Dr. Aknos,
The Back Surgeon
Grifters take advantage of people
by exploiting information their victims do not have.
In medicine they do it by not having the information themselves.
fiction under construction
After the life-ruining crimes committed against Aaron in a hospital, but
before he got diagnoses of the injuries, and before he understood
it was nearly impossible to get those, and before he was sued for complaining
about it,
his father decided to get an operation. Considering the family's history with healthcare, what the family would
think about this was known. When
Aaron's mother told him about it, his first
question was:
“Why now?”
“I asked him that too.”
His father’s back problems were small compared to his own.
His father’s passion in life was tennis, and his back was no problem when he was
playing tennis. Second only to tennis was his passion for golf. How bad could
the problem be if it didn’t bother him when he played golf?
“It hurts when I drive. It hurts when I sleep,” his father
said.
“Get rid of your car and get rid of your bed.”
“What do you mean?”
Aaron knew his father knew what he meant. This was the way
his father responded when discussion was useless. His father knew
that Aaron drove a van, rather than a car, in order to be able to sit up
straight and that Aaron slept on the floor, rather than a bed, in order to
have the kind of support under his back that kept it from hurting.
“Get rid of your car, you'll get rid of your back problem. At
least most people will. Surgeons earn their livings by operating. That inclines
them to believe that an operation is the best thing for you.” He once had asked
an orthopedic surgeon he'd known socially why he had bought a full-size van when
he had no kids, had nothing to haul and didn't even do yard work. The surgeon
said he decided he should practice what he preached. Everyday he told people,
"Get rid of your car and you'll get rid of your back problem." His back didn't hurt, but he didn't
want it to. So Aaron tried it. He bought a van. His car turned out to
have been the last
link in the chain of things hurting his back. The reduction in daily pain was
noticeable in about a week. He was ecstatic finally to have figured this out. None of the orthopedic
surgeons he went to as a patient had told him about this. He'd wondered why
they hadn't. If they themselves hadn't known, why they hadn't they?
Aaron had spent years battling the healthcare system trying
to get someone to pay attention to his back. The story of that is of a lumbering
machine working with a cookie cutter's indifference to problems that did not fit
its cutter. The errors and indifferences with which his case had been handled
caused him to question the system. He tried to find information on how well such a system
was serving its other constituents. In the end he wondered if it’s
real constituents weren't doctors.
“Dad. Most people who get back surgery are not improved by
it. An unfortunately large percentage are made worse. It’s not a good risk.”
“Huh?”
“Huh” from his father was the same as the previous “What do you mean.”
It meant his
father had heard but was not going to consider what he had heard. Aaron, as
usual, responded anyway, “It’s not a good risk. Most people are not improved and
many are made worse by back surgery.”
“I trust this doctor.”
"Doctors are in the business of gaining your trust. Appearing
trustworthy and competent is how they earn their livings."
“He says he does this operation all the time. It is cut and
dried. He gets good results.”
“All doctors say that.”
“But I believe him.”
“I can see that.”
"How can you think he would be
lying?”
“I didn’t say he was lying.”
“What reason would he have to lie to me?”
"I'm more concerned about how he might be lying to
himself."
"Huh?"
"He makes his living by doing operations. Not by figuring out
whether they are the best thing for his patients."
"I don't believe he'd do an unnecessary operation."
"I'm sure he doesn't either. That doesn't mean he doesn't do
them."
"You haven't even met him."
“You want me to meet him?"
"What do you mean?"
"You want me to come to an
appointment with you?”
"Huh?"
"Make an appointment. I'll come."
"You can't make an appointment with a doctor to question
him."
"Why not?"
Aaron's mother was not in favor of the back surgery either
and goaded his father into making an appointment at which Aaron could meet the
surgeon. She said, "What could it hurt? This is your son. He's concerned about
you. Let him help. Let your family look out for you. It's not as though the
doctor isn't getting paid for the appointment."
So Aaron went to yet another doctor’s office to see yet
another doctor. This one resented having to explain himself to a patient’s son.
He was polite,
but removed and cold. He was the expert. He was the authority. What did this kid
know? The doctor explained about disks and ruptures and bulges. None of this was
new to Aaron. Aaron had taken notes during such appointments for his own back in
the past and then gone to a medical library to read more about it. He had talked
to nurses, looked at models of spines, and spent considerable time learning
about his own back. He already knew more than this surgeon was explaining.
When the surgeon finished, Aaron said that according to the popular press back
surgery is a bad risk.
The doctor said thousands of these operations were done every
year. It was routine. Aaron said that according to the lay press most people who
get back surgery are not improved by it and that many are made worse by it. The
odds of getting better after back surgery were not good. Dr. Aknos related
statistics on the high success rate of this particular operation. Aaron told him
that one always hears statistics of high success rates from the surgeons who
perform the surgeries, but completely different numbers from surgeons who don't.
Aaron said all this as politely and humbly as a child concerned for
his father could. This particular surgeon did nothing to charm or humor him back. This
surgeon directed his answers to Aaron's father as though to say, "Your son is a
lost cause. I hope you can see reason."
Aaron found himself wondering why he had imagined that
visiting the surgeon could be anything other than a waste of time. Surgeons are
not dispassionate observers of what they are selling. If he had been buying an
appliance, he would have been able to gather data and information that was not
available on surgeons and surgeries. With medicine, one was rolling dice and
hoping for the best. Aaron was unable to persuade his father not to get the
operation.
After the operation, while still in the hospital, Aaron’s
father needed help with things. He fumbled a lot. He was unable to sign his name
on a form, but they told him just to make whatever scratch he could and that
would be acceptable. No one seemed to find anything disturbing about this.
After a couple of weeks, his father still could not sign his name. At
a follow-up visit to the surgeon his father mentioned problems with his right hand
and arm. He’d lost more than half the use of his right hand. The surgeon said it
would clear up. A couple of months after the operation his father went to the
surgeon again to say that it had not cleared up. He no longer could play tennis.
He no longer could play golf. He had difficulty driving. He could not even sign
his name.
The surgeon said that he sees that all the time and it is a
result of the injury, not the operation. When his father related that to Aaron,
Aaron said, “On your way into that operating room you signed forms, didn’t you?”
“Yes.”
“But on your way out you couldn’t and never were able to
again. For five or six years you had that back problem without it effecting your
ability to play tennis or drive or sign a form. But from the moment of the
operation onward, you no longer could sign your name.”
His father turned to his mother and said, “Aaron says that on
my way into the operation I could sign my name, but on the way out I couldn’t.”
His mother said, “I heard him.”
His parents, like most people, believed what authorities told
them. The doctor had issued an edict and they believed it the same way they believed religious leaders, school teachers, plumbers
and all the other authority figures on whom they relied. And like almost all other
patients, it did not cross their minds to complain, let alone sue.
But Aaron was in the business of evaluating the performance
of licensed professionals. For a living he investigated securities brokers. As
he watched his father’s life grind on miserably with his ability to work severely handicapped and without the chief joys
his private life used to have, Aaron wanted to know more about the performance
of the specific licensed professional who had done this to his father – the
doctor who “sees this all the time," the doctor who created the official record of
the operation on his father saying that it was 100% successful with no complications.
But how do you investigate a surgeon? Medicine is a
closed shop that does not collect such information even for itself. Where could one get data and patient information? The only thing
Aaron could think to do was follow some patients. He called private investigators, names picked from the yellow pages, to ask
questions. He happened to say to one, “If we
just could monitor who visited his office . . .” The cost of having someone
monitor the comings and goings of all the cars in a parking lot, even though it
was a small parking lot, were prohibitive. Some suggested that Aaron sit
in a car and watch the parking lot himself, but ever since he had been assaulted in
a hospital, sitting like that for any period of time was painful, and possibly
injurious for all he knew. He hadn't been able to get anyone to diagnose the
injuries to tell him.
After talking to eight or ten firms, one investigator
mentioned “surveillance vehicle.” Aaron had never heard of one. They were
not used in Aaron's work. This private investigator had one. Rather than pay a
person by the hour to watch, park an empty drone vehicle in line of site of the
doctor's office. Motion
detectors would turn on the camcorder to videotape every person who went in and out
of the doctor’s office and capture the license plate numbers on their cars.
It was a fraction of the cost of the other options, but it
still added up. He made a deal with the
investigator. When no one else was contracting to use the surveillance vehicle,
it would watch the surgeon’s office. Since that would keep the vehicle
constantly working with no downtime, he gave it to Aaron for half price. Aaron contracted to
use it for a month. Since he had become a fulltime patient himself, he had no money coming in, but he
didn't know how to investigate this without this vehicle.
As time wore on the private investigator got to know
Aaron and his cause better. He took pity on him and gave him some additional help. Aaron needed to have a name and address and phone number for every license
plate number. Usually there is an additional charge for each of those, but this
private investigator let Aaron go through the video tapes himself to cull out the
license plate numbers. The investigator then gave Aaron the access necessary to search
for the names associated with them. He
wouldn’t have done this for anybody else, but Aaron, after all, was an
investigator in a different field, and was doing research that he came to see was in the
public’s interest. And the investigator was right there next to him at the next
desk when he was doing it. When the month was up, he told Aaron that he’d leave the
surveillance vehicle sitting where it was until someone else needed it. Aaron
got an additional three weeks for free.
Seven weeks of license plate numbers produced a list of
people eighty-eight people who had back surgery with Dr. Aknos. More people than
that had gone into that office. Aaron contacted all of them. Most had either
seen other doctors or seen Dr. Aknos about something other than their backs. But
eighty-eight had back surgery with Dr. Aknos. Aaron told them he was doing
research on surgical outcomes and created profiles on them. Some had had their
surgeries long ago and were back for follow-ups. Some did not get their
surgeries until after he contacted them as they had been seeing him for
preliminary visits. He wished he could call every each of the eighty-eight every
month to see how they were doing, but that would be too intrusive. He called
them only once per year. This wasn't a scientific study, but it was the best he
could do.
Nineteen of them reported no significant changes in their
lives after the surgery. The rest tended to discuss their lives in terms of pre-surgery and
post surgery. Before the operation life had
been one kind of thing. Afterwards it had been another. They did not date the
change in their lives from the moment they first were injured or first started having back pain. The
pain had been a problem, and had been incapacitating for some, but
incapacitating in terms of discomfort, not in terms of a loss of coordination
and strength. It may have hurt to sleep on a mattress before, but they still
could operate the tools of their trades. What they spoke of as being a
watershed was the surgery.
After six years of calling them once per year, out of
eighty-eight patients, sixty-four no longer could engage in physical activities
that previously had been normal for them, like pushing lawnmowers, riding
bicycles, operating the tools of their trade, or even just washing dishes
without dropping them. Forty-two had lost their careers. Twenty-three had gotten
divorced. Eleven had committed suicide. Each year Aaron called them, heard the
despair in their voices and recorded numbers that were increasingly worse. Aaron asked them
to get their medical records and send copies to him. He researched the
operations they had. He read the assessments written by the surgeon stating complete
success with no complications. Even the records of the follow-up visits did not
record the problems they were reporting. "Returned with questions" covered a visit
from someone whose career had become pain avoidance since that surgery, now
spending 24 hours a day lying in a stupor in front of a television on which he
barely could focus because of pain medication. Through it all none of them filed a complaint or called a lawyer. Most believed the
doctors who told them the surgeries had been successful. Quietly they resigned
themselves to sad ends, just as his father had.
Aaron wished his study could be more scientific. There was a
bias in the fact that patients for whom things had not gone well would be more likely to return for
follow-up visits and therefore be more likely to end up in his study. This
study had no way to measure whether he had happened on a blip of unusually
severe cases. And he was not a dispassionate observer as he
followed their cases. But why was he the only one following up with them? Why
was no one else aware of what he found? It is not as though these patients had
not sought medical help over and over again since their operations. Most had
been to other doctors. As Aaron examined their medical records, none of the
additional doctors had recorded any of their complaints about the operation
either. Many of the patients had reported
their problems as having their onsets at the time of the surgery just as his father had.
Many had said that to the surgeon himself. Why was this information not
recorded anywhere even when they went to other physicians?
According to the United Nation's World Health Organization,
an average of one in ten hospital patients world-wide suffers preventable harm
having the potential to result in disability or death. The numbers are
staggering, but it is not in the interest of people in medicine to be aware of
that. So they aren't. Instead, they create records that obliterate such information.
It is not in their interest to be aware of it. The community of doctors
collectively agrees on a version of reality that is at odds with the experience
of patients, but is good for itself.
Aaron's dynamic, energetic
father's schedule always had been crowded with work and family and friends and
sports. Now his father could not engage in the sports, had difficulty with work, and
was out of the loop with his friends. He wasn’t walking the links or helping
organize the tournaments. Instead he was having to learn how to scratch some
semblance of his signature with two hands holding the pen. And he believed the
pronouncements of the surgeon who
“sees this all the time” without suspecting that seeing this all the time might
mean something other than what the surgeon self-servingly chooses to believe.
Aaron was naďve enough to think that the surgeon would want
to learn what he had found. Something about the surgeries must not be right or
the outcomes would not be this bad. The surgeon would want to know that,
wouldn't he? It wasn't a scientific study, but twenty-three
divorces and eleven suicides in a group of only eighty-eight? He had witnessed
his own father's experience. He had spoken to these other families every year. He
had heard their stories about trying to adjust to the incapacities that had
their onsets at the time of their surgeries. He had spoken to spouses and
children and heard their tones change as their families deteriorated. Surely the
surgeon would want to know.
He did not call the hospital to tell them about what he had found.
He had called St. Virgin about his own case previously to ask how to
complain about the crime an angry surgeon committed against him. Their response had been, "He wouldn't do that." They would
not let him file the complaint. So who would he call at that hospital to tell
about this? Instead he contacted the surgeon’s office.
Shortly thereafter a
summons arrived. He was to appear before a judge. He was prohibited from talking
to anyone ever again about “the nonsense” he was “fabricating.” He was
prohibited from contacting any patients of the surgeon ever again. He was
prohibited from contacting or going near the surgeon or his offices or any of
his employees ever again. Lawyers for the surgeon stated emphatically that his
"so called" study proved nothing. The lawyer Aaron had to hire to defend him
against the threatened lawsuit charged him more per hour than the surveillance
vehicle had cost per week. Financially it was ruinous. Which was the point,
according to the lawyer. They wanted to make it so expensive for Aaron that he
would whither. And if he didn't whither, he could be put in jail if he "defamed"
the doctor but did not have enough assets to compensate the doctor for his pain.
Aaron had to sign an agreement saying he would not complain to the hospital or
the state medical board or anyone else about what he had found.
There is nothing new about this. A couple of hundred years
ago Dr. Benjamin Rush, one of the found fathers of the United States of
American, was a prominent physician who practiced bloodletting and mercury
purges during a plague. When a man pointed out that the death rate increased
wherever Rush practiced, Rush sued him and ruined him financially.
It is no different now. Dr. Aknos continued to do what paid
his student loans and the salaries of his nurses and his mortgage
and insurance and supported his family and maintained his standing in the
community. Unfortunately, he did not do what would make it so that his patients
could do the same.
"It is difficult to get a man to understand something
when his salary depends upon his not understanding it."
-Upton Sinclair
Putting work on the Internet, especially work in progress,
is inviting people to look over your shoulder and comment
or contribute or
object or check your facts.
Persons, places, events, names and situations in this story are purely
fictional.
Any resemblance to actual persons, living or dead, or to their names or
histories,
is coincidental and unintentional.
Rough Draft / Under Construction
|