Another Challenge To The Covenant

It has been a while since I’ve written here. I’ve been on vacation, traveling and writing and relaxing, and something else happened to me that made a recent article in the New York Times Read Article Here particularly interesting to me.

I was jogging on a treadmill, something I do about every two weeks because I enjoy running, even if what I do now is only a vague facsimile of running.  Four years ago, I underwent knee surgery for a torn meniscus, and my surgeon advised me to use an elliptical trainer, walk, or ride a bike unless I wanted to aggravate the knee arthritis that he had seen inside my knee. Anyway, during the jog I felt an unusual pain that forced me to stop and walk, and when it persisted, ended my workout early.  By the time I got home, my knee was very swollen with pain identical to my previous injury. This was the other knee, giving me an unwanted matched set.

My surgery four years ago followed three months of physical therapy and other conservative measures, none of which had improved my pain or ability to exercise one bit.  Ultimately, what was found was a large flap-like tear that had folded over on itself, making healing without manipulation impossible. For one day, I felt concerned that I was headed for my second knee surgery.

And then I read the article in the Times. The evidence strongly suggests that a torn meniscus will respond to conservative therapy alone in nearly all cases. So, I embarked on rest, ice, compression, and elevation followed by physical therapy exercises taught to me last time. And now, nearly four weeks later, my knee is much improved, though not completely well.

What should we take from this article? My own experience can provide some guidance. Even in the same person, the injury can behave differently, based upon how severe the tear is, where exactly it is located, and other factors. But, we all should expect that physicians will act based on the evidence, and make recommendations that lean in the direction of conservative therapy unless there is a compelling case for taking the risks associated with surgery. This is the physician’s obligation, to fulfill the covenant with society that conveys respect, financial well-being, and license to invade privacy in return for the assurance that the physician will always act in the patient’s best interest, which includes applying best available evidence to treatment decisions.