Let’s Get Personal

What should I do to provide the most cost-effective care to soothe the pain in Joe’s throbbing shoulder? Do I think only about Joe? What is the place of systems-based practice? Where do I factor in the reluctance of some to spread the money around as required by any insurance system, whether supported by taxes or healthcare premiums?

In my mind, I can see a few options that I can frame as a multiple-choice question. What should be done for Joe the Plumber’s aching shoulder?

1. Prescribe a nonsteroidal anti-inflammatory drug and teach Joe some exercises;
2. Inject the subacromial space with methylprednisolone (DepoMedrol);
3. Perform an ultrasound, and then do the injection;
4. Send Joe for the MRI that he requests; or
5. None of the above.

Let’s get personal. I know what I would do for Joe. What would you do?

Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.