They say medicine is an art, not a science. You would like to think that your doctor knows what's best and that his or her recommendations will make you better. In some cases, this is true. We have come a long way in the last century. In other cases, the doctor is tasked to choose the lesser of two evils.
Last week, I was shadowing a podiatrist in a hospital. A 69 year old woman was admitted after being hit by a car. Luckily, her most severe injury was a fractured second metatarsal. (The metatarsals are long bones in the middle of the foot where the toes attach.) The fracture was displaced, meaning one piece of bone was slightly off to the side and not lined up with the other piece.
In general, bones will heal if you line up the pieces. In cases like this, surgery is needed to put the pieces together (called reducing the fracture), and the podiatrist will probably use pins or screws to keep the bone fragments aligned to ensure it heals properly.
However, for whatever reason, the patient refused surgery, and the doctor accommodated the patient's wishes. Ideally, we would like the bone to heal as best as possible. But do we want to put an elderly woman into the kind of trauma that surgery entails? Without surgery, the bone would heal—not properly, but it would heal. On the one hand, the bone might not hold and the woman could be back in the hospital years down the road. On the other hand, considering her activity level, she might happily live out the rest of her days and never worry about it again.
In podiatry school, we are tested with questions that have right and wrong answers. However, in practice, sometimes there are no "right" answers. In complex situations like this, podiatrists will not easily come to a decision, but rest assured knowing they are doing what they believe is best.
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