Archive for July, 2003

The Old Course and the MRI

Sunday, July 6th, 2003

In 2001, I had a serious problem requiring a medical intervention: my golf game had collapsed. For a Scot, this is the end of healthy living. I have played since the age of seven, not well, but I could usually get round most courses in the 80s or low 90s. In 2001 I went through a miserable spring of golf, unable to break a 100. I lost fifty yards off the tee, and could hardly swing through the ball. This agony was compounded by having the opportunity to play some of the world’s great courses (as a guest, too) including Mid-Ocean in Bermuda and the hallowed Pebble Beach. I had injured my neck lifting luggage (the macho one-handed garment bag catch it in the air from the overhead bin trick). I guess two million frequent flier miles and thousands of scrums as a hooker in rugby had taken its toll. But, I was trained that one ought to be conservative in treatment and so I had dutifully turned up for physiotherapy and had traction (what medieval torturers called the rack). The conservative approach resulted in only modest improvement in the symptoms, (tingling in the fingers, weakness in the legs and a constant neck tick resembling Tourette’s) and the golf game.

My wife (a former critical care nurse) finally, prodded me to return to my primary care physician. He suggested that I have an MRI. What a thrill for a Scottish-Canadian to have an MRI! It is easier for Canadians to win an Olympic Gold Medal in figure skating than it is to get an MRI. No one in Canada has ever had one and I was the toast of my extended family in Scotland and Canada.

The MRI showed a significant herniated disk in my neck at c5-c6 and some spinal cord damage. My neurosurgeon explained what he could do. This is not what he said, but it is what I heard. “First, we cut your throat, push the throat stuff aside, we go in, take out the disc, replace it with a piece of bone from Dead Uncle Frank, and screw it all back together with a titanium plate.” This did not sound very appetizing and like a dolt I went for a second opinion to a neurologist (as I recounted in a previous column “There’s No Screen). The neurologist referred me for a second MRI and back for surgery immediately.

My care at Stanford was fantastic and fast: in on the Monday out on the Tuesday, very little pain and very professional and caring staff. Although, even as a non-clinician I did detect enormous opportunities for error, what with the constant handing over from one nursing team to another and the myriad of people who seemed to come and see me, and lots of toing and froing and form filling in various places in the hospital. This led me to the unkind characterization of my patient experience at Stanford as “islands of clinical excellence surrounded by the Department of Motor Vehicles”.

Over a year has passed and the golf game is on the mend. Not brilliant, but enjoyable again. On a visit to Scotland last summer with a whole party of Canadian and American friends, we had a magical day playing the Old Course at St. Andrews in a forty mile an hour wind. I made an eagle on the par 5, 14th hole thanks to the following gale and a brilliant read on a 50 yard putt from my caddie, Willie Campbell. I was back, literally and figuratively, courtesy of American healthcare.

At a recent family wedding in Canada I asked my visiting Scottish doctor friends what would have happened to me if I was still back in Scotland. They said that the surgery was done in cases with serious clinical indications. When asked whether my clinical conditions would have warranted such surgery, they argued that shooting a hundred was not classified as a disability in Britain, indeed Dr. Calum said “Och, they would have told you to play from the white tees and putt better!”

I am deeply grateful to my doctors, to Stanford, and to my health insurers, for restoring my ability to enjoy what is an important part of my life. My story is a metaphor: American healthcare distinguishes itself from other systems internationally by delivering such quality of life improvement albeit at significant cost. Moreover, the quality of life can be improved only if you are well-insured and can come up with the diagnostic down-payment. But should the healthcare system pay for it all? Are there more deserving uses of the scarce resources? And who decides all this? As I have said in this column before, what Americans want is a decent floor for all Americans and the right to trade up with their own money. We need to figure out how to bring this about, with freedom and justice for all. No one should have to give up golf.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California. This column was published in the Summer 2003 Issue of Health Forum Journal.