“I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”–Hippocratic oath

The Hippocratic oath was created several centuries ago to guide health practitioners, then and today. The power of the oath is that it creates a compass for decisions that take place in the intimate interactions between patient and practitioner. My concern is that we are moving farther and farther away from this philosophy by trying the most extreme intervention rather than starting with the least harmful. Unlike our approach in the past, the system is moving away from an escalation process of least harmful therapies to the most invasive to one that starts with the most extreme first rather than last.

Clearly in certain acute situations, the escalation to the most invasive intervention makes sense but certainly not in all (or even most) cases. In cases of a car accident or advanced cancer, it makes sense to move to “whatever it takes” mode right away whether its surgery or experimental drugs. But in cases of systemic or chronic issues, it makes sense to look at the fundamentals whether its lifestyle choices, or natural treatments, or structural issues as you will see my example below.

A recent experience: I was recently struck when an office neighbor, Deb (an alias), informed me that she would be out of commission for a month due to a surgery.  I thought, “a  healthy-looking, 25 something, young woman–what type of surgery could she possibly need?” The answer was bunion surgery. For anyone that doesn’t know, a bunion is a bone protrusion on the side of the foot near the big toe–can be caused by wearing high heels, poorly fitting shoes, or the structure of someone’s foot. So I asked, “What does this bunion surgery involve?” Her response shocked me. Her surgeon would need to cut off the bunion, then break and re-align her foot, all under general anesthesia. Deb’s recovery time was expected to be 6 to 8 weeks. The doctor had not suggested any other alternative. But there are other alternatives, at least as a starting point. Here are some logical suggestions that are far less invasive and get to the heart of the issue:

  • Fix the structure of the foot using orthotics. These are not usually attractive but no more problematic than hobbling around on crutches for several weeks.
  • Stop wearing really high heels. Deb really liked to wear 3 to 4 inch heels, usually in boots or pump, which would put a great amount of stress on her front toe. Her doctor did not counsel her the importance of changing this behavior so that the issue does not present itself again.

How does Deb’s story end up? She did get surgery for bunions on her left foot. After 8 weeks of recovery, she was able to go back to “normal” shoes. 4 weeks later, she had bunions on her right foot and was scheduled to go back for another surgery. I think to myself, “if the surgeon had addressed the fundamental issues in the first place, could she have been spared 2 surgeries, a lot of pain, 2 months out of work and the risk of recurrence.”

I say lets get back to “never do harm” in that critical relationship between health care practitioner and patient. On FoundHealth, we want to discuss the whole range of treatments from least to most invasive. In that case, patients can understand their choices and make more informed decisions.

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