Surgery versus Conservative Treatment

Over my long career, it has never ceased to amaze me how very little the average doctor knows about physical therapy and what the physiotherapist is capable of in the conservative treatment of musculo-skeletal conditions. When the average Jo or Jane hurts themselves or suffers pain due to accidents, injuries or even wear and tear in the joints - the first port of call is usually the family physician or (in the U.K.) the GP. I could write the book (maybe number 9) on the awful diagnoses I have encountered that GP's have given patients, which usually goes with terrible advice. When, however the doctor is unable to cope with the patient's symptoms, they are often referred to a specialist. That would be great - if the specialist were a physician who had more knowledge of the particular condition than the GP. But the patient usually ends up on the doorstep of an orthopaedic SURGEON. Now I have known some really great 'orthopods' but, equally, have also known some who are very anti (mostly due to ignorance) any kind of physical medicine.

Surely it makes sense that a patient is treated with physio (or osteopathy, etc.) before surgery is attempted yet, sadly, surgery is often used as the first option. Why is there no such doctor as an orthopaedic PHYSICIAN? A surgeon quite naturally thinks in terms of surgery. One can easily recover from unsuccessful physical therapy (you can't win 'em all), but you cannot easily undo surgery. As a physiotherapist, I spend a great deal of time in trying to 'make the most of a bad job' for those who have had surgery that has not worked. I am then treated as a last resort instead of a first resort.

A case in point is the way that Freddie Flintoff was handled. I am biased towards this case as I am a cricket 'nut' and feel we have lost one of the best cricketers of the last generation. I do not know what the original ankle injury was that Freddie sustained and I am sure that he received excellent care by the medical team who looked after him. It seemed to me though that he was subject to the surgeon's knife within a very short time of the original problem. A further operation was required before he returned, tentatively to cricket. Then, lo and behold, he started getting knee pain. This is not exactly a revelation as the surgery would have tightened ligaments and altered the weight bearing line in the lower leg thus inflaming the knee. The knee was then operated on (three times) before time was called on his career. If only conservative treatment had been given a longer run in the first place - who knows what the eventual outcome would have been.

Having said all that, surgery is, obviously, the ONLY way forward in some conditions and is very successful. I suppose if I were a surgeon this blog would be putting the other side of the argument!! Keep well - JRC