by Dr. Kenneth H. Cohn

As I mentioned last month, I began an inadvertent fellowship in orthopedics when I slipped on the ice and fractured my right wrist. In my saner moments, I reflect on how many more things I can do with my left hand now and how much more empathy I have for people in casts and members of our armed forces who are missing extremities.

Recently, I extended the learning process to dermatology, when I developed painful, red, itchy lesions on the fingers of my right hand that made me feel like red ants were nesting inside my fingertips. In retrospect, I made the error of telling the dermatologist that after 10 days of not sleeping well, I was feeling fatigued and that morning on a cold, wet morning in New England, I felt chilled. He took a biopsy, wrote me a prescription for a course of oral steroids, and sent me for blood tests, which took about 20 minutes to draw due to my poor-caliber veins from chemotherapy for lymphoma several decades ago.

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Imagine my surprise when, two hours later, he called me to say, "Now that I have had a chance to sit down and dictate my findings, I realize that you need to go somewhere to get blood cultures and be worked up for SBE (subacute bacterial endocarditis)."

SBE is a term that makes clinicians perk up their ears because it can be fatal if untreated. So I went to my local emergency room, not knowing where else to initiate the workup at 3:30 p.m. There, I learned how healthcare is wasteful, because even though I gave the hospital personnel the name of the laboratory where I had my blood tests earlier that day, they redrew all of the bloodwork rather than calling the other lab. "The money wasn't coming out of their pocket," I thought, now that I had switched from a health insurance policy with a $1,000 to a $3,000 yearly deductible to save on monthly premiums--which had risen 26 percent in a year.

The good news is my blood tests were normal, the echocardiogram displayed no evidence of bacterial vegetations on my heart valves and the biopsy of the skin lesion was diagnostic of chilblains, a benign condition in which blood leaks out of small blood vessels after exposure to cold, followed by rapid rewarming. The suspicion of SBE also kept me from taking the oral steroids I had been prescribed.

But the real gift is that I appreciate the full use of my hands even more than I did a few months ago, and that I am relearning the lessons of patience, humility and self-acceptance that I only thought I had mastered during chemotherapy. Living in the present and not reliving the fall or wondering about the differential diagnosis of the finger lesions is an ongoing, iterative journey.

Ken is a practicing general surgeon/MBA and CEO of HealthcareCollaboration.com, who works with organizations that need to engage physicians to improve clinical and financial performance in this era of healthcare reform.