Knees and kneed

+Pictured

Knees and kneed

Jim Vause

Jim Vause

Isolated fiord in typical Icelandic weather...we have had little sunshine
Eastern Iceland

Context: my right knee has decided that with its more distal neighbours the tibia and fibula being “cabrioletted” since they commenced weightbearing, it can only take so much of being genu varum and it’s time to let the brain know

Sixty five years of service delivery seems pretty good for something designed by chance and environment. To those who reckon it's intelligent design, perhaps you are right.

But why, after going to all that trouble to create, in all its perfection, the human body, then build in planned obsolescence? Maybe marketing and intelligent design go hand in hand.

Context: my right knee has decided that with its more distal neighbours the tibia and fibula being “cabrioletted” since they commenced weight-bearing, it can only take so much of being genu varum and it’s time to let the brain know.

Eskifjörður is a charming seaside village in the middle of the eastern Fiords

Quite why it decided to do so just when I was about to start a two-week hike around Iceland, is anyone's guess, but if ACC listens nicely to my fascinating anecdote of downhill antics in the Pyrenees, then I might be able to get a return on all that money I have paid into their investment funds over the past four decades.

Thirteen Kiwis hiking around Iceland might sound a little Roger Hallish, but we have a lot in common, particularly knees.

They're an interesting lot, these knees. None are encumbered by an excess of adiposity and most support reasonably well-off mountain hiking bodies that average 65 years of age. Some of these joints are well known to bone doctors in New Zealand while others are destined for their TLC in the near future, judging from the dinner table discussions.

Eiders are large seaducks

However, the demographics of this group highlights a clinical dilemma that troubles me as a GP. Namely, should I provide patients seeking publicly funded, joint replacements with the information on the surgical criteria and scoring process?

The HDC code has pretty clear advice on what I should do.

The problem is that patient comprehension and use of the thus acquired information causes great inequity, for the persons who gain the most from my information provision, as poorly informed as it is, are not the disadvantaged and the health illiterate.

Isolated fiord in typical Icelandic weather...we have had little sunshine

Comments

The difficulty   with  the hospital   assessment  of   knees and  hips  is  that  the  surgeons  want  the GP  to  fill  in   one score sheet  which has  no  bearing on  the likelihood of passing the  Montreal     hip  and knee  scoring sheet  which  is   a  copyrighted validated assessment  and  there fore  not available  to  General  practice and is  administered in the  hospital Physio  therapy  department. It is  a  pss (  or fail  )  on this  test that determines  the     decision  to  go  on  a  Public  hospital  waiting  list  for  taxpayer   funded  ops  with  in  4 months .

 From  the  patient  point of view   the patient  wants  the operation   even if there is  no  pain just like the umbilical and   inguinal  hernia , repair  or the cataract operation all  of   which , if life was fair  would have the same criteria  for  maximal  gain for  the   dollar whether  patient , Corporate (  ACC)  SX or public  .

 The  pointlessness of a GP  writing a referral simply because  of patient insistence  when they  will  not  meet the  threshold for a public  operation    doesn't seem to  register with  the  majority of  patients.