I always get what I want, so when I wished I could be more like TR Reid (best-selling author, probably rich, bum right shoulder) I got what I asked for and now have a bum right shoulder. And it’s not just bum, but probably permanently bum unless I go see a surgeon and get it cut open and fixed. This really ticks me off, because having an important joint that starts causing me problems out of the blue, will not heal on its own and may permanently limit my ability to do everything I want sounds a lot like getting old, which I’m not.
Eternal optimist that I am, I thought I would give being like TR Reid another shot by stealing his idea of looking at American health care from the perspective of a gimpy shoulder and add a twist of my own by using the same lens to look at our health care as we age. This will require me to talk about my health problems, which also sounds like what people do when they get old, but again, I’m not.
Just about everyone who comes to me with a dysfunctional joint wants an MRI scan to identify the problem. Me too, because I know it would tell me what’s screwing up my pitching arm. But I have to ask myself the first question I ask patients with a bunged up body part before they get a test to identify a problem: Does the problem we might find need to be fixed? Not everything wrong with us needs to be fixed, and fixing things comes at prices — pain, risk of complication and money out of our pockets — that may not be worth it.
That’s especially true if it’s a problem produced by our aging, because aging is going to bring us a slew of problems and we cannot fix them all. Fixing things also comes at a social cost: The more we spend on ourselves fixing things that we could put up with, the more our health care and health insurance costs and the less money there is to fix bigger problems in someone else.
As I think about my shoulder I need to take into account that it’s just flat out irresponsible for anyone — even a physician with good insurance who could see the World’s Greatest Shoulder Surgeon anywhere in America — to spend money on their health care without really thinking through whether that’s money well spent.
Which takes me back to my right shoulder, and whether it should be fixed. So here’s what I have asked myself in order to answer that question:
1. Is it hurting all the time and thereby making life miserable for me? No — it doesn’t hurt most of the time and rarely interferes with my sleep or requires me to take pain medication. In fact, I would not know I have a problem except that it hurts like hell when I try to do certain things, so much that I can’t do those things any more.
2. Are the things I can’t do anymore really important to me? Well, if I wore a bra I could not unhook it, but I don’t, so that’s not a problem. But my right arm is my best power tool and I now can’t do much overhead work with it, a real problem for a guy who likes to renovate his house. I also cannot throw snowballs at my nephews and footballs to my daughters, which really pisses me off because I have — make that had — a great right arm.
But I can still do woodworking and play golf without any pain, lift a camera to my eye and walk hand in hand with my sweetie. And I have figured out that graceful aging is partly the process of giving some things up without spending a lot of time whining about the loss.
So no MRI for me, because no matter what it shows, at this point I’m not doing anything about it. TR Reid would be proud of me.
Sounds like your rotator cuff. I had surgery on mine and it is still giving me problems. The pain after surgery was horrible and I swore I wound not go through this again so I will just live with it. Sorry for your pain.
I love Dr. Steele’s articles, plus this one is livened up with “hell, bra and pissy.” Oh my…..I completely agree with the over-testing theory. I have amazing insurance and I refuse everything unless something is REALLY bothering me. But then there are people who sit in the ER with MaineCare for hours over the weekend with a runny nose. Only reason I know that is because I had to go there recently with my dad, for his chest pain; it couldn’t wait. I avoid the ER at ALL costs (using common sense obviously), plus my job doesn’t allow the waiting time. Keep up the good articles, Dr. Steele. Good job “manning up.” Rotator cuff repair doesn’t work for everyone.
Dr. Steele, thanks for another very insightful posting. No doubt, you are familiar with the benefits of osteopathic manipulative treatment in addition to its very cost effective approach. I often see patients in my own practice with very smart complaints and, within the context of “conservative” treatment, often find that we can attain and/or regain a great deal of range of motion in addition to lessening the overall discomfort. I would certainly agree with you that more times than not, imaging of such conditions is rarely indicated and only warranted after a more pragmatic treatment approach. Despite its long history, osteopathic medicine is still an unknown entity for much of the population. I would direct your readers to the American Osteopathic Association’s website for further information and, of course, would certainly be willing to see if we can get your shoulder at a place where you might get a call from the Red Sox Scouting team.
If it’s the rotator cuff, Physical Therapy could be very helpful. I get “swimmer’s shoulder” now and then and have to go through a couse of PT before I can resume swimming. Lots of very specific stretches and exercises to do at home, on top of what the therapist does in the office.