Technology and Pain

In reply to Lloyd Krieger’s article “A Folder Full of X-Rays and Computer Printouts, Not a 20-Year-Old Squirming in Pain” (Op-Ed Page, Feb. 24):

We physicians are criticized for ordering too many tests, and sometimes for ordering too few; for prescribing too many drugs, and for occasionally having the wisdom and stubbornness to prescribe none; for doing too much surgery, and for not resorting to it soon enough. When the diagnosis is correct, it wasn’t made sufficiently quickly; if quickly enough, then not eased by enough analgesia; if painlessly, the side effects of the narcotic should have been anticipated and explained. As each difficult day in the hospital produces new information, patient and family ask why it wasn’t used in yesterday’s decisions.

Krieger’s father’s friend made a good guess as to the diagnosis. Now try presenting this case to a few other physicians, both young and old. I predict you will hear other diagnoses as well--lymphoma, Hodgkin’s disease, a dozen other deadly infections--all of which are discovered daily in others not as fortunate. The myth of old Dr. Gray, that warm, compassionate old man who could make perfect diagnoses in a snap without doing painful tests, is just that: a myth. In reality Dr. Gray made many mistakes, the inevitable consequence of his very limited tools.

The lawyers do indeed second-guess our every move, and juries often inflict severe punishment when we dare to substitute intuition for reliable tests.

Fifty years ago the patient with fever and abdominal pain followed a short path to the operating table. There his doctors were likely to find any of a hundred diseases, only some of which required surgical intervention. I can only imagine how much more vehement his column would have been if the surgeons had found only mesenteric adenitis (a benign condition), or tuberculosis (which requires only medical therapy). The fact is that they found a major surgical disease, and cured it.

DANIEL TEMIANKA, MD

Palos Verdes Estates