The Doctor Game: Sometimes best treatment is no treatment at all

What is one of the major health hazards today? It’s being a patient. Because there are so many pitfalls, and it’s easy to fall into them. Modern medicine has much more to offer today, which makes life better for millions of people. But it can also create problems, unless you know where the traps are and how to avoid them.

I’ve never forgotten an incident that happened years ago. I’d completed a successful surgical procedure and returned to the recovery room to check on my patient. But I noticed several doctors crowded around one bed, which is never a good sign.

A male patient had undergone a gallbladder operation and was experiencing difficult, laboured breathing. His surgeon and anesthetist were concerned. They called an ear-nose and throat specialist for another opinion. He concluded that the patient might die unless an immediate tracheotomy was done.

Just as the patient was being wheeled back to the operating room, his family doctor arrived. He was advised of the situation and bent down and listened to his patient’s breathing. He looked up quickly and said to the specialists, “I’ve known George for 40 years. He always breathes that way.” End of discussion. George will never know how close he came to a needless operation.

I don’t know of any better safe-guard than a family doctor, male or female, especially those who have treated a patient for years. But we all know the family physician is now hard to find in many parts of North America.

So patients also must use good sense. This often means “It may be better to live with the devil you know, than the one you don’t know.” And remember another adage: “If it ain’t broke, don’t fix it.” Joan Rivers, the comedian, made the mistake of having too many cosmetic procedures. She died of cardiac arrest during the final one.

Today, it’s also wise to avoid another trap. If it’s only partially broken, think twice before fixing it. Why? Because people forget that any operation, major or minor, is always associated with risk.

I recently wrote a column about cataract surgery and since that time, several readers have contacted me. The general response was, “I wish I had read your column before agreeing to the procedure.”

These patients, visiting their eye doctor for a regular checkup, were told they had developed a cataract. They were all advised it should be removed and they accepted this advice without question. But one patient developed a retinal detachment and lost part of her vision. Others developed infection following the surgery.

Before the surgery, some patients had been able to read the newspaper and drive a car. Now, they had lost part of their vision in one eye, making these tasks either difficult or impossible.

The moral? It’s prudent to never, never agree to surgery unless your quality of life has been seriously diminished. I’ve seen the same error committed with knee and hip replacements, where surgery is done for minimal discomfort, but with poor post-operative results and little comfort.

Another possible pitfall is the increasing number of ultrasounds for diagnostic purposes. But this test can also have negative affects when it detects abnormalities, such as a stone in the gallbladder. This may have no connection whatever to the patient’s symptoms.

It’s reasonable, of course, to consider removing a gallbladder loaded with small stones. These may escape from the gallbladder, become trapped in the cystic duct, causing severe pain and emergency surgery.

But a single large stone may have been present for years. Since it is too large to leave the gallbladder, it may never cause trouble and usually the best treatment is leaving the stone to the crematorium.