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Why I’m Leaving My Spine Surgery Practice
From the day I entered medical school, I wanted to be an orthopedic surgeon. I was planning on practicing internal medicine, but on a whim I applied for an orthopedic residency and, much to my surprise, was accepted.
I came out of my residency and fellowship in 1985 on fire, ready to solve the world’s spine problems with my surgical skills.
About six months ago, something shifted deep within me. In the three decades I’ve practiced spine surgery in the Seattle area, I’ve tried to address the whole patient. But I didn’t yet have a clear idea about all the factors that affect a person’s physical and mental health.
In fact, for the first eight years of my practice, I was part of Seattle’s movement to surgically solve low back pain with lumbar fusions. A new device had been introduced that ensured a much higher chance of a successful fusion. Our fusion rate for low back pain was nine times that of New England’s. I felt badly if I couldn’t find a reason to perform a fusion.
Then a paper came out in 1993 documenting that the success rate for fusion in the Washington Workers Compensation population was only between 15 to 25 percent. I had been under the impression that it was over 90 percent. A lumbar fusion is a major intervention with a significant short and long-term complication rate. I immediately stopped performing them.
I also plunged into a deep abyss of chronic pain that many would call a burnout. I had no idea what happened or why. I had become a top-level surgeon by embracing stress with a “bring it on” attitude. I was fearless and didn’t know what anxiety was.
What I didn’t realize was that my drive for success was fueled by my need to escape an abusive and anxiety-ridden childhood. I was a supreme master of suppressing anxiety until 1990, when I experienced a severe panic attack while driving on a bridge over Lake Washington late one night.
Although I was skilled at consciously suppressing my anxiety, my body wasn’t going to let me get away with it. Anxiety and anger create a flood of stress hormones in your body. Sustained levels of these hormones translate into over 30 possible physical symptoms. I descended into a 13-year tailspin that almost resulted in my suicide.
I can’t express in words how dark my world became. I experienced migraines, tension headaches, migratory skin rashes, severe anxiety in the form of an obsessive-compulsive disorder, burning feet, PTSD, tinnitus, pain in my neck, back and chest, insomnia, stomach issues, and intermittent itching over my scalp.
In 2002, I accidentally began my journey out of that dark hole by picking up a book that recommended writing down thoughts in a structured way. For the first time I felt a shift and a slight decrease in my anxiety. I learned some additional treatments and six months later, I was free of pain. All of my other symptoms disappeared.
I began to share what I learned with my patients and watched many of them improve. Addressing sleep was the first step. Slowly I expanded it to add medication management, education about pain, stress management skills, physical conditioning, and an improved life outlook.
I still didn’t know what happened to me or why. Then in 2009, I heard a lecture by Dr. Howard Schubiner, who had trained with Dr. John Sarno, a physiatrist who championed the idea that emotional pain translates into physical symptoms.
Within five minutes of the beginning of Dr. Shubiner’s lecture, the pieces of my puzzle snapped into place. I realized that sustained levels of stress hormones can and will create physical symptoms. I also learned how the nervous system works by linking current circumstances with past events. If a given situation reminds you of past emotional trauma, you may experience similar symptoms that occurred around the prior event.
I felt like I had been let out of jail. I’ll never forget that moment of awareness.
What’s puzzling is that these concepts are what we learned in high school science class. When you’re threatened for any reason, your body secretes stress chemicals such as adrenaline and cortisol. You’ll then experience a flight, fight or freeze response, with an increased heart rate, rapid breathing, sweating, muscle tension and anxiety. When this chemical surge is sustained, you become ill. It’s been well documented that stress shortens your life span and is a precursor of chronic diseases.
Modern medicine is ignoring this. We are not only failing to treat chronic pain, but creating it.
Spine surgeons are throwing random treatments at symptoms without taking the time to know a patient’s whole story. It takes just five minutes for a doctor to ask a simple question, “What’s going on in your life over the last year?” Answers may include the loss of a job, loved one, divorce, or random accident. The severity of their suffering is sometimes beyond words. But once we help them past this trauma, their physical symptoms usually resolve.
What has become more disturbing is that I see patients every week who have major spine surgery done or recommended for their normal spines. It often occurs on the first visit. Patients tell me they often feel pressured to get placed on the surgical schedule quickly. At the same time, I am watching dozens of patients with severe structural surgical problems cancel their surgery because their pain disappears using the simple measures I’ve learned.
I love my work. I enjoy my partners as we help and challenge each other. My surgical skills are the best they’ve been in 30 years. My clinic staff is superb in listening and helping patients heal. I’m also walking away from it.
I can’t keep watching patients being harmed at such a staggering pace. I have loved seeing medicine evolve over the last 40 years, but now I feel like I am attempting to pull it out of a deep hole. I never thought it would end this way. Wish me luck.
IN THE SPOTLIGHT INTERVIEW
BSO: Since our interview years ago, please share with us ways in which you’ve 1) challenged yourself and 2) grown, personally AND professionally.
• I have become increasingly disturbed by this aggressiveness of the medical culture encouraging and even pushing physicians to offer treatments that have been documented to be ineffective in addition to being expensive and risky. Mainstream medicine is pretending to offer care and not delivering on the promise. I quit my surgical practice at the end of 2018 to do what I could to slow down this juggernaut of surgery.
• My main focus is on writing a book, Do You Really Need Spine Surgery? Advice from a Surgeon, that will be published this fall of 2019.
• Other efforts include:
o Creating a business structure to educate the public and providers about effectively treating chronic pain and avoid the pitfalls of surgery. The name of the corporation is, “Vertus, Inc.”
o Chairman of the Scoliosis Research Society non-operative care committee – focus is defining the structure of non-operative care and to define it prior to undergoing surgery.
o Co-creating a software program to teach the DOC (Direct your Own Care) process to patients and providers in a self-directed manner.
o Ongoing podcasts, lecturing, consulting
• My personal ongoing challenge is to become more aware of people’s need’s around me – especially close friends and colleagues. I realized that I have been moving so fast that I am often not really seeing what is right front of me. Even more importantly, I am watching my effect on others. If I am impatient or sharp, I may not see it, but if is perceived badly by others, I want to be aware of their reactions and adjust my behavior.
• I am committed to taking full responsibility for every aspect of my life. It is difficult, as it is easy for me to blame others. However, the benefits have been huge in that I am no longer pulled into a lot of controversy and spend little energy thinking about all the wrongs in my life.
• There is an increasingly disturbing trend to perform major surgery on spines that have normal age-related changes. I retired from my spine surgery practice in December of 2018 to do what I can to slow down the juggernaut of aggressive spinal surgery.
BSO: With what you’ve learned about yourself and all that you’ve achieved, what are 3 pieces of advice you’d give your younger self?
• Don’t take anything too seriously.
• Be nice to people.
• Play – at work and home
BSO: That never ending ‘balance’ question (wellness, career and family). What’s your typical day look like? Or share with us a sample of 2 days.
- I feel that “balance” is a word that creates stress, not lessens it. It implies that there is some way of creating a work-home balance that will make you a happier person. I feel the key is to get happy first and work on staying that way. That translates into a passion for what you are doing, which is rarely reflected in a “balanced” life.
- If balance is your goal, you’ll constantly be judging yourself and your day against what should be happening to create a balance. It takes away from your day. I feel I am better diving into what I am doing with a full commitment and don’t worry about balance.
- I retired in December of 2018 to pursue presenting viable solutions for chronic pain to the general public. My work days were usually between 12 to 16 hours a day and I loved what I did.
- My retirement is almost as busy, and I am working on creating a structure to engage in my mission and also create a more enjoyable personal life. My day begins between 5:30 and 6:00. I work on my writing for 3-5 hours. I catch up on my “to do” list around the middle part of the day and am able to take most
BSO: To function at our highest level and to continue tapping into our creativity, Weekends should be restorative, physically and mentally. What does yours look like?
- I am trying to take one of the two days off of the internet and mobile devices. I am having some success with it. We spend time with friends, playing golf, tennis and I do work out at the gym almost daily. My favorite part of retirement is taking an afternoon nap.
- Am deciding on what hobby to take up. I have historically enjoyed bird watching. I am taking voice lessons.