Case #3: Mr. Johnson

     Mr. Johnson is a 31-year-old architect.  At the insistence of his wife, he made an appointment with her primary care doctor to discuss a shoulder problem he’d had for more than a decade. His sports career had been cut short during high school because of an injury to his shoulder. Since high school, he had continued to experience intermittent pain, and he had seen several other primary care doctors, an orthopedic surgeon, and a physical therapist. John had tried rest, heat, and ice, a variety of exercises, an injection, and anti-inflammatory medications, each of which helped but only temporarily. The orthopedist had offered an operation, but he said that he couldn’t guarantee the shoulder would be significantly better afterward.     

      The new primary care doctor took a different approach. He asked, “How does the pain affect your life? What does it keep you from doing?” Mr. Johnson replied that the most important thing he was unable to do was to hunt deer with a bow and arrow, a hobby he had shared with his father and brother prior to the shoulder problem. Then he said, “You know, I’ve seen some deer hunters using crossbows. I could probably do that, but to get a crossbow license I think I would need a doctor’s note saying that I am not physically able to use a traditional bow.”

      His doctor wrote the note, and soon Mr. Johnson was enjoying hunting again.