Wednesday, July 08, 2009

Better Medicine - You Decide

As I sat in my gynecologist's (GYN) office, hearing the results of some not-everyday-blood and urine tests concerning calcium and PTH (Parathyroid Hormone) levels, I marveled at her intuition of ordering these tests. It had been 50 years since I thought about 'parathyroids' in college level human physiology courses.

Also a specialist, she and I, were considering the next step in treatment of osteoporosis, because my gastrointestinal system does not tolerate oral and more economical choices.

Her choice, which ultimately turned out to be right, was referral to an endocrinologist (END), a specialist.

However, intermixed in her decision was some erroneous interpretations of the tests she ordered, including bone density and blood levels. Instead of analyzing the actual tests and results, she and most other physicians rely on the 'written summary' report, also written by specialists (pathologist, radiologist).

The GYN said I probably had a tiny non-malignant adenoma on one of the four parathyroids, which would need to be surgically removed, a minor procedure.

In the interim between my Endocrinologist (END) appointment I had appointments with my primary care physician (PCP)and my oncologist (ONC), a specialist. The ONC opted to await the results of the END and advised not to rush into and surgical procedures.

PCP ordered a nuclear scan to see if there was an adenoma; if positive, she had a referral to a surgeon ready. But to her amazement the test was so negative, her solution was wait and see. I told her of my appointment with the END, which she advised I keep.

In the final analysis, the END looked past the 'written summary' reports to the actual data provided him, found discrepancies, and made preliminary diagnoses of Vitamin D deficiency syndrome. He did NOT repeat tests. The nuclear scan, he said, was unnecessary at this point. A prescription for Vit D is being tried. This is a relatively inexpensive drug.

Now why am I going into this boring detail?

Four reasons:
1. Medical practice is not nearly as precise, as we, or our government surmises.
2. The 'written summary' opinion of physicians conducting and reading various tests and procedures is often too interpretative, and sometimes erroneous. [One report observed I was missing my right kidney; WRONG, it is my left kidney.]
3. The role and need of a specialist is under attack by our government's rush to a national health insurance program.
4. In the end, which path led to the seemingly correct and least expensive cost?

Who practiced the better medicine for the patient, not the government's perception of economy?

It seems my GYN, ONC, and PPC physicans all arrived at the same decision, but took different routes.

My own evaluation based on this one experience, is the endocrinologist saved the most money, OVERALL. Yes, his fee is more, but surgery is avoided, at least, for the moment. By not repeating radiology and blood chemisty tests, but re-interpreting the results, instead of accepting the summary report, he also saved money.A ball park figure based on previous surgeries, hospitalizations , lab work and radiological procedures, I suspect nearly $50,000 was saved by one visit to this specialist.

Otherwise, I would already be considering unneccesary surgery. Granted, this diagnosis may not be the long-term ultimate outcome.

In the
New York Times today, is an article about current medical practice concerning prostate gland cancer treatments. My brother chose a wait and see attitude, but finally chose surgery. Bth time the physician recommended treatment, the cancer was protruding outside the prostate gland. According to physicians, they did not get it all, but it seemingly has not spread further.

Also, in an earlier New York Times, a disasterous VA prostate treatment is exposed. Neither our veterans not our government deserve such malpractice.


Arkansas Patti said...

I have no idea which is right. I do believe we are over tested. Our doctors are a crap shoot. Anyone can miss something, we can only hope it is not on us that he/she misses.
I was once misdiagnosed for 10 years so I am not very trusting of doctors.
Am so glad you dodged surgery and found an easy fix. Stay well.

Pat - Arkansas said...

I agree that our medical system is "bent," and needs repair but not to the extent that it needs to be fixed by the presently considered means.

I'm so glad you have an intelligent and knowledgeable endocrinologist.

Get better; stay well. :)

jinksy said...

Goodness gracious - it seems America is as good as England at giving us patients the run around! Good luck with your latest diagnosis...:)