Is my doctor dumb?

[DanCottle]

I hurt my shoulder 2 weeks ago. I went to my doctor the next day. She did not do a single test like a x-ray, ultrasound, or MRI. She said that it is probably tendinitis. She said just to take it easy for a week or two so i did and it is still the same. So I called back to see her again but apparently she is on vacation. So I asked to see another doctor but they just gave me a script for Medrol which is a cortisol steroid.

So shouldn't they do a test or two before they assume what it is and just give me something that will temporarily relieve the pain rather than fix anything that might be wrong?

[thebm]

did she do any kind of physical test by moving your arm around or anything? i dunno if they do that for the shoulder but i assume they do. when i tore my acl, the doctor did a test where he held my leg and pulled on it a certain way, and he said he could tell that my acl was torn. he still ordered an mri to be sure, but he may not have ordered the mri if everything felt normal to him.

so maybe she could tell just by doing a similar test that you didn't have any serious damage and could tell it's just tendonitis.

[crystallinentity]

I love the thread title. Makes me laugh for some reason.

[mad-man]

I hurt my shoulder 2 weeks ago. I went to my doctor the next day. She did not do a single test like a x-ray, ultrasound, or MRI. She said that it is probably tendinitis. She said just to take it easy for a week or two so i did and it is still the same. So I called back to see her again but apparently she is on vacation. So I asked to see another doctor but they just gave me a script for Medrol which is a cortisol steroid.

So shouldn't they do a test or two before they assume what it is and just give me something that will temporarily relieve the pain rather than fix anything that might be wrong?

I recently learned a lot about shoulder injuries the hard way. I don't want to alarm you, but did your doctor do any resistance tests? (asking you to push away while he holds your hand, or resist as he pulls back, etc.) Weakness in these type of tests is an indicator of rotator-cuff injury, which is fairly common, particularly in weight-training. More serious tears require surgery (which mine unfortunately does); less serious tears can be healed with rest and physical therapy. If your doctor hasn't done anything like this and two weeks later you still have pain, go see an orthopedist; this is nothing to fool around with.

[Fresch]

Once again shwoing up the fact that musculoskeletal injuries are 40% of a doctors clientele, and only 2% of their training.

Shameful, but true.

[The_Colonel]

I recently learned a lot about shoulder injuries the hard way. I don't want to alarm you, but did your doctor do any resistance tests? (asking you to push away while he holds your hand, or resist as he pulls back, etc.) Weakness in these type of tests is an indicator of rotator-cuff injury, which is fairly common, particularly in weight-training. More serious tears require surgery (which mine unfortunately does); less serious tears can be healed with rest and physical therapy. If your doctor hasn't done anything like this and two weeks later you still have pain, go see an orthopedist; this is nothing to fool around with.

what he said...

[KarateChris]

Once again shwoing up the fact that musculoskeletal injuries are 40% of a doctors clientele, and only 2% of their training.

Shameful, but true.

Pretty sure we get more than enough training; thanks for judging something you probably know nothing about.

Original poster, they didn't perform those tests on you because they're not indicated in this case. Radiographs aren't indicated in many musculoskeletal cases because the VAST MAJORITY of cases resolve on their own, and if we don't have to expose you to x-rays or ionizing radiation (CT scan) then we won't. For many cases (such as lower back pain that isn't getting worse and isn't stopping you from performing activities of daily living) it takes about 6 weeks to resolve. If the pain lasts for more than six weeks or it's getting worse or your activities of daily living are stiffled, then a radiograph could be indicated.

Your doctor SHOULD have however performed a musculoskeletal exam on your shoulder/neck area. From that he/she would probably have a good idea of what it is and the proper course of treatment.

[DanCottle]

She did do resistance test but it seems like she should hae done more than that.

[paulstar35]

I tor my rotator cuff last year in wrestling it is probally the worst thing that could happen to me. I cant play baseball anymore and therefore lost my scholarship but s*** happens. How did you do in the resistence test i could barely lift my arm and it still hurts to do that but i dont want to get surgery because the Doc says it will only result in more scar tissue. I would get an MRI though if i were you i should of done that immediatly and maybe it would of saved me. Good luck man

[user18799886210]

My doc told me she prefers to follow "conservative treatments first." Rest, rest and more rest. After a few weeks with no improvement then she suggested MRI, but even then she stated all the MRI is going to do is confirm that there is in fact a problem. She went on to say "let's assume the MRI shows you have a tear. I don't suggest surgery unless the pain is completely unbearable." In her words "give it time."

So in your doc's defense perhaps she subscribes to this way of thinking? I followed my doc's suggestion and did eventually get the MRI. Sure enough it showed exactly what she suspected and the results were the same...either live with the discomfort or surgery. In her opinion I should steer away from surgery for at least now.

Now, the upside of the MRI is peace of mind. It's closure. Not fun walking around wondering if it's rotator, labrum, ac joint, etc...

[rampagefc77]

If anti-inflammatories and pain relivers dont work in a few weeks, find an orthopedic doc and see what they say. They will likely order a costly mri, which will only tell you A) nothing is wrong B) something is wrong but they cannot/dont recommend anything C) something is wrong and surgery is recommended

unless your symptoms are extremely plainful and life altering, surgery should be a last resort.

[bballmom]

yes your doctor is dumb very unprofessional to write a prescription without doing any tests.

[KarateChris]

yes your doctor is dumb very unprofessional to write a prescription without doing any tests.

Huh? But they did resistance tests, and they probably made him bring his hands up, behind his head, behind his back, etc. to test out extraversion and intraversion of the shoulder joint. Did you even read my post when I said radiographs aren't indicated?? They gave him a medrol dose pack which is for inflammation. They probably think he has an inflamed bursa or maybe just an inflamed muscle of the rotator cuff.

[GolGotha]

Huh? But they did resistance tests, and they probably made him bring his hands up, behind his head, behind his back, etc. to test out extraversion and intraversion of the shoulder joint. Did you even read my post when I said radiographs aren't indicated?? They gave him a medrol dose pack which is for inflammation. They probably think he has an inflamed bursa or maybe just an inflamed muscle of the rotator cuff.

I would normally agree. However, doctors are very eager to dispatch patients and don't normally do the amount of tests required. I went in for a shoulder injury not too long ago. My doctor did not do flexibility tests, only prodded around my shoulder. He assumed it was tendinitis and was on his way. Over three months later now, I've had my injury suggested as a possible labrum tear or a pectoralis minor flexibility issue. Doctors just assume you have something common and move on, which I don't think is right. Doctors need to spend more time on their patients to give a more complete evaluation. They shouldn't have given him a prescription without ruling out other injuries.

[Fresch]

Pretty sure we get more than enough training; thanks for judging something you probably know nothing about.

I definitely do know a lot about this area, thanks for judging.

Huh? But they did resistance tests, and they probably made him bring his hands up, behind his head, behind his back, etc. to test out extraversion and intraversion of the shoulder joint. Did you even read my post when I said radiographs aren't indicated?? They gave him a medrol dose pack which is for inflammation. They probably think he has an inflamed bursa or maybe just an inflamed muscle of the rotator cuff.

So giving medication when the diagnosis is unclear is a satisfactory outcome is it?

Extraversion and intraversion of the shoulder joint?? The shoulder joint has personality issues??

[KarateChris]

I definitely do know a lot about this area, thanks for judging.



So giving medication when the diagnosis is unclear is a satisfactory outcome is it?

Extraversion and intraversion of the shoulder joint?? The shoulder joint has personality issues??

Haha nice catch. I was thinking inversion and eversion of the ankle joint and external and internal rotation of the shoulder joint. Thankfully, I'm not a doctor yet hahaha

Fellas this is what we call humble pie.

Anyway, even as a first year medical student we had to perform many many physical exams (obviously haven't done a musculoskeletal one since last semester).

And to GolGotha, I agree (believe me) that I wish doctors had more time to spend on their patients. When we go into a patient's room to perform anything (history, neuor physical, musculoskeletal, vital signs, etc.) in the past they've only given us 15 minutes to do so. This year we see patients in the hospital and we have to do a complete workup on them which from what I'm seeing will probably take like 1-2 hours. I wish doctors had that much time to devote to any patient.

I just don't like how so many people have a negative view of doctors when I know myself and everyone in my class are working their ass off one day to help people. So I try to give insight into what my life is like studying everyday and working hard for my future patients, but I guess I kinda stuck my foot in my mouth with writing inTRAversion instead of inversion (and yes I know what an intravert and extravert are; I just didn't catch it as I was typing it).

[melon]

I'd have to agree with Fresch about doctors not receiving a representative amount of training on musculoskeletal issues. Luckily that is why we have physiotherapists and occupational therapists (and dare I say it, chiros - even if it's not really regarded highly by most doctors). A doctor in family practice will know more than enough however to deal with simple shoulder issues such as this one.

I don't think further tests were indicated. Treatment with an NSAID can be diagnostic - if the pain goes away with a week or two or NSAIDs then it probably wasn't a serious injury. If it doesn't change, then we have indication for further tests such as radiographic studies. A history and physical examination is all you get for most joint injuries in primary care - joint injuries that require further investigation tend to be serious enough to send you to the ER anyway.

Fresch - I believe you a chiro or physical therapist of some kind? KarateChris will soon learn that you guys will wipe the floor with us over anatomy and joint problems - I remember when I got my ass kicked by a physio when we were discussing the rotator cuff when I was a first year. 4 years on, I have definitely learned my lesson!

[melon]

I would normally agree. However, doctors are very eager to dispatch patients and don't normally do the amount of tests required. I went in for a shoulder injury not too long ago. My doctor did not do flexibility tests, only prodded around my shoulder. He assumed it was tendinitis and was on his way. Over three months later now, I've had my injury suggested as a possible labrum tear or a pectoralis minor flexibility issue. Doctors just assume you have something common and move on, which I don't think is right. Doctors need to spend more time on their patients to give a more complete evaluation. They shouldn't have given him a prescription without ruling out other injuries.

This is true, however there is a saying in medicine: "When you hear hoof beats, think horses, not zebras". It was most likely a common shoulder problem, so performing invasive tests to rule out a tiny possibility, especially if the examination was unremarkable, is unresponsible and expensive for the patient.

[Darkrid3r]

I too love the title, and they are right, find a ortho, have them see whatsup, they will most likely give you a referal to physio.

Doctors are indeed dumb...they see 100 people a day, and write prescriptions like mad.

they have more people to deal with each day than time.

This is why i NEVER see one for a sport related injury, find a sport type doctor that understands, in most cities there is a foot ball team, or hockey team, find out who the doctor is, and see if he can give you a referral to someone, or see them yourself. You might pay a lot for their services, but let me tell you, they can help you more than any other doctor i have ever visited in my whole life.
I would gladly pay 300 bucks for the right information, than "ya don't do that any more, rest and put ice on it" on a side note....the same advice has cost me 300 bucks in the past

[KarateChris]

This is true, however there is a saying in medicine: "When you hear hoof beats, think horses, not zebras". It was most likely a common shoulder problem, so performing invasive tests to rule out a tiny possibility, especially if the examination was unremarkable, is unresponsible and expensive for the patient.

Exactly. We hear that saying all the time.

And we've actually had discussions about chiropracters in small groups, and I'm a HUGE supporter of chiros. My chiropracter is a family friend and both times I've messed up my back he's come through for me and helped me out. In ortho related injuries, I feel doctors/PTs/chiros all working together make the best team.

[hank-williams]

I hurt my shoulder 2 weeks ago. I went to my doctor the next day. She did not do a single test like a x-ray, ultrasound, or MRI. She said that it is probably tendinitis. She said just to take it easy for a week or two so i did and it is still the same. So I called back to see her again but apparently she is on vacation. So I asked to see another doctor but they just gave me a script for Medrol which is a cortisol steroid.

So shouldn't they do a test or two before they assume what it is and just give me something that will temporarily relieve the pain rather than fix anything that might be wrong?

If i were you i would go see another Doc.

[Fresch]

Exactly. We hear that saying all the time.

And we've actually had discussions about chiropracters in small groups, and I'm a HUGE supporter of chiros. My chiropracter is a family friend and both times I've messed up my back he's come through for me and helped me out. In ortho related injuries, I feel doctors/PTs/chiros all working together make the best team.

Chiros are not team players unfortunately.

If you hear hooves, it might be pretty safe to assume it is horses, but you look pretty stupid when the zebras come around the corner and you could have known that with a little extra looking.

There is a rule called Orcam's razor - go for the simplest thing because it usualy is.

If the patient has his recoverfy delayed by 2-4 weeks due to your failure to diagnose (and I don't mean invasive tests) that might not be much to you, but it cvan eman a lot to the patient!!

[DanCottle]

update
3 weeks since the injury
sitll pain in shoulder
had an xray done today and will get results of that in a day or two. Doc said, over phone, that i will need PT if nothing is wrong with the xray.

[Goatse]

Go to a physio.
/thread

[LongtimeLurkr]

Occam's Razor

Fixed for you. I appreciate the fact that you were trying to be helpful, but trying to cite a principle like that and misspelling it detracts from your credibility and makes you seem dumb... the exact opposite of what you were trying to accomplish.

[rampagefc77]

update
3 weeks since the injury
sitll pain in shoulder
had an xray done today and will get results of that in a day or two. Doc said, over phone, that i will need PT if nothing is wrong with the xray.

x rays will show little to nothing unless there is something wrong with your bones. Xrays typically fail to see tendons, ligaments, labrum, muscle (rotator cuff), etc.

[2.0Tsunami]

Fixed for you. I appreciate the fact that you were trying to be helpful, but trying to cite a principle like that and misspelling it detracts from your credibility and makes you seem dumb... the exact opposite of what you were trying to accomplish.

The smartest people are usually the worst spellers...just sayin.

[LongtimeLurkr]

The smartest people are usually the worst spellers...just sayin.

Strong generalization. I would have given him a pass if it was phonetically similar (I'll agree that some smart people just spell phonetically because they aren't inclined to care for grammar), or a result of a misstroke on the keyboard. This was neither of those cases.

[Fresch]

Fixed for you. I appreciate the fact that you were trying to be helpful, but trying to cite a principle like that and misspelling it detracts from your credibility and makes you seem dumb... the exact opposite of what you were trying to accomplish.

And the fact that you attach more significance to the spelling than to the sentiment says exactly what about you?????

[aaronk277]

I'm sorry for your pain, I tore my RC about 3 months ago catching a motorcycle from falling dumb move but can't do anything about it. My doc didn't even try to look at it and sent me directly to the orthopaedic surgeon. X-ray came back clean other than my arcomion has a hook to it which it not helping the problem and then said he wanted to give me a cortisone injection. I asked him if he would take one. No answer just went into a different topic. Said to give it 3 months of rehad and see how it goes. I have pretty good range of motion but can not sleep on it at all the pain wakes me right up and lifting anything is not a fun task. Getting a second op. in two weeks. Good luck with your shoulder bro