Saturday, September 5, 2009
The Worried Well
The bane of a surgical practice over the years was the frequent referral of the worried well by general practitioners. They were referring the neurotic who needed an opinion to confirm what their doctor had already told them. I understand the need, but it was tiresome in a busy surgical practice to repeat what everyone knew. Occasionally however there was a new discovery which meant the prudent never said ," No! " The decision to operate on someone based on symptoms, or sympathy, or speculation is a recipe for disaster. It is not dangerous to send someone for treatments that carry little or no risk , but there is considerable risk to ill advised surgical treatment. Harm can be done! Surgery is never, however, the last resort. It is best done at an optimum time and it has to be based on the objective (that is the measurable) findings rather than based on the symptoms (the subjective findings), or the patient's desire. That may seem a cold approach to some, but it is a reflection of the science rather than the so called art of medicine. Hippocrates said, in his aphorisms, "Cure occasionally, comfort always! " but, it is cold comfort if you do an operation for reasons other than on a scientific basis. It is incumbent on the surgeon to be selective, which may offend some patients. A surgeon may get away with doing the wrong operation well, and may get away with doing the right operation poorly, but they never get away with doing the wrong operation badly. A little vignette from the distant past I remember is, someone asked the professor why he did that clearly non-indicated operation. He said it was a mistake, "They came to see me once too often !"