Posts Tagged ‘find a doctor’

There is no Team in Medical Specialist

Tuesday, May 25th, 2010

Peter (not his real name) developed a red spot on the tip of his nose 2 years ago. He is now 16 years old. Last week the spots became more red and formed 2 blisters. His mother took him to a board certified plastic surgeon. The surgeon told the mother he didn’t know what the lesion was but that he could cut it out. He advised them Peter would be left with a permanent scar on his nose.
A 30 year old man told me every time he sees his dermatologist the doctor removes a mole from his body. A mother told me her dermatologist removed 6 moles at 6 different times from her 16 year old son. The moles were said to be “suspicious”. The moles were all benign!
A man came to me and said he had a lesion removed from his face. The doctor told him the biopsy showed “it was nothing”!!
A patient with arthritis was seeing a rheumatologist. He saw her monthly and did repeat blood tests each month which showed no change in her condition.
The chief of orthopedic surgery at one of our Chicago university hospitals billed a patient for a complete physical exam while she was in the hospital. He never saw her!
A patient went to a plastic surgeon asking for help with her neck. He did not comment on the anatomic abnormality which caused her neck appearance or on the obvious bone erosion of her chin due to a 35 year old chin implant. He offered to raise her eyebrows and do a facelift. (I raised my eyebrows too.)
An allergist did repeat series of allergic skin tests in a patient with eczema. The patient cleared in 2 weeks with a prescription for antihistamine.
The stories go on and the conclusions are the same. Many patients experience inaccurate diagnoses and needless care at the hands of medical specialists. The reasons are numerous and include the fact that payments are higher for performing a procedure instead of using diagnostic skills; reduced reimbursements lead to doctors spending less time with patients; failure of any effective oversight for medical care.
Yet the most overlooked cause may be the patient. Last week I did an informal survey of 10 consecutive patients. I asked each if they had seen a primary care doctor in the past 3 years. None had done so! In fact most did not even have a primary care doctor. Patients are self-referring to specialists, which raises the cost of medical care and deprives a patient of the managing expertise a primary care doctor brings. Most of us doctors spend little time in hospitals and because of that we rarely see each other. We certainly don’t talk to each other about our care for a mutual patient or whether our treatments conflict with one another. We don’t discuss what is best for the patient. This is the role of a primary care doctor. The patient who thinks the specialist is smarter than the primary care doctor is cheating himself. He exposes himself to abuse of possibly less ethical or less concerned specialists. He not only gets poor care, he deprives himself of the opportunity to get proper care. The team concept simply doesn’t work without a manager. Following my own advice I made an appointment to see my primary care doctor today. I suggest you do as well.

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