By Dr. Jim Ferguson
Good storytelling is a practiced art, like writing. My wife’s cousin, Sam, is an accomplished spinner of yarns, and I am a better writer now after penning a half million words.
As I work on the second novel in my planned science fiction trilogy, I realized that I gravitate to plot development more than elaborate character descriptions as in a Charles Dickens’ novel. Perhaps if I had received formal education in writing techniques I would have discovered this proclivity long ago. However, I offer no excuses for being self taught. I believe one learns to write by writing just as I believe you learn other things by doing.
There is a saying in medicine, “Watch one, do one, then teach one.” Some might find this disturbing, but this means you must observe the removal of an inflamed appendix before doing an appendectomy yourself (with supervision). And only then will you become skilled enough to mentor others. Actually, this wisdom applies in most activities and professions. My wife Becky doesn’t have a culinary degree, but is a great cook through practice. And I would not want an apprentice electrician wiring my house or a novice plumber connecting my pipes.
Choosing a doctor or a surgeon can be tough and should be based on more than just availability, convenience or whether a doctor participates in your health plan. For simple things, perhaps a non physician at a walk-in clinic may be fine. But how do you know your misery is simple or the “provider” is competent?
Actually, I chafe at the word provider, a term promoted by insurance companies and used by the government. To lump all doctors, nurse practitioners and physician assistants together and proffer them as equal providers of healthcare is ludicrous. I once asked an attorney friend of mine if he would allow his paralegal to try a case in court. He looked at me as if I were nuts. And yet, in the new order of American medicine, “providers” render medical care.
Recently, I had need of surgical consultation. I have a long-term relationship with my doctor and therefore trusted his judgment. Nonetheless, I challenged him to choose a surgeon who had considerable experience with the procedure I needed. And being in the business myself, I had more than a layman’s knowledge of the surgeon’s reputation and expertise.
During my consultation, I was comforted to learn that my surgeon performs the procedure regularly and has data to support his good surgical outcomes. Furthermore, his bedside manner was excellent and his appearance and explanations attested to his professionalism. I did not need the five-star rating system from the Internet, where kudos are mixed with the disgruntled, and everything in between. But again, I’m in the business. So, what does a layman do?
I recommend choosing your primary care physician before an urgent issue or an emergency arises. And if the chemistry is not there, respect your instincts and choose another doctor to serve as your counselor and advocate. And if you need to see another type of practitioner, challenge your doctor to pick someone with experience and a good reputation among his/her colleagues.
In the case of surgeons you can also ask how many operations they have done and their surgical success rate with a given procedure. Again, you should trust your judgment and seek further consultation if you feel uncomfortable. And take a friend or spouse with you to the consultation. I believe two sets of ears are especially helpful in stressful situations. Lastly, take some assurance in knowing that surgery is still done by comparatively trained MDs and DOs rather than “physician extenders.”
Lumps and bumps in life are common and sometimes just a consequence of getting older. Remember, most breast lumps are not cancer, but should always be investigated by a doctor’s examination, mammography, ultrasound, needle biopsy or surgical removal.
Similarly, thyroid nodules are common, and thyroid cancer is far less common. A prior history of head and neck radiation is a risk factor for thyroid cancer, but is not an issue for most people. The chief of my internal medicine residency thought that infection was the cause of most illness. After more than 40 years of reflection, I think viruses and other infectious agents may influence disease, but I believe genetics influence everything including our responses to infectious agents. Even casual exposure to radiation in the nuclear industry is influenced by genetic predispositions. And there are rare heritable forms of thyroid cancer.
One of the more common causes of lumps and bumps are lipomas or fatty deposits. These isolated lumps are different than the bulge which accumulates around your belt line in middle age! My elderly dog had a big one on his neck which we managed by removing his collar. Lipomas are soft and doughy, whereas cancerous tumors are hard like a rock. I’m not an advocate of self diagnosis, so if a new lump appears, have it evaluated by your doctor.
Another common complaint is the bodily changes which occur in people on high doses of prednisone for a long time. Steroids are potent anti-inflammatory and immunosuppressive agents used in a variety of diseases. Your own body produces a form of corticosteroid which is necessary to maintain blood pressure and other vital functions. When large doses are used to suppress the immune system, steroids cause a redistribution of fat from your arms and legs to the trunk of your body. Women, especially, complain of these bodily changes and find little comfort in my assurance that the changes will eventually reverse when the steroids are stopped.
Swollen lymph nodes can also produce bumps along the lymph drainage system. You can imagine the lymph system, placed alongside arteries and veins and part of the immune system, functioning as a gutter system for extruded fluids. Lymph nodes are small nodular areas like train stations on a rail line. These nodes are strategically placed, for instance, in the groin or armpit. Infectious agents and inflammatory or malignant cells are collected within the lymph drainage system and then trapped in the lymph nodes and can cause swelling and sometimes pain. Actually, swollen lymph nodes are serving a purpose by trapping harmful material and protecting the body.
The Psalmist sang, “We are fearfully and wonderfully made.” Yes, we are, but when changes occur, don’t panic. Just seek guidance from a fellow traveler with expertise.