The most common complication in medicine is poor doctor/patient communication. lt’s especially problematic for knee patients because few have had much exposure at all to orthopedics. What do you ask? What do you say? And more fundamental yet: Who should you go to see?
ARE YOU THE RIGHT DOCTOR FOR ME? FIND OUT!
When you decide to see a doctor you may first visit your family practitioner. This approach has some advantages: lt's probably cost effective, you have good access, the doctor knows your medical history, and probably has some important insights into you as a person as well as a patient. However, if your doctor feels the need to inject you with cortisone, immobilize you in a cast or brace, or recommends physical therapy, you may wish to consult an orthopedist. The first two approaches may simply cover up the symptoms, while the last one could actually compound the problem in the absence of a complete and clear diagnosis. In any event, if after a few days you show no distinct signs of improvement, it’s definitely time to get a second opinion.
This is not so much a reflection on your own doctor’s capabilities as it is an indication of the complexities surrounding‘ this medical specialty. Simply put, the doctor who is best at treating life-threatening problems may not be the one to get your bum knee back to work. The examination of an acutely injured knee can be very difficult and misleading, even to an experienced clinician. So you need to find a doctor who has managed to keep up with the changes and whose knowledge is based on experience, not just a review of the
literature.
If you suspect you’re going to need a specialist, instead of asking your doctor for a generic referral, ask a specific question: “Who would you send a member of your family to if they had a knee problem?” Take your doctor’s advice and contact the person suggested. But at the same time tell your doctor that you would like to ask friends and associates for recommendations. Then ask if your doctor would be willing to review the list of suggestions and help you make a choice.
Ask your sources how they found their doctor. Are they satisfied with the treatment they received? What problems have they experienced? And, most important, ask, “How’s your knee?” Have they recovered or simply decided to live with a serious knee deficiency? A lack of pain is one thing, a complete recovery and return to active participation is quite another. Find out what their particular knee problem happened to be, then look it up in these pages. Was it a truly serious injury that would explain their lack of performance, did
they neglect their rehabilitation program, or did their doctor simply go on to other patients, leaving this one to hobble into the ranks of the seriously impaired?
A good health club, a well-designed and -managed aerobics class, friends or associates who are deeply involved in sports, a sports specialty store—any of these sources could provide you with referrals to competent sports medicine experts. But again, check the names with your family doctor. The runner’s store may merely suggest a favorite doc who happens to do a great 10K run or the ski shop may give you the name of a physician who recently ran up a $500 tab on a major shopping spree.
Once you come up with a name or two, the best approach is a face-to-face meeting. You’re entering into a relationship with another human being and a lot can be learned from the rapport that can come only from personal contact.
First, of course, you need to phone the doctor’s office. Before you even make an appointment you might want to ask about office hours and insurance acceptability. You can also quickly ask if the physician is board-certified, the percentage of his or her practice that is knees, and if he or she is a member of any special societies, such as the American Orthopedic Sports Medicine Society or the North American Arthroscopy Association.
While you wait for your meeting you’ll be surrounded by people who can give you inside information. Start a conversation by saying that you’re new and would appreciate any information they might offer regarding this physician or this office, in the case of a group practice. Besides questions about the surgeon, find out if they’ve ever had problems getting an appointment. Ask if they’ve ever called the office after hours. Was there a prompt response? Most people will be flattered that you asked and the ensuing discussion will undoubtedly be more educational than the dog—eared magazines you could be reading. If you have a general reluctance to enter into conversations in doctors’ offices, remember that this is the ideal setting: Bum knees are not considered a communicable disease.
Once inside the hallowed halls of orthopedia, don’t hesitate to ask questions. Here’s a starter list:
Where did you go to medical school?
Where did you do your orthopedic training and was it an accredited program? (The American Board of Orthopedic Surgery evaluates various residency programs to make sure that they fit their criteria of exposure to all aspects of orthopedics, including trauma, reconstructive surgery, pediatric surgery, hand surgery, etc., and in order to become qualified for a certification in orthopedic surgery, the surgeon must be a graduate of an approved program.)
Are you specially trained in sports medicine or have you gone through any fellowship programs?
Approximately how many knee surgeries do you do in a year? If surgery is one of your options: What is your success rate with this particular surgery? (lf the answer is 100 percent, you’ve probably got the wrong surgeon. There is no 100 percent in medicine—no guarantees, no warranties. If you can’t trust a surgeon to answer a simple question honestly, do you really want to put your life in his or her hands?)
If the surgeon is in a group practice: Do your partners cover you in the event of an absence?
If it's a solo practice: Who's on call whwn you're unavaiblable? Again, you want to know the background of these people if they're likely ever to care for you.
you will most likely be charged for an office consultation. However, if you use this approach to find a good doctor or to avoid one you're not gong to be happy with, this will be a good investment of both time and money.
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