Treating the patient, not the X-Ray

A dignified man, mentally sharp with clear blue eyes, sat before me. Next to him, his wife of 51 years, and next to her, their three children. His voice – surprisingly soft, and muted – offered the probability that he was nervous. Yet his attention was unwavering. He appeared to be waiting for me to speak. Mr. Meyers (not his real name) was in my office for a fourth opinion regarding his ailing, aching legs – or so his intake paperwork said. The first portion of the paperwork was filled out in a quivering manner, often illegible. The latter part was neat, perfectly written, and precisely poised on the lines provided. Clearly, someone had felt he needed some assistance. His medication list was a mile long.

The X-rays on the computer were awful. Those knees and hips had seen far better days. They hurled him forward as a college ball player, and helped him retreat from trouble during the times he served to protect our nation. Still, you cannot predict who will or won’t have surgery – or who should or shouldn’t have in based on an X-ray alone. “Treat the patient, not the X-ray,” I said, turning to the resident in the room. It wasn’t the first time I’d said this. The resident had heard my “personality of an injury” talk many times before.

Mr. Meyers struggled to get to the examining room table, but he seemed more unstable then uncomfortable. His family reached to assist him; he brushed them away. The exam was brief. But telling.

“How can I help you, Mr. Meyers? What brought you here today?”

He seemed taken aback. He wasn’t sure what to say. He glanced at his wife and his children in the cramped, now humid room.

“Mr. Meyers, there are times when patients come in to my office with a very clear understanding of what they wish to accomplish on that day. And there are other times when they are looking for me to help them reach a conclusion. I sense that you have something to ask.”

“Doc, I’ve lived a long and wonderful life. I’m not well, and I’m not long for this earth. I want to be able to get around without being a trouble or burden to my family. I’m not in terrible pain, and I’m not willing to have the surgery everyone wants me to have.”

Mr Meyers’s issue was not unique. As a matter of fact it is all too common. He’s from a generation that often defers to the physician for advice and often follows that advice, perhaps against personal judgements or desires.

“Sir, you do not need surgery – you might not even survive it,” I began. “Mr. Meyers, we are going to work with a hospice agency and a physical therapist to get you the assistance you desire.”

His eyes, if that were possible, became sharper. I believe he even had a little more determination as he reached out for his wife’s hand, gathered his children, and left the office.

And I was once again reminded of how deeply a patient’s own expectations and desires matter.