Saturday, November 26, 2005

Head, Shoulders, Knees and Toes

After my last frisbee outing (the clique league tournament) my knee was really sore. It was stiff and falling in many of its knee-ly duties, most importantly the part about allowing my lower leg to move without pain and in a stable fashion. In what I can only hope becomes a trend, I decided rather than whine and wait I would see a doctor and get it looked at.

As a true liberal (old use of the world) I tend to believe that education and training improve a person. These things make a person more capable of understanding their world, and improve their ability to function within their chosen field. When politicians run for office as an "outsider" and decry the damage that Washington experience does to ones judgement or capacity to govern, I often recall a little witicism (I like to believe it's witty, though maybe I'm a bit self-congratulatory, here) I came up with in a class back at Oberlin: "When I need brain surgery, I'd prefer a doctor not a dockworker." I think that specializing and training make you better at something. I don't expect my doctor to know how to use a fork lift, or how to move freight. That's not their job, that's not the skill set they've chosen to enhance through training and education and prolonged experience.

Yeah, well sadly, I think my doctor may be trying to practice medicine like our president practices politics, as a purposefully ignorant outsider. Upon arriving at the office on Monday I was promptly greeted by the first of two exceedingly helpful nurses. The nurses asked me about my knee and about the other cause for which I was visiting. They seemed able to judge the importance of various words I used, and were able, as best I could tell to faithfully relay information gleaned through listening into their short term memories, supplementing their recollection of my injuries by carefully writing down what I had said. This seemed neither novel, nor like it would be the most demonstrable sign of competence I was to witness this visit. Sadly, it was. After weighing and measuring me (I am now, officially, by independent standards exactly 6 feet tall. No more guessing. That's it, that's all. I am also 158 lbs, meaning I've lost about 14 lbs since I lived in Seattle.) I had my blood pressure checked. I'm pleased to report that my blood courses through my veins at a healthy 120/80.

After all the basic steps, I was ready to see the doctor, and shortly thereafter he was ready to see me. Dr. Theobalds is a rounded man. He seems to have had some of his features worn my time, and travail. He gives off an appearance of kind wisdom, which is why the incompetence he so ably embodies is something of a shock. He promptly asked me about the non-knee condition. We talked for a bit and without really talking about changes in health, age, weight, work, or anyother factors normally related--he represcribed medication for me that I haven't really taken since I was 21. So that was the first sign that there might be some bad doctoring going on. He then proceeded to prescribe a dosage of a medication that, upon visiting a pharmacist later, I came to find does not exist.

After dispensing with the non-knee concern, we turned our attention to my knee. Actually, that's a lie. I turned my attention to my knee, rolling up my pant leg and indicating the knee with such terms as, "this is the knee that hurts, my right knee." The doctor, for his part, turned his attention to my foot. "Let's have a look at that foot." To which I helpfully responded, "actually it's my knee."

Doctor: "Oh, right." [pause] "So how long has your foot hurt."

Nurse: "Doctor, it's his knee."

Doctor: "Foot?"

Me: "Knee."

It felt a little like the Simpsons where Marge tries to order something besides beer in Australia. Or quite like the King from Monty Python and the Holy Grail who is constitutionally unable to count to 3. I'd prefer that my medical professional's behavior not call to mind such images.

I figure that medicine is hard. I have friends in med school and some who have just graduated. They're bright people, able to memorize many obscure things, competent in what I believe to be a challenging field. I never once figured that in order to be more capable than my doctor all I would need to have done is memorize the children's song "Head, Shoulders, Knees and Toes." Because, I can safely say that having learned that song, I, unlike my doctor know what and more importantly where a knee is.

After convincing the doctor that my knee was injured, I hoped his years of training might equip him to offer insight as to why it hurt. Alas, twas not to be. He put his hand in the knee and moved my leg towards him once. Then back. Then he pulled my lower leg slightly to the left and then to the right. That's it. When I was injured at Regionals, Shana (an Oberlin alum) playing on the team we faced came over and conducted, a considerably more thorough exam with me laying on the ground.

Dr. Theobalds then said, what I later had retranslated into English, that I needed to get an x-ray to determine if I had degenerative arthritis and then when that was negative (as it will almost undoubtedly be) that I should get an MRI. No other questions, no other advice. Nothing. I have conducted more thorough examinations of fishing rods, and cantaloupes. I realize that an MRI is necessary to properly diagnose a knee injury, but that he could offer no possible insight beyond that, is surprising.

There is something wholly unsatisfying about going to a professional and knowing in your heart that the only service you received was that a person whom others have certified as compentent looked at you. Nothing he did in my presence required him to know anything about medicine. He didn't do anything except give me, no questions asked, medication in the dosage I requested (though he did change my request for 2 20mginto one non-existant 40mg), and send me to someone else to look at my knee. To make it worse the only thing he actively did, he did wrong. After receiving a faulty prescription I returned later in the week to get the prescription re-written, but this time for a drug that actually exists, I asked for him to prescribe a dosage that would permit me to get a generic. He protested saying that the generic has less of the active ingredient, and "you know you get what you pay for." The only definitive statement I've heard him make, is factually incorrect.

I still believe that experience and education matter, but just to be certain I'm calling Blue Cross and seeing if there are any dockworkers in my network.

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