Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

The Other Side of the Stethoscope: Sunday musings…8/28/2022

1 Chicago. Great little town, especially if you have a native friend to give you pointers.

2 Chicago. Great little band. Went to see a regional cover band last night with friends. Very good musicians, but as is so often the case the lead vocals are what separate the Major Leaguers from Triple A. Still, some music is just so good that you go just to sing along.

3 Whoop. As I sit on the porch at Casa Blanco there is an infomercial on the tube taking up space before the FedEx Cup begins. Whoop, as you may know, is the activity tracker that is the darling of professional athletes of all kinds. Unable to track activity-specific metrics (like a CrossFit WOD, for example), it is really little more than a steps tracker with a heart rate monitor, sleep tracker, and what looks like an HRV (heart rate variable) tracker. The schtick is that it provides you with a recovery “number” that you can use to determine your level of fitness and your readiness for the next work-out.

This particular informercial joins Justin Thomas, a PGA tour pro who is arguably at the top of his game, with Michael Phelps, the 20+ time Olympic gold medal swimmer. Phelps, like so many retired athletes before him, has used his newfound spare time to fall in love with golf. On the infomercial the two are playing a casual round of golf, goofing around in a hotel-like gym, and talking about the importance of recovery for all athletes. They are hawking the Whoop as the way to do so.

I have nothing against the Whoop. Heck, it may be the only stand-alone fitness tracker that I haven’t tried. There are a couple of points to be made after watching Thomas and Phelps talk about recovery. First, they are correct. Not only from the viewpoint of the elite athlete but also for washed-up ex-athletes and never-was newcomers to athletics of all kinds. I once wrote (although I’m sure it wasn’t original) that under-training and over-training both result in a reduction of your ultimate outcome. HRV-based recovery data is the best option I found in my 15+ year odyssey in the fitness tracker world.

The second point is that we have reached a point in the evolution of the tech that prices have fallen. Whoop is expensive. The business model is to pay a monthly subscription fee of $30 or so in perpetuity. I think that’s a lot of money. You can pay less than $360 once and get everything you need to track the same metrics with most trackers. I use one called a Biostrap which I like very much. As an aside it will also do an adequate job of tracking exercise specific activities if you add a shoe-worn monitor.

Bottom line: the pro golfer and the pro swimmer have similar needs when it comes to tracking sleep and recovery as do the amateur golfer and the CrossFitter.

4 Stethoscope. Everyone except the unlucky will eventually find themselves on the other end of a stethoscope. While my life has been filled as much as anyone with visits to that place, for the first time in my life I, a physician, am about to experience the entirety of what it feels like to be a patient in the U.S. healthcare system.

Let’s be super clear about the background for what comes next. Since entering medical school as a 22yo in 1982 I have been treated as a VIP at the very least. As the years have gone by it has been more akin to a B-list celebrity if I’m being honest. I’ve never waited for an appointment in my adult life. Obstacles of any and all types magically disappear when I need to see a doctor or get a test. When I’ve needed surgery my docs and their staff have bent over backward to make sure that it happened when and where it was most convenient for me. In return for taking care of our colleagues patients, doctors of my era and the one that just followed us took loving care of each other (and their families). We no longer get comped when it comes to fees, mind you. But when able the docs who have shared patients have taken a deep interest in not only our mutual care, but also how we feel while getting it.

So what’s different now? Well, first a bit of a preamble. My right hip, the good one, has failed me spectacularly over the last several months. Where once I had minimal pain in my left hip that accelerated with activity and prompted a replacement in 2019, this one hurts all day every day. Like the left hip it doesn’t keep me from doing my job, it just hurts this time. No big deal, right? Just get this one replaced just like the other one and go on about your life. Sadly for me, and wonderfully for him, the surgeon for my first hip retired 3 months before I needed him again. I would have to have someone else do this next hip, but my friend picked out the guy he planned to have do HIS surgery when the time came. A surgeon from another system across town who literally has no idea who I am, and wouldn’t care less even if he did.

Welcome to American medicine Eyeball Boy.

For the first time in my adult life I will be a regular patient. Number whatever, hip number X on the day of the surgery headed for Room Y. Show up at the appointed time. No, we can’t tell you what time that is before hand. Why? Because. Pre-admission testing WILL take place live and in person on this particular day at this exact time. No, we cannot change that because you have a full schedule of patients to see in your office that day. Did you reply to our daily reminder email? Did you? Hey, we’re talking to you. We don’t care that you’re a doctor over there; you’re not one over here. Reply or your slot can go to the next number on our list.

Has it really been like that? Well, in the beginning, sure. Why wouldn’t it? That’s what my patients complain about when we have to refer them out to large institutions because we have so few private practice referral options remaining. But to be honest, I understand the system very, very well, and as soon as I started to find my way to a live person on a phone stuff started to loosen up a bit. It surely helped a bit to be assigned to a PA who is an ex-college athlete raising elite athletic children; we’ve got tons to talk about, including her very strong thoughts on whether I should return to CrossFit after my recovery. And it surely made me feel a whole lot better when my cardiologist came in for a visit and scheduled me for a pre-op stress test on his phone before he left my office. When it came back suspicious he worked me in for a cardiac cath, and the cardiologist who would be doing it did my informed consent after we finished with HIS appointment in my office. (It was negative. Phew).

It may sound like I’m complaining, whining even, but I’m really not. It’s not that I’m worried that things won’t go well with the surgery. This is still the U.S., my surgery is one that is done hundreds of thousands of times each year, and the buddy who did my first hip handpicked my surgeon. Medically it will likely be a non-event. No, after all of this, the really crazy hard part about being just a regular patient will be not knowing a soul where I will have my surgery and where I will recover. No one. No nurses I’ve taken care of or physical therapists whose Mom I just did cataract surgery on. No one who has had a glass of wine at Casa Blanco is gonna be there if I have trouble with my bladder. I will be mostly alone in my room; Beth will be kept out like all family members because of the institutional madness around the Pandemic.

It had to happen someday. Despite years of medical attention directed at various and sundry stuff, ailments and health risks, with multiple surgeries along the way. After 40 years I finally find myself in the most usual and normal place for a 62 year old man. I am, for the first time in my adult life, fully and completely on the other end of the stethoscope.

I’ll let you know how it goes…

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