Archive for December, 2009

Your Expert Doctor May Be His Own Best Advocate

Sunday, December 6th, 2009

One of the rewards of a career in medicine is getting to know people from many walks of life on an intimate basis. This is also true of meeting other doctors who possess many skills including intelligence, wit, perspicaciousness, verbal skills, and so on. I have enjoyed countless hours listening to great teachers lecture on everything from basic science to pathophysiology; from the psychology of illness to compassion for the infirm; from immunology to quantum physics. And on several occasions I have had the pleasure to teach with them and to spend an evening regaling each other with stories of experiences had and some exaggerations to be enjoyed.
And so it was with some regret that I watched NBC News this week promote a new breakthrough in fat destruction that would revolutionize body contouring. The breakthrough is a machine that freezes fat causing the fat to self destruct. The expert was one of my most esteemed colleagues who described (promoted) this technology even though it has not passed through any testing by the FDA (or any other scientific body to my knowledge). He said his group had tested it on 32 patients and found it to be safe. Now look, I can run 32 people across a busy Chicago street and all 32 may make it across the street. Does anyone want to advocate that running across a busy Chicago street is either a safe or effective way of crossing a street? Then he tells us that his studies show that on average a lump of fat on the body was reduced by up to 20%. What a bargain! You come in with a 5 inch waistline of fat and after you pay your dues you can look forward to a 4+ inch waistline of fat!! Any takers? You bettcha. There will be many takers who ante up their 600 bucks to get less than a 1 inch reduction in one small area of the body so they can look the same to everyone except what they might think they see in a mirror.
I wish this was an isolated incident. The truth is that I see experts in medicine, many of whom I have known, selling their reputation for money, or stock, or profit from individual patients. I see experts hawking lasers that have “special” wavelengths to destroy fat, lasers to vanquish signs of aging (Dorian Gray did not have to sell his soul to the devil), and now lasers that destroy fungus under your toe nails. I see anti-aging doctors selling bio-identical hormones as safer than God’s own creation, anesthesiologists selling pain clinics that numb your pain and your brain, and rheumatologists who will repeat your blood tests every month to prove that, yes, you still have rheumatoid arthritis (as if your morning pain told you anything different). I see a callousness among some doctor experts that is only matched by a naiveté and infantile willingness to be a victim on the part of some patients. And when all is said and done I see a public repudiation of accepting responsibility for our own health.
The cure: use your intelligence to evaluate your situation and investigate your possible remedies.
• Get a diagnosis before you get a cure. A laser may be a good tool, but it won’t treat every disease
• The treatment must fit the disease. Spot fat reduction is like wearing a new tie on a crumpled shirt.
• Your expert is as good as the time and concern he invests in you. If his nurse practitioner, physician assistant, medical assistant or other paramedical person is diagnosing and treating you, beware!
• Not all experts are expert. Some of the framed certificates on the wall are certificates of attendance at 3 day courses. There are so many Harvard and Yale certificates of training in Chicago I am wondering if there was a mail-order sale and I missed it.
• Two opinions are better than one. Two doctors in the same community equal only one opinion. It’s OK to travel 30-60 minutes to insure the quality care you deserve.

Edward B. Lack MD

Do You Trust Your Doctor

Tuesday, December 1st, 2009

Today I saw a new patient. She is female, educated, economically stable, about 54 years old. Several months ago she sought treatment for spider veins on her legs. She went to a … laser clinic. The clinic treated her with some injections and some lasers and they burned her skin and her spider veins remained. So she decided what she needed to do was go to a … vein clinic. That doctor did a Doppler test and told her the last doctor treated the wrong veins. What she has are varicose veins and his tests prove it and he can do surgery on her and all the veins will go away. Best of all he will bill insurance and he is sure they will cover her expenses. Today I examined her from head to toe. She is an athletic, trim, muscular female with not a single varicose vein in either of her legs. (For any who might not understand I conclude the vein doctor is guilty of false diagnoses, potential mail fraud, insurance fraud, and at the least patient abuse.)
Now I ask myself, “why would an intelligent person go to a laser doctor or a vein doctor to treat any problem?” Has anyone checked if there is board certification with special knowledge of the circulatory system for laser doctors or vein doctors? If I wanted a carpenter to repair my home and I knew he would use a hammer would I go to a hammer clinic to get help? If I wanted a plumber to repair my leaking pipes would I go to a pipe clinic to get help? Then why would anyone who does not like the appearance of spider veins on her legs go to a laser clinic or a vein clinic without even knowing what was wrong. OK, OK. So she figured out the vein doctor might be milking her for an ill-begot fee. Why was she there anyway?
Here we have a dichotomy of problems. More and more doctors are unethical. You have every right not to agree. It just happens to be true. More and more doctors “doctor” the diagnosis or “doctor” the treatment to get the most money they can from the insurance company or from the patient. When lawyers, politicians, judges, teachers, religious leaders and the rest of society are more and more overtly unethical should anyone be surprised that more and more doctors are unethical? Like the doctors at 2 of the major University Hospitals in Chicago who got caught billing for services that were never rendered and the government levied fines for Medicare abuse that you never read about. Like the doctors who hawk diet programs that at best don’t work or at worst harm people. Like spas that perform surgery (I never knew a spa could have a degree let alone a license to practice medicine).
And at the same time we have patients who do not want to take responsibility for their care, who do want something for nothing as in “bill it to my insurance”, and who do not want to be their own health care advocate. On the one hand patients do not trust the system so that they refuse to enter into cancer trials which save lives and on the other hand they entrust their welfare to gimmicky phrases like “laser clinic”, medical spa (an oxymoron?), and longevity clinic (are there doctors who do not promote longevity for their patients).
Now, I think I can explain the evolution of this problem. Trouble is, that does not solve the problem. So once again I suggest the best way to find a doctor is:
• Use the advice of other doctors whom you trust
• Use the experience of friends and family
• Research the doctor through the internet, the local hospital, the state
• Interview the doctor to make sure you communicate well with each other
• When in doubt get a second opinion from a doctor in a different community
Edward Lack MD