The view from the other side of the doctor’s desk.

Something happened a few weeks back. I had somewhat of a whoopsie. You see I had been ignoring the pain in my back for about three weeks. Even after the altered sensation in the left calf and foot kicked in, I figured that with some tried and tested physiotherapy and McKenzie exercises all would come good in 6 weeks or so after the pesky disc had learned to behave itself. Well, maybe not. After successfully removing a small phone charger from a socket at Townsville Airport something went horribly awry and two days, and two less than comfortable flights, later I ended up flat on my back.

This meant a few things. Firstly, I realised that my own company sucks as I am nowhere near as entertaining as I thought I was, and secondly; I had to see a doctor. Or two.

Whilst I could probably have utilised a network of colleagues to sort it out, I though it might be time to get a GP. As I preach the advantages of such a thing to the patients I see, I thought I might as well do the same. So off I trotted to the local clinic, the only one that happened to be open on a Sunday.

My new GP was kind and spoke softly. He asked me what I was taking for the pain and I told him that I had run out of Panadeine forte and NSAIDs and would like to discuss a regime for treating what was no doubt a combination of disc pain and neuropathic pain. He looked at me strangely (though he did know I was a doctor according to my brand new and shiny medical record), and asked me what I would like for the pain. I’m not a fan of self prescribing, so I asked him to make suggestions. He did make suggestions and then kindly called that magical service to check if I was recorded as a ‘drug seeker’. 

At the time I was a little taken aback by this, and borderline offended. However, on reflection I now admire that my GP did this. Its not easy to make difficult decisions when there is someone in front of you asking for help. And there is a significant problem in our society regarding the use and misuse of opioid based analgesics. And just because someone is a doctor doesn’t make them exempt from potential misuse. So well played, sir! Anyway, script in hand, off I trot - well stagger like an old man actually.

Then to the dreaded MRI. I had avoided this for the previous three weeks as I ‘knew’ what it would show. Like nearly 70% of men my age, there would be some disc bulges, and one of them would be misbehaving and I would just have to suck it up until the physio etc did its job. I didn’t want to know if it was worse than that as pure vanity prevents me from believing that I am no longer 25 years old. In my mind, I’m still ready to jump the fence and fill in as Centre Half Forward for the Melbourne football club at a minute’s notice. Also, but to a lesser extent, if I didn’t get an MRI my GP would not prescribe me any more medication, so off I went. Long story short, the MRI result required me to go to see another doctor, one with a scalpel.

Fortunately, I deal with many of these in my day to day work so I knew who I would like to see, and they had a spot available. I thought that I could take an alternate approach this time and state my case a tad more proactively - “I reckon a nerve block will do the trick and then I can fly to Cairns tomorrow, and from their to Darwin and back home again as I have a lot of people to see and if that doesn’t work we can discuss other options.” Again, my doctor smiled at me whilst looking at the MRI and, speaking softly, knowingly said ‘Sure, give that a go, and if it doesn’t work we can always talk about surgery as I don’t think this one is going to settle.” Sweet, a win for Dr Sid and all other ignorami out there!

The nerve block was great. I hobbled less and was even able to sit for more than 2-3 minutes for the first time in a week. Look out Cairns, here I come. Or not. Two days later I’m joking with an anaesthetist and wearing paper underwear and a gown whilst awaiting my microdiscectomy.

The rest isnt that interesting. Great surgery (thank you Dr Paul Licina), out of hospital three hours post op, walking around normally the next day and able to be back at work three days later, including interstate travel. Modern medicine - you rock!

What did I learn from this little adventure? Quite a lot really. Being a patient is not fun. Pain that stops you doing simple things like riding your bike, or seeing patients without having to get up and stand every couple of minutes, or sitting down, or walking, is bloody frustrating. And sometimes its easy to forget that when it has been a while since you’ve experienced it, or if you never have. Doctor lingo is great when talking to doctors, but can often fly over the heads of others, including patients. I discovered this when trying to explain to my family what was going on. I resorted to drawing pictures and will do this for patients now. Or use an App. There’s surely an App for that.

Making hard decisions regarding a patient’s health (in this case, pain management), is challenging for both the doctor and the patient. Communicating the reasons for making the decisions and undertaking the actions that you must do is vital to reduce the likelihood of creating a barrier between the healthcare provider and the patient. Actually communication is the key to all aspects of healthcare, and it is the main differentiator between an excellent and a poor practitioner.

I learned how important it is to keep an injured person’s mind active. I was going bonkers when I couldn’t sit to type or lie in a position that allowed me to read my notes and dictate. And daytime television is atrocious (BTW - 'Dr Oz’ and ‘The Doctors’ does not constitute health education any more than looking stuff up on Wikipedia does).

I learned that assumptions and ingorance are, well, stupid. Assumptions about what the pathology is. Ingoring the clinical signs. Assuming what the MRI would show based on the clinical picture, after ignoring the clinical signs, so avoiding it for 3 weeks. When asked what I would have done if a patient presented in front of me with identical symptoms, my answer was completely different to what I had done to/for myself. 

I learned the benefit of having something to aim for post op, it is a vital factor in recovery. For me it was getting back to work to put food on the table and do the things that I love doing. Different people have different priorities and its important to identify these and mold them into achievable steps to facilitate a return to normal living.

I learned about professionalism in a way that can only be done by observing how a colleague goes about their job. Occupational Physicians generally do not have the benefits available to them of the collegiate atmosphere that a hospital or group practice can facilitate, as we tend to work in relative isolation. This can also be true for others in the Occ Med sphere; health and safety reps, return to work co-ordinators, and site based nurses, physios and medics. Any opportunity that you have to discuss cases that went well or poorly, or where there was difficulty getting your point across to the injured worker, you should take it. And if there aren’t any opportunities, create them.

Now I have to go a wrestle my shiny new swiss ball back from the children and do my exercises, just in case my physio reads this.