Health and wellness

Shared Decision Making is very personal!!

At WiserCare, my team builds a Shared Decision Making (SDM) platform and Decision Modules that sit on top of the platform to support a variety of conditions across Urology, Women’s Health, Orthopedics, Advanced Care Planning, Cancers, etc. This combination of the SDM platform and decision modules is designed to help Physicians and their patients make informed and shared decisions resulting in better health outcomes.   To say that we live and breath shared decision making on a daily basis would be an understatement. Given my personal experience in the healthcare space, my work, the growing number of physicians in our family, I spend a lot of time thinking about how we can possibly improve how we deliver and consume healthcare.

This all became even more personal recently when a few weeks back I suffered a fracture of my right Radius in a gym accident. At the end of my hour long personal trainer session that Friday, I was jumping on to a 24″ block set against the wall when I stepped on the edge by mistake and fell backwards/sidewards. In the process which was all sudden I attempted to break my fall with my right hand and paid the price of a fractured wrist. It all happened so suddenly that my personal trainer Chris didn’t even have the time to rush forward and attempt to stop my fall. With some help from Chris, I put some ice on the mangled right hand and had the receptionist call 911. The paramedics came within minutes and whisked me off to nearby Swedish ER.  Meanwhile Chris had called Prasanna from his phone and I let her know what happened and requested her to come to the hospital.

The ER doc and the nurses took charge and very quickly stabilized my wrist after the mandatory local block, some intravenous fluid, pain medication and blood draw for tests. They reset the wrist so it didn’t looks as grotesque and bent out of shape. The pain was somewhat bearable thanks to the block and meds. The x-ray after the reset while better definitely indicated multiple breaks in the bone, so it wasn’t going to be a simple fix. After consulting the Orthopedic surgeon on duty, the ER doctor let me go home with a prescription for some pain meds. I was to follow up with the Ortho the following Tuesday to determine next steps. Meanwhile Prasanna had come over with our good friends Rajeev and his wife Shalini. After providing the needed support and company Rajeev left for a morning meeting. Prasanna and I are so thankful for their support and help.

With my right hand in a temporary cast and in a sling we headed home with Prasanna and Shalini. After we got home Prasanna picked up the medication and then I started the long wait for the Tuesday consult to find out how bad it was and what could be done to fix the problem. To say that it was painful and uncomfortable would be an understatement but I grudgingly dealt with it. It is amazing how much I used to use my primary hand for day to day activities and not having any use for it but it being a handicap in a sling made it that much worse.

Tuesday Prasanna and I drove to the Proliance Orthopedics (partner of Swedish) in Redmond to consult with the Ortho. After a brief conversation with the nurse I was walked to the x-ray machine to get an updated x-ray of my right hand. The surgeon who walked in to the waiting room after a few minutes was a young man who didn’t look much older than our son. Not that it mattered.  He introduced himself as Dr. Lohse and reviewed the x-rays. While reviewing the x-rays with us (showing the specific fracture) he proceeded to very calmly explain to us the various possibilities. Turned out the fractured radius had managed to settle in to a not so perfect position pushing against the Ulna. He explained that if the same thing had happened to an elderly patient he would have recommended letting the fracture heal on its own without surgery. However given my active lifestyle, my age (At 52 I am apparently still considered fairly young!!), and the fact that it was my primary hand, his recommendation was to surgically fix the fracture and insert a titanium plate and screws to support the bone. Not undergoing surgery I ran the risk of lack of full movement and potential arthritis in the next five years.  He said that surgery would be his recommendation if I were his brother or best friend or if he had broken his arm similarly. That statement sealed the deal for Prasanna and I. Overall I felt very comfortable with his recommendation and didn’t in any way feel any pressure to make a decision.

We walked away with a promise to get back to him with our final decision the next day. I requested Dr. Lohse to call and talk to my brother Sundar who is a pain management physician in Chicago. He readily noted down the phone number and said he would be happy to make the call later that day. On my way home I was talking to Sundar explaining to him what happened when Dr. Lohse called him up!! Apparently they had a good call and Sundar felt very comfortable with the diagnosis and the treatment recommendation. I requested Sundar to do a bio check of the doctor to feel comfortable we were in good hands. He called me back in a few minutes to let me know that Dr. Lohse had impressive credentials. He had a BS in Mechanical Engineering from Purdue, MD from Northwestern, residency training from University of Washington and a fellowship in hand surgery from Vanderbilt. Very impressive indeed. In his nearly five years of practice he had performed over 500 surgeries. I couldn’t have asked for a better surgeon to fix my hand.

Overall I felt as informed as I possibly could and decided to undergo the corrective surgery the same Friday. There was no point in waiting once the decision was made. Our good friend Azeem came home to give Prasanna and I a ride to the Proliance facility in Issaquah. We checked in around noon and the anesthesiologist explained the two options of local block versus general anesthesia. I thought the obvious choice would be the local block until I learned that would result in a limp limb on my side for a 24 hour period followed by a pain train. I didn’t like that choice at all. Instead I preferred to be administered general anesthesia that I could wake up from and manage the pain gradually with medication.  It turned out to be the correct decision. Again all of these shared decisions are very personal and another patient may have been strongly recommended a local block and preferred it as well. That’s why getting decision making right is so critical to delivering great health care.

Anyway I woke up from my anesthesia induced sleep in the recovery room after surgery and other than a temporary brace on top of a bandaged arm I felt fine. While I was undergoing surgery, Prasanna and Azeem had picked up my pain medication so we could head home soon after. The recovery has been surprisingly quick given my overall good health heading into surgery. I was on a combination of narcotic pain killer, extra strengthTylenol and Ibuprofen for the first few days. I have been off the narcotic since then and I am just on Tylenol right now. Today I went for my post-surgery follow up and Dr. Lohse was very pleased with the overall progress.  The bone seems to be settling in nicely, inflammation has mostly subsided. In fact I typed most of this using both my hands!! I am hoping to gain full function of my hand in the next few weeks with occupational therapy and can’t wait to get back into the gym and onto the golf course. Wonder if my game will be any better!!







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