Doctor Doom

George Washington's doctors couldn't save him - they might even have killed him

On Dec. 14, 1799, doctors attending to George Washington bled the first president of the United States five different times, extracting, depending on which account you believe, 1.7 to 3.75 liters of blood in a failed attempt to cure him from a severe throat infection.

The invasive practice of bloodletting, which had been carried out by healers for more than 2,000 years, was disparaged by Dr. James Brickell, who criticized the practice six weeks after Washington’s death.

“Very few of the most robust young men in the world could survive such a loss of blood; but the body of an aged person must be so exhausted, and all his power so weakened by it as to make his death speedy and inevitable,” Brickell wrote.

More than 200 years later, medical science has progressed to a point where such a “cure” would be considered truly cringe-worthy by most physicians and patients alike, particularly when held up against the medical triumphs of the polio vaccine or the discovery of penicillin.

Yet every day in the U.S. and in developed countries around the world, at hospitals and high-tech outpatient surgery centers, hundreds of similarly invasive – and often, unfortunately, similarly unsuccessful – procedures are carried out on willing patients hoping to get relief from back, knee, or shoulder pain.

Surgeons slice through muscles and nerves, cleat together bones with metal, replace aging joints with mechanical ones and reattach ligaments to bone.

Sometimes the results are spectacularly good – aging weekend warriors who spent their cartilage have a new lease on life, skiing again for the first time in years or even running marathons after stints of serious debility.

But sometimes they’re just as spectacularly bad, causing more pain, paralysis, infection or even death and often leading patients to undergo numerous other surgeries in attempts to rid themselves of pain. Doctors even have a name for this downward spiral, it’s called Failed _____Surgery Syndrome (fill in the blank with back, knee – you get the picture.)

What most patients don’t know is that many orthopedic surgeries are proposed and conducted despite the fact that their efficacy, or their capacity to produce a beneficial change in the patient’s condition, is relatively unproven against alternative, more conservative treatments. That’s because designing a randomized clinical trial (the gold standard of medical research) comparing surgery to alternatives requires that surgeons conduct “fake” surgeries – procedures that many would consider an ethical breach of the oath to not harm patients unecessarily.

When it comes to back surgery, this cut-first mentality is harming patients. According to this 2004 study, which looks at 18,325 patients with back pain, “previous back surgery is associated with significantly worse general health status than those without surgery.”

Studies like these and others that emphasize psychological factors as an important element in many kinds of chronic pain, make it clear to me that surgeons often don’t know if their invasive treatment is going to relieve their patients’ pain. Worse yet, they’re absolutely playing with fire when they start cutting into healthy tissue. Consider this report, in which nine percent of more than 8,000 surgeons surveyed reported they had made a “major medical error” in the last three months.

I believe more research is sorely needed into how emotional and psychological factors can impact or even cause chronic pain. After all, if counseling, group therapy or other non-invasive treatments like exercise or biofeedback can help, we’re risking a hell of a lot less than the patient who agrees to get cut on under anesthesia.

This report, presented at a major conference called Orthopedics Today Hawaii 2010, signals that some doctors are moving in the right direction. Dr. John Bergfeld, of the The Complex Patellofemoral Pain Clinic in Cleveland, spoke of 150 patients treated at the clinic – all of which had previous failed surgical treatment to correct either instability or pain in the knee (patients, 87 percent of which were women, had an average of 3 unsuccessful surgeries and one had 32 procedures on her knee.)

Bergfeld reported that 42 percent of those 150 patients were victims of childhood abuse – 23 percent of that was physical, verbal or neglect and 19 percent was sexual. Therefore, he added, “malalignment does not mean pain, and realignment [read surgery] does not guarantee the relief of pain.”

He went on to urge those doctors attending the conference to listen to their patients – not to presuppose that surgery was the cure for their problems.

“Listen to what they are telling you,” Bergfeld said. “Do a physical exam without bias; do not have your mind made up about what you are going to do before you even start.”

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