is tied to the shoulder pain, it is possible. A few extra minutes assessing my wife’s wrist might have revealed the diagnosis and probably a referral to a wrist specialist (or a curative intervention.)
My training as a generalist taught me to do both a thorough history and a complete exam of whatever ails my patient. I’ve been told by multiple patients and docs that I was an excellent diagnostician. I did attract the difficult to diagnosis patient and, by being meticulous in taking a history and performing a full exam, solved many of them. Today, I want to tell you about Sarah.
Sarah was a 34-year-old mother of four who had a history of severe attacks of right shoulder pain. She had seen 3 orthopedists, including a shoulder specialist, a chiropractor. She had received multiple prescriptions and had various injections all to no avail. Sarah was miserable. Her husband was scared, describing the attacks of pain as so severe that he thought they were going to kill his wife.
Since I failed to find an answer, I had Sarah, her husband and my staff publish Sarah’s history and findings and send copies to the heads of orthopedics at multiple major teaching programs. I know it sounds nuts, but I got a reply from a doc in New York suggesting that we film an attack and send him the film. Back then, the movie camera was expensive and huge; but Sarah’s husband went all in buying the best.
Six months later, Sarah experienced an attack while in church. Her brother filmed the attack while her husband lifted her out of the chair and started for the car to go to the ER. As per her usual, by the time Sarah got to the ER, her pain was gone. The following day, I watched the video and there it was, the answer. Sarah’s shoulder was spontaneously dislocating. Sarah’s husband reduced the dislocation while pulling her up to get her to the ER without knowing what he was doing.
A lot of extra effort and the use of new technology led to Sarah’s diagnosis and curative surgery. I’m disappointed in today’s specialty-based care system. The future of medicine sure does look bleak.