Personalizing Health Care
When Pt. Rajeshakar Hiremutt (Name changed) approached Knowurture, he wanted to know where he could get operated for his Knee pain. He had visited six specialists by now, including two orthopedics and two knee replacement specialists, including a tertiary care center. He had been diagnosed with arthritis of the knee. The physicians consulted had taken X ray and MRI scan and had diagnosed the problem right.
We administered the patient history collection interview Hx.me, which popped up the Knee injury and Osteoarthritis Outcome Score (KOOS) scale and we objectively assessed the impact of knee pain on the activities of daily living of Ptji. We then collated all the document and presented it to our panel expert in Knee arthritis. Dr. PB assessed the case and commented "this knee (right) demands a surgery". He was of the opinion of not having a surgery done to both knee at the same time, which was a deviation from earlier advice. I asked him isn't it better if both surgeries are done at the same time from a cost and hospital admission once and logistically easier. He smiled and said "my professors always taught me never operate on both eyes or both knee at the same time". I asked but isn't bilateral knee replacement the trend today? . Dr. PB explained it is common knowledge for those who do two knee replacements at once, that knees often recover each at a slightly different pace from the other. With double the surgery can come twice the risk of infection which is a surgeon and patient’s greatest fear with this surgery. You will need more care at the very beginning after a double, which sometimes puts people in skilled nursing facilities after their surgery. That means not recovering in the comfort of your own home; generally not as good for a fast recovery.
He again looked at the scans and reports, something caught his eye in the first page of the history report, it was occupation of Pt. Rajeshakar Hiremutt. He immediately said I need to see the patient, we scheduled a meeting the next day in his clinical room. Dr.PB spoke to the patient to understand his preferences about the surgery and at some point asked him to show him how he sits during his stage performances, Pt. Rajeshakar Hiremutt squatted on the floor with folded legs. Dr. PB said "I can rid of your pain and in a few days you could walk for three miles comfortably, but you will never be able to sit down like you are sitting now! the best of the implants do not sustain bending of the knee in this position, You have to make up your mind about which of these choices are important for you?". This was something the earlier physicians had missed, understanding the patient preferences in context. Pt. Rajeshakar Hiremutt said "I am 60 now and retiring in the next four months from AIR ( All India Radio) where I am employed as a vocalist. All the while I have been planning public concerts and if I am unable to sit down I will not be invited to perform."
Dr.P.B suggested Arthroscopic washout and debridement for the knee and postponing the surgery by a couple of years and pain management in the meantime.
Treatment is not a one size fits all approach.
