Orthopaedics: good cop, bad cop

This morning I sat in on a spine clinic, fully expecting a succession of elderly folk with slipped discs, and therefore to be bored at least to the perimeters of my mind.

I was quite, quite wrong. The first patient I saw was a man in his late 40s - not old by any means - who'd had the shite beaten out of him repeatedly while institutionalised as a kid, and had then joined the navy for several years of heavy lifting, twisting, and lots of other back-wrecking seafaring activities. Despite having been in constant pain of varying severity since he was 17, he was extremely pleasant to talk to, and willing enough to suffer an examination from me to establish just how little movement he had in his back.

Then the consultant (Mr K., a surgeon) came through to talk to him, and immediately wanted to know why he hadn't had a follow-up after an MRI scan of his back...in 2004. Mr C (as we will call him) seemed bemused:
Mr C. "Because no one sent me an appointment."
Dr K. [shaking his head] "The way it works is that you have a follow-up appointment to discuss the scan."
Mr C. "They didn't send me one."
Dr K. "Hm. Well - you should really have taken responsibility for that - you should have called the department and said, I've had this scan and I need an appointment."
Mr C. "I didn't realise I should..."
Dr K. "You just needed to get on the phone."

It then emerged that in addition to failing to send him an appointment, no one had injected him with gadolinium, which you need to make the image clearer, and the doctor couldn't access the scans anyway thanks to the abominable computer system the DoH in its infinite wisdom has forced us all to use. In this context, it's perhaps unsurprising that they added insult to injury by suggesting it was all his fault...

After a brief diversion during which the surgeon talked about surgery with such evident relish that he almost put the patient off having a second (very expensive) MRI, Mr C. expressed an interest in his outlook:
Mr C. "Really I want to know what my prognosis is so I can plan my life."
Dr K. [cheerily] "Well - you're not a winning horse."

Images of the consultant taking him outside, shooting him, and sending him to a glue factory flashed through my mind.

I should say that the doctor was evidently a phenomenally good surgeon. He told me glumly that "I get all the revisions these days", 'revision' being a polite medical way of saying 'surgery which didn't work first time'. He had one guy in his mid 30s come in who practically kissed him, having had a disc fusion 6 weeks earlier and was evidently absolutely transformed by the results.

The patients who hadn't seen Dr. K first time through tended to have a rougher time of it. There was one 18-year old kid who'd been a champion martial artist and had had back surgery at an (aptly named) Kent hospital under Mr. M; at follow-up, he and his parents had been told that his ongoing pain on any sort of exercise was unavoidable and there was nothing more to be done. Mr. M had then repeatedly refused to see them, instead sending his registrar in to do the dirty work; the poor reg had eventually apologetically suggested they get a second opinion, which they'd done privately. The private doctor had taken one look at the X-ray and noticed that one of the screws wasn't even in the bone, and referred the guy on to Dr. K "to get things sorted".

Dr. K was relatively reserved in his criticism, but it became clear that the original operation was probably the wrong one to have done, hadn't been done properly, and hadn't been followed up at all well. I should say the boy had been consented for a clinical trial on the morning of his operation while on the anaesthetic table - which is just totally unacceptable practice. Anyway - while I reckon Dr. K can probably sort him out, he's essentially lost a year out his life, has had to drop out of school, and needs a day's rest after doing a day's work.

I'm not in favour of suing the NHS - it's too often provoked by fucking ambulance-chasers because some thick clutz has fallen over - but in cases like this, hitting the trust in the pocket is about the only way to get the suits to curtail the sociopathic tendencies of folk like Mr. M.

The moral of the story? Think twice before having back surgery. Then think another dozen or so times, and go to a regional centre to have it...