Armchairing the docs after the fact is a slippery slope. If a doc believes amputation = 90% survival chance, and trying to save a limb = 60% survival chance, the doc will likely go for the amputation as many believe their goal is to save the life.
It's an interesting point about goals that may not align with the patient's.
In 2012, I experienced a pinched nerve in my neck that made my left hand go numb. I'm left handed. It affected my ability to do a number of things that had been important to me throughout my life, including playing guitar.
When this occurred, I was insured by Kaiser. They did some diagnosis and then proceeded down a very scripted protocol, starting with physical therapy. The therapist went through the motions, the condition did not improve and she eventually asked, "Do you make your living playing guitar?" When I answered no, she advised me to get used to not being able to play.
Kaiser continued to seem institutionally disinterested. I changed to a PPO plan sometime later and then found a neurology clinic local to me. Their initial approach would have been to try regenerative therapies until they saw the MRI results. They instead fast-tracked me to a surgeon.
The surgeon is a motorcyclist. He understood what I needed to be able to do with my neck, how impact resistant I needed to be, etc. He also understood my priority was to regain function in my hands. His proposed treatment was very invasive. He suggested I get other opinions and told me that each one would likely be different, as the spinal damage involved several levels and the options were not straightforward.
I did see another surgeon, who had a great manner, was friendly, confident and engaged. He recommended a less invasive procedure that would address the numbness on my left hand but would not address some of the other symptoms.
At that point, I began to wonder if the first surgeon might have been over prescribing treatment. I saw him again to go over the second opinion. He explained that the other approach would work as far as it went but would not address all of my loss of function.
In the end, I was convinced that though his approach was going to be more painful and a longer process, he had listened to what my priorities were. He knew that I valued being able to stay active more than anything else, including being pain free. His treatment would preserve mobility, allow function to return and would be stable. It would not necessarily reduce pain.
The surgery was done in late August and I am back to normal activity now. A few things still hurt, as expected, but I can feel my hands and strength has returned.
There were a few lessons in the experience for me, among them that our impressions of good or bad treatment are partly driven by what our desired outcome is and whether we find someone who will try to achieve that.
