Second and Third and Fourth Opinions

I'm afraid that the only lesson that most physicians will take home from "A Shoulder to Cry On" [Oct. 11] is: No good deed will go unpunished. If we do everything we know for a patient and follow the standard of care, many of our patients will still be very unhappy with us.

But we are used to it. We may not expect to see ourselves disparaged in the newspaper, but we all must learn to live with the fact that our care may not result in the improvements we hope for.

Why do people feel the need to cast blame? My theory is that it is out of fear of loss of control. We want to be able to trust the systems around us; we build mighty structures to protect us from harm. But pleasant though this illusion may be, it is still an illusion: We are not in control of most things in our lives.

Yet many patients seem to accept what has happened with equanimity. However they come to this inner peace, they not only do better spiritually but often physically as well.

Margaret Fisher, MD


Robin Wright shared some valuable lessons with readers, but others should be included.

The first is that if you have any doubts about your treatment, as she seemed to in regard to the cortisone shots before the first surgery, get a second opinion.

Second, write down questions as you think of them before your appointment. Especially if you are already in pain and discouraged, it's easy to forget what to ask.

Third, always take someone with you to surgery to be your advocate. It's not a bad idea to take someone with you to office appointments, either. Again, pain and illnesses are distracting; it's easy to miss explanations and instructions.

Fourth and most important, get your primary care physician involved at the beginning. This is your ombudsman, the person who can get through to another doctor for questions you haven't asked or to help develop a treatment plan.

Elizabeth Kingery, RN, BSN

Chevy Chase

The article only serves to emphasize: (1) why extreme care has to be taken in dealing with limits on medical malpractice lawsuits; and (2) that insurance companies are extremely negligent in paying for authorized care that is performed in an incompetent and careless manner.

Perhaps if the insurance company had stepped in at the first sign of repeated and questionable injections, multiple surgeries and unfocused physical therapy, denying payment to the health care professionals involved and holding the patient harmless for the charges, someone would have questioned and redirected treatment.

Randy Rawson


Shoulder, joint and back pain are incredibly common in life and medical practice. This is probably because they often do not represent treatable disease, but wear and tear.

I have a similar problem to Robin Wright's with a rotator cuff injury, as well as a possible herniated disk in my lower back. I sought the advice of an orthopedist and neurosurgeon to evaluate both problems. I also received a cortisone shot for my shoulder, and the pain recurred within a week.

However, at that point I had a frank discussion with my physician. We agreed that the problem would progress slowly, and that it was okay to take a fair amount of ibuprofen to control the symptoms. I never expected resolution of pain, merely toleration. I still have daily, even hourly pain from both areas, but I am well aware that surgery could leave me worse off.

It is possible that my physicians were more honest with me because I was a physician, but patients should realize that if their doctor tells them to tough it out, they may be giving them the best advice.

Jeffrey Young, MD

Keswick, Va.

Robin Wright likely seriously increased her problem by not promptly changing doctors. She knew she was not getting good treatment, but she "wanted a clear chain of responsibility."

I am an attorney with significant experience on personal injury cases. In some cases, whether the injury stems from medical causes or accidental causes, clients ask me what they can do to increase liability or damages. I have always told them to forget about that and focus on getting the best health care they can. No amount of money will compensate them for a bad result.

I would be willing to bet a large sum that Wright, if she could do it over again, would not make any decision based on keeping a clear chain of responsibility.

Leonard Koenick

Fort Washington

Seventy-five million Americans suffer from chronic pain and most are not receiving the treatment they need. There exists a severe lack of services to specifically address their unique needs.

Pain Connection Chronic Pain Outreach Center is a nonprofit organization that provides support groups in the Washington area, community outreach and education, and a Web site to help sufferers, their families and the community.

Our support groups help people explore their options, learn coping skills and offer "a shoulder to cry on." We can be reached at 301-309-2444 and

Gwenn Herman


Pain Connection

Chronic Pain Outreach Center


It is frustrating that so many of us get little relief from contemporary medicine. After performing major neck surgery, my doctor told me that my new after-surgery pain was only water on the shoulder -- and that it would go away. I am still waiting, 15 years later.

Remarkably, I have found the most caring medical practitioners to be vets; every time my rabbit or dog has had some sort of procedure done, the vet's office has called to check up on the pet. On the same day that I had a colonoscopy, my dog had his teeth cleaned -- the vet's office called to ask how my dog was; my doctor never even took the time to see me after surgery. If I do have to have a medical procedure some time in the future, I'm definitely calling my vet.

Joan Murray