I arrived at the first podiatrist to examine my injury. She was referred to me by the MD I first saw at the urgent care center two days before when I had the accident. The first MD took x-rays and said because of the diagonal fracture, I should have a podiatrist examine it. Lucky for me, the referred podiatrist was on my insurance plan.
"Who was the podiatrist?" Asks Mr. Skeptical.
My eyes narrow in on him. "I don't want to say yet."
Mr. Skeptical shrugs his shoulders.
Subconscious Fat at 30,000 feet
The podiatrist said she’d take her own X-rays to see if the fracture aligned correctly. She claimed that most fractures that go across the pinky-toe bone heal normally on their own. But since my fracture is diagonal, it may not.
She went on to say that she would try to manipulate it back into place. I'm sure I made a face, and she added, "Don't worry. You won't feel a thing. I'll give you a shot of anesthesia."
I grimaced, remembering my shot two days earlier when I went to the urgent care center. It made me yell out in pain.
Mr. Skeptical remarks, "Awww did you cry?"
I give Mr. Skeptical my typical disgusted look.
The podiatrist continued, "I'm only trying to save you from surgery. You want to avoid surgery, right?"
"Yes, I do. And I think you'll adjust it right back into place."
The podiatrist left and returned later with a big needle in her hand, which, unfortunately, I saw. I started to breathe in and out slowly and deeply, bracing for the shot. It hurt, but a little less this time. Then, after waiting a while to ensure the anesthesia sunk in, the doctor came in to manipulate the pinky finger into place.
I said, "I don't need to look, right?"
"Nope. No need to see it." She grabbed my pinky toe and started manipulating it. I didn't look at my foot, but I saw the doctor's face distorting as she wrestled with my most distant bodily appendage. However, the Novocain worked, for I didn't feel a thing. Yet, feeling someone distorting my pinky toe felt unnerving.
The doctor said, "Let's get more X-rays."
I stood up to get on the X-ray machine designed for the foot. I noticed my left pinky area was much more swollen. She shot two X-rays, then looked at the screen and said, "Nope."
The comment wasn't hopeful.
She then walked over to me, and while my foot was on the X-ray platform, she manipulated it again. This time, I saw it. She took one more X-ray. She looked at the x-ray monitor again and said, "Nope, it's not happening." She told her assistant to place my foot differently, and took two more X-rays, for a I total of 5 X-rays.
The podiatrist looks at the x-rays again. "Yeah, it's not aligning. You're going to need surgery."
My foot is still on the x-ray platform when it starts to bleed again. Blood spills. It's throbbing. I begin to feel nauseous. Her assistant helps me sit in a chair.
"Clean the blood."
Feeling like passing out, I said, "Let me lay down."
The podiatrist sternly said, "Just sit in the chair till you feel better. We don't want you on the floor. Get some alcohol wipes for him to smell."
After some time and smelling the alcohol wipes, I started to feel better.
"You're such a wuss." Says Mr. Skeptical.
I shrug my shoulders. "It's not something to be brag about, for sure."
Later, my dad came to pick me up. He was surprised that the doctor recommended surgery. Since it was the pinky toe, he assumed it'd heal on its own. But the podiatrist showed with her hands how they appear displaced on the x-ray, like a sliced-in-half avocado.
I asked, "What if I just leave it alone?"
The doctor shrugged her shoulders and splayed her hands. "Then it may not heal. The surgery is a simple procedure. We put a little pin in there to ensure the bone aligns properly. You don't even get full anesthesia. You'll be knocked out but breathing on your own."
My father asked, "Are you the doctor who does the surgery?"
"Yes, we perform it here in the office."
On the drive home, I told my father I'd likely have the surgery. He casually said how she stands to earn a lot more money doing surgery than an office visit. He thought I should get a second opinion, and I agreed.
It also felt weird that the other doctor at the emergency care place mentioned this podiatrist. I knew from my past as a chiropractor that when you get referred to another specialist, it's usually not because they're better than anyone else; it's simply someone they met. And if a doctor is out there meeting a lot of other doctors, creating a larger network to get referrals…
Mr. Skeptical comments, "It seems capitalistic. A doctor is supposed to be above that. They are supposed to live by the Hippocratic oath: first, do no harm."
"As a chiropractor, I'd network with other doctors to get referrals, but this is more serious. It's a surgical procedure, and I'll have a metallic pin in me. It goes with what I've always said: " Love and money make the world go round."
I went home and researched the need for pinky-toe surgery. It appears that, mostly, surgery isn’t needed.
Subconscious Fat at 10,000 feet
A chiropractor friend referred me to a podiatrist he knew. I was placed in a room with a chair that brought my foot up so the doctor could easily view it. He came in and asked the usual questions. I told him I just wanted a second opinion.
But then he asked, "Who was the podiatrist you saw?"
I tilted my head and looked the doctor straight in the eye. "I was a chiropractor for twenty-two years. You know how it is. You become friends with others in your profession. I just want an unbiased opinion."
The doctor looked at me and smirked. "Yeah, okay."
He looked at all the X-rays and said he didn't think surgery was necessary. He also told me to get rid of the crutches.
Subconscious Fat at Eye-Level
Mr. Skeptical jumps in. "You must've been pissed?"
"Well, I had already booked an appointment to see another podiatrist the next day, so I decided to get a third opinion."
"What did that doctor say?"
"The doctor there wanted new x-rays before even seeing me. However, I told the medical assistant no. I already had enough of them. The medical assistant gave in, and I got to see the podiatrist. She didn't ask who had recommended surgery. But she still wanted me to get X-rays. I insisted that she was my third opinion and that the second podiatrist didn't insist on x-rays. After looking at the previous x-rays taken, she also agreed surgery wasn't necessary."
"So, two out of three didn't think surgery was needed?"
"Yep. The third podiatrist was very nice yet insisted, "It be a good idea to get new x-rays."
She assumed I'd just agree to it, but I didn't. I felt the X-rays were unnecessary. It was lunchtime, and she added, "Well, the x-ray team is out to lunch."
I was happy about that and left.
Practical Suggestions and Conclusions
"So, who was the first podiatrist who recommended surgery?" Asks Mr. Skeptical.
I sigh and decide. "I don't want to say. No need to put bad karma out into the universe."
"But you told me and all the readers earlier that you'd tell us."
"I know, but I changed my mind. The main point is using common sense to control your healthcare."
Mr. Skeptical gets animated, getting up and putting his hands in the air. "The public should know that there's a podiatrist out there promoting unnecessary surgery."
"The truth is maybe the first podiatrist genuinely gave her honest opinion."
"You believe that? After she’s incentivized to make a lot of money on a surgical procedure."
“I believe it's unlikely, but it's still possible. Besides, my foot is still healing. I get my stitches taken out in a few days, so we shall see how this all ends soon.”
The main suggestion is this: always get a second opinion in health care, especially if it involves a surgical procedure.
Be assertive, and don't give in. When getting a second opinion, be sure it's unbiased. Don't let the doctor know who gave the first opinion. Don't let yourself be X-rayed more than you believe you need. Use common sense.
Be aware.
Fantastic stuff, Hermann! So damn informative, too.
Thanks Travis!