Sid has another wonderful post up on the surgeons blog.

...Couple of months ago I read an article about a guy who did a three or four simple un-fixes to his Subaru, took it to a bunch of repair places, and reported the results. Bottom line: only about twenty percent found the problems and provided the appropriate and easy repairs. The others suggested all manner of unneeded and very expensive work, and missed some things. Not a surprise.

The article analogized to medical care: experts who have a stake in providing the care and charging for it may not always be trusted to give the best advice. It's not an entirely specious proposition. I was reminded of it recently.

 An Orthopedic Perspective...

I recently met a wonderful gentleman  sent to me for evaluation by a mutual friend, who happens to be a talented physical therapist.  He believed his friend suffered an Achilles tendon rupture and  referred his friend to me for surgery.  A quick history and physical confirmed that his suspicion was correct.  When do I need an MRI?  You don't.  Really ! No I don't own an MRI machine.  

The patient wasn't particularly active and was told by all his friends about their surgical adventures in a similar situation.   The patient informed me he had cleared his schedule and was 'ready" for surgery.  When I mentioned that the gap was small, his activity level low and the likelihood of healing without surgery was high he was taken aback.    He looked at me like I was from another planet.  i asked him if he was familiar with the side effects, or complications of surgical intervention... a resounding "no" resonated through my office.  An infected Achilles repair is a nightmare... a DVT...a potential nightmare, and so on.  The patient nor the competent therapist had never heard of this injury being treated non-operatively.  We reviewed all the literature and decided to cast him and manage his injury without surgery. 

 The literature supports non-op mgmt of Achilles ruptures in many instances..and an MRI is not needed to diagnose an Achilles rupture 99% of the time.... why then do I feel like the only one in my area who treats this injury non-operatively.... with anticipated excellent return to function in appropriate selected cases.

 What do you think Sid???????????