Really have no sympathy for a health system administrator who’s job is to pester down needed treatment to justify their likely 6 figure salary.
On substance abuse, why do you seem to be the only one concerned if it is, as you say, obvious? 20 years is a long time to hold this information, or grudge.
On Doctor not advising. he may have had an unpleasant experience with someone who took his advice but was disappointed with the results. On the next visit, ask him.
3
I am appalled at the reported behavior of the urologist. As a retired physician, I'd kick that doctor to the curb!
What no one here has addressed, and I find it glaringly odd, is that not everyone in the USA has access (training, ability, faculty, etc.) to do research online. Sure, almost everyone has a cellphone, but that doesn't mean everyone has full "access" in the USA. And not everyone can make it to a medical library, etc. to get help. Maybe they live far from one with no good transportation. Perhaps they are anxious in such circumstances. I've seen people, such as my own father, really up their game when faced with a cancer diagnosis, and learn to do excellent research. But my father was middle-class, college-educated, lived in a city, drove a car, was white, owned a computer, etc. And he still wouldn't have made it through experimental chemo without his oncologists holding his hand. The onus cannot be completely on the ill person. Or their support system. Access depends on socio-economic-status and a myriad of other factors. Access depends, so far, on privilege.
30
When my husband was diagnosed with Prostrate Cancer his urologist recommended that we both read Surviving Prostrate Cancer by Patrick Welch before we met with an oncologist. He explained that this cancer was different for everyone and wanted us to understand it fully before the appointment. It was very sound advice and helped my husband decide on the appropriate course of action for his situation. Reading the book and discussing the options was also healthy for us as we began on the road to battling cancer. Thankfully, my husband has been cancer free for almost five years. I have recommended this book to countless others.
35
This is so totally unbelievable. You are told you have cancer. Then like a child who doesn’t know how to swim, you are thrown into the deep end. So many are commenting as if this cancer treatment is widely known among all of us. Not to me, evidently it wasn’t to the patient. Where is compassion, absolutely none. I would want the doctor to advise me, guide me. Research? Isn’t that what doctors do? Like has been said good information out there yes but as a patient with cancer how are you supposed to know the difference? Doctor do your job! I hope if I or one of my loved ones are ever diagnosed I don’t get his kind of doctor.
24
No one tries to stop the drunk physician from driving?
The doctor needs his colleagues to confiscate his keys and either drive him home or call him a cab. If he insists on driving tell him they will call the police.
His family is undoubtedly aware of his alcoholism, unless he lives alone, in which case they may not know the extent of the problem. If so, they should be told of his propensity for driving while drunk.
19
I believe in a simple theory of hiring "experts".
Recognize in every barrel there is a top third, a middle third and a bottom third. Try and get at least middle third and preferable a top third experts. No guarantee of any success, but it looks like you got a bottom third this time.
I have what I think is a top third doctor (but how can I really know?). When i ha a problem he sat down with a sheet of paper and drew a matrix explaining three "normal" courses of action. We then chose one based on his recommendation. (second part of the top third approach is from the book "Up the Organization" written in the 1960s. "When you hire an expert, don't tell them what to do.")
Maybe my doctors previous work in the military made him more open to a matrix?
6
I cannot believe that someone who considers themselves an "ethicist" thinks that only family and friends are appropriate intervenor's for someone risking others lives (not to mention their own!) by driving inebriated. Drunk driving is illegal and unethical, and *any* person who knows that it is about to occur has a direct responsibility to call the police. I suggest that the ethicist does some refresher courses as it seems to me they don't have a clue about right and wrong. What other crimes does he think should only be resolved by family and friends? I am deeply disappointed at what I just read.
16
I hope you share all these responses to the totally unacceptable care you received to your ice cold doctor. Incompetent and out of the realm of expectations from a good, qualified, and decent doctor is all that can be said of him.
10
We don't know precisely what the doctor said, we only know the patient's interpretation. Criticizing the doctor based on the statements in this letter may be unwarranted.
Prostate cancer is extremely complex. Each case is unique as is each patient. All of the treatments carry risk of adverse side effects and the fact that someone you know had success with a certain treatment is no guarantee that you will have the same outcome.
Prostate cancer strikes the young, old, healthy and infirm.
Most prostate cancer treatments leave the patient with varying degrees of incontinence and impotence. Each patient needs to decide which treatment gives them the best chance of an outcome they can live with.
Finally, there are lots of resources on and off-line. It is up to us to determine how reliable they are - consider the source. Support groups (online and in real life) were helpful and educational for me and with a little patience you should be able to find a group, or groups, that you can learn from.
4
@Bob M
There is a world of difference between saying that the patient needs to make his own choices about a complex range of options based on his personal values, and saying that the patient should do his own research in order to reach those personal decisions. Interpreting medical information is not easy, nor is know which sources to trust. Presumably the physician has that type of training. He should be helping this patient gain the understanding of the range of treatment options and their relative effectiveness given his particular type of cancer. Anything less is unethical.
27
Seems this doctor has been in practice for a long time and has had it. You tell someone they have cancer tell them they can pick plan A or B. And say you are on your own now? So much for bedside manners. I know inevitably it is the patient’s decision but come on that’s what they get the big bucks for. He could have said “Listen John, I know you’re scared but trust me you should talk to dr. So and so or Dr. they will advise you what you should do next. And help you. Sounds as if he was passing the buck.
13
There is a wonderful source of objective health information available to the public called MedLinePlus, a platform of the the National Library of Medicine.
If you aren't sure about the information, please reach out to a medical librarian. Many hospitals have them. If you're not sure whether your hospital has one, just ask. You could also reach out to your public librarian--many librarians reach out to one another when researching outside of their fields of expertise. We are here to get you the information you need in a way that you can understand and use. It's not interrupting, it's our pleasure.
11
@Mary Shah, MLS AHIP, again, that is a workable suggestion for someone with at least a college education, an ability to read complex medical material, and the critical thinking skills necessary to winnow through vast amounts of research results to yield a decision. One of the most important functions in the physician-patient relationship is the clear communication of viable alternatives and their pros and cons. Had it been one of my doctors, I would have sought someone more able to help me come to an informed decision.
13
No. 1 I thought the doctor who sent the patient out on his own to gather info & decide for himself was incredibly horrible & shirking his duty. The least he should have done, if he was unsure of what treaatment would be optimal for his patient would be to recomment an oncologist - not leave a patient with a serious medical problem dangling in the wind.
17
If the urologist merely told the patient to "do his own research" that's awful as information on the internet ranges from excellent to terrible and inbetween . I hope and suspect that the patient was actually given some specific sources of appropriate information and told to review them and choose. Of course the urologist should also have offered to go over any questions the patient may have had after reviewing the information. If there were a "best" treatment there would be no discussion. Some people put maximizing the odds of long term survival above all else; others may place higher value on better odds or retaining urinary continence and/or sexual potency so the physician cannot decide for the patient.
6
The choice of treatment for (localized) prostate cancer is a no-brainer. Surgery and radiotherapy have the same survival rate success, but radiotherapy has almost no risk of incontinence and is noninvasive. Case closed.
Nevertheless, most urologists will recommend surgery (although a majority of men will correctly choose radiotherapy).
Why? The common explanation is that urologists are trained as surgeons and thus biased. A more sinister explanation is that urologists receive significantly larger (illegal) kickbacks for surgical referrals.
So perhaps you should be happy your urologist refrained from making a recommendation.
BTW, there are excellent websites on these and other health matters from the NIH, the American Cancer society, even the Wikipedia.
3
@gs
Like as if nobody ever sustained radiation burns with radiotherapy?
Not arguing that, to a carpenter, everything looks like a nail, but just show me the site that does more than just *mention* radiation burns, their frequency and complications. There's an up side and a down side to everything, and (given that everyone has their own skill set) in the final analysis, a key factor is the track record for the facility and provider of the treatment.
Think twice if there's a problem with having a reasonable discussion of success and complication rates.
Believe me, I know it's a tough call at a rough time, but o/w it's simply a roll of the dice.
6
I have yet to see a newspaper article about doctor’s care that realizes the complexity of decisions doctors make everyday. Every situation is different, every patient is different. The textbook examples are only that. Doctor bashing. Remember, MD really just means “make decisions”. No one really likes to make decisions since it always leaves the possibility of error. No professional is a monolith. Doctors are people.
5
“Why not consider telling him that you’d need more evidence to act on those earlier offers, ..”
Calling him a liar isn’t the best way to start. Companies promise all kinds of things to get valued employees, and more often than not those fizzle. I give the doctor credit for being patient, but it’s time to move on. It’s clear they will never abide by their word. And the word of an earlier administrator should be as valid as the current.
4
You should be getting the advice of an oncologist, not a urologist. If I'd have been your urologist, my advice to you would have been to start interviewing oncologists. If I had a name or two that I could recommend, I'd pass their names along to you. Urologists don't treat cancer. Oncologists do.
10
I am in exactly the same situation as the writer has cancer. I was just informed that I have prostate cancer with very similar test results, and now I am left to decide.... should I have radiation or should I have my prostate removed.
I’m not a doctor. I have no medical training whatsoever and yet I’m supposed to make this decision for myself. It’s a very difficult choice to make because there are pros and cons to both treatments. The original urologist who made the diagnosis had an excellent bedside manner and was incredibly empathetic, but he still left the whole thing up to me. I’m 54 years old and this is the first time I’ve been presented with this kind of a Hobson’s choice about my own medical care. I’m going to MD Anderson in Houston to talk to them about radiation next Monday. Wish me luck.
16
@Mike Friedman
OMHO, probably the worst place to go!
@Mike Friedman
Mike, best luck!
Consider Proton radiation. It is so different from other treatments. It may not be right for you just look at it before deciding. I was at California Proton Center two years ago. If you call, they will give you contacts for other men who have happily survived your situation. If you have a biopsy Foundation One will return a list of genetic mutations. That will tell you how aggressive your tumors and how likely it is to metastasize.
7
A cancer diagnosis is always hard to hear and we're sorry that this doctor didn't offer more support, both emotionally and practically. There are multiple treatment options for prostate cancer, different at different stages, and types. Treatment decisions should be dictated by the biology of the cancer as well as the man's overall health, age and personal preferences.
Not all prostate cancers are the same. To better understand the differences, a patient should get a second (or third or fourth) opinion, including on pathology.
After better understanding his specific cancer a patient needs to learn about the treatment options possible, and choose what seems best for him, given the cancer's biology as well as the potential side effects and their timing. Meet with at least two prostate specific surgeons, radiologists and oncologists, who can help the patient to understand his cancer, treatment options and side effects.
It takes time and research as well as second opinions. The doctor would have better served this man by referring to prostate specialists and resources (such as online websites of the NIH and the NCI), and to one of the many reliable free advocacy, support and educational groups ready to help a man understand options and make specific decisions, including our patient run nonprofit www.CancerABCs.org, which provides free written material, support groups (face to face and online), forums, blogs and other educational materials and support.
9
I think the doctor should just quit practicing. His patients go to him for care and advice and he sends them to the Internet. His patient was ill served. Let’s look at the fact that this was a long time patient who has supported this doctor for years and whose medical issues were well known to him. Who better to help him though the difficult task of choosing a treatment program but NO the doctor took his money and shirked his obligation, not to choose for the patient but to walk him through the analysis that would help him choose.
Why he did it? laziness, fear of litigation ? Who cares? He let his patient down and he should be ashamed.
14
Whenever you observe someone - anyone - driving impaired, please call 911 and report it.
15
The doc's response to the prostate cancel patient was absolutely right if a little insensitive. And the patient's response is symptomatic of what ails our nation. If the patient is to ignorant, or lazy, to research a procedure vitally important to his own health why should he be allowed to vote? Would he investigate a candidate's policies for how they affect our nation's health--or ask (Fox) news to tell him how to vote?
@roger craine: Those are very poor analogies. (And is there really no context now in which politics will not be inserted?) Doctors are what the law calls "learned intermediaries." That means it is part of a doctor's job to communicate complex medical information to patients at a level they are capable of understanding. No package insert, pamphlet, or website can do that because package inserts, pamphlets, and websites can't tell how intelligent their readers are. At the very least, the urologist should have steered the patient towards appropriate and reliable on-line sources of information. The better practice, as many others have noted, would have been to refer the patient to an oncologist.
14
To the guy complaining that his doctor didn’t advise him on what course of treatment he should pursue, you got a taste of what women go through all the time. How do you think it feels to be told you can remove your uterus, or not — your choice. Or you can remove a breast, or both, or not. Think it over and get back to me.
I can tell you from personal experience: it stinks.
Doctors can’t decide for you, but yours should have at least provided handouts on prostate cancer, and referrals to a specialist or counselor. Did you expected more personal “friend” advice, based on your long time in his care? It’s not his job to be your buddy.
I’ve been furious over the cold detachment of my medical caregivers. But I remind myself that I’m just another billing code to them, in the end. They don’t have to like their patients. When they fail me on follow-up and options for treatment, Google is the ”friend” I turn to for advice. Sometimes I find useful research there. Don’t dis Dr. Google!
Most recently, I researched vertigo treatments online (I have been suffering from severe vertigo and fainting, for which my doctor gave me a handout on the Epley maneuver and told me to drink lots of water). I found a study showing Ginkgo biloba to be effective. I started taking it and — hallelujah! — it was as if gravity returned and the merry-go-round I’d been stuck on for months had finally come to a halt. No more spinning wheels going ‘round. Thank you, Google. No thanks to you, Dr. X.
9
Re: Prostate cancer diagnosis. Even if a physician provides confident advice about treatment, cancer survivors may benefit from:
1. Obtaining 2nd opinion. Find a radiation oncologist who has experience with prostate cancer patients. Try the Prostate Cancer Foundation: www.pcf.org/patient-resources/patient-navigation/find-a-doctor/
2. Consulting a reliable Dr. Google source for your own research. Try the National Comprehensive Cancer Network for a detailed but non-jargony discussion of diagnosis, staging, and treatment here: www.nccn.org/patients/guidelines/prostate/33/index.html#zoom=z
3. Finding a local support group, or asking for a peer-match to someone with your same diagnosis. Try the American Cancer Society (www.cancer.org) or Imerman Angels (imermanangels.org).
Peers are unique sources of info for the newly diagnosed. They know the uncertainty, decision-making, and post-treatment consequences. Most medical professionals don't have personal experience with the diagnosis they are discussing. Certainly get their professional advice, but consult the non-professional experts as well.
6
My husband was diagnosed with prostate cancer four years ago, with a Gleason score of 6 (less aggressive than the writer's). We had the same uncomfortable discussion with his doctor on the options, and the doctor offered no advice on which treatment was better. I too thought it was bordering on malpractice until much later, when I was having a discussion with our broker. The broker kept asking, "what is your risk tolerance? Where will you be comfortable?" I realized that the doctor had told us that for my husband, radiation represented a 95% chance of cure but with these side effects, and surgery represented a 98% chance of cure but with another set of side effects. The question wasn't which therapy was better, but rather where was our risk tolerance. We spoke to friends and to Dr. Google and my husband chose radiation. Four years later, he is still cancer free. He was not pressured into a therapy which he might have later regretted, and this was because his doctor was unbiased and made us make the decision.
9
Regarding LW#1......... Your experience is not unusual. I had the same answer given to me , with pamphlets on the 2 processes.
Delving into it, I found subsets in the 2 choices..... Surgery?.... Robotic or Traditional! Radiation?..... Traditional or Seeds! Then, I found another choice... Freezing!
I visit all the speciality Docs and hear I am a great candidate for each treatment type; Great help, huh??
Months pass and I have a check up with my GP; who says to me... "No decision is a decision". Did I rip him a new orafice...told him exactly as I felt. Thrown into the netherworld and left to flounder on my own!
5
For the first guy: get a second opinion. But first, get a first.
5
At around 70 years old, I began to have rising PSA. My Primary care doctor referred me to the Urology department at the VA Hospital Center where I go for care. So began a two year battle with VA Urology who insisted on performing a biopsy, and me (and my Dr Google) insisting on first having an MRI. I provided studies from various medical journals, that were very clear that the protocols were changing towards non-invasive testing prior to biopsy. In the end, I had the MRI performed in France on a trip there, and the radiologist was very clear - no need for a biopsy. The VA urologist, not to be outdone, wrote in my medical record that I had been offered an MRI, but refused it! Not sure, but this smacks of malpractice. Any thoughts on this?
5
File a complaint, and insist that your medical records be corrected. The MRI should be added to your file. Out of curiosity, how much did your MRI cost in France?
4
@ST MRI with contrast all in cost Euros 240 about $265 State of the art machine, and experienced radiologist. People in the US have no idea of the degree to which they overpay everything.
7
@Walterk55 I do - I’m also a UK citizen. Good for you; biopsies are not trivial. But definitely file that complaint and insist that your file be corrected and updated. You have a right to do that and you can complain to the state medical board and a federal agency (I forget which one) if they refuse to do it.
4
A friend gave me the best advice when I was diagnosed with prostate cancer. Seek several medical opinions. Speak with others who’ve had different treatments. Go with the doc and treatment with which you’re most confidently. Boy, did I learn a lot. Unfortunately, some of it was discouraging. A couple of docs seemed to be pushing the treatment that would get them the most money, even though my own research didn’t support it. Example,seeds are risky and unnecessary in many cases. But one doc pushed that treatment. I found a very caring radiation oncologist and staff. Received 47 treatments of IMRT radiation. Suffered no side effects and am cancer free 15 years later. As my friend had said. Do your homework. This is the most important decision of your life.
9
As a physician, rather than complaining about patients seeking "Dr. Google" for answers, why are we not pushing for a national, accredited, patient information database that would provide the opportunity for patients to become educated about the basics of health? Having patients 'in the know' could markedly improve outcomes and reduce healthcare costs. It could provide preventative guidelines, nutritional information, how to read a blood test, the basics about medical conditions, how they are diagnosed, 'staged', evidence-based and gold standard treatment recommendations, updated on a regular basis. Adding a registration feature to allow for achieving points for 'learning' could be used for premium reductions or food coupons.
For too long we have had this patriarchal medical system where 'the doctor knows best'. We force patients to come in every quarter before we'll refill their medicines when they could very easily be checking their own blood pressures and getting their own blood tests and making adjustments based on parameters.
As soon as we start catching up with the Chinese, we can implement AI to sort through medical data without biases, memory issues, or 'bad days' and render the primary care physician obsolete. Then the doctor will be there to comfort the patient. I'd much rather be treated by advanced machine learning than by one of my cranky, distracted colleagues.
12
My doctor offered me the same options for prostate cancer -- then referred me to a team of specialists; one surgeon doing prostatectomies and one doing radiation, together with an oncologist who followed patients with either approach. In the end, I followed the oncologist's answer to the question: "You're about my age. What would you do?" The result: 19 cancer-free years. Is this man's case an example of declining practice today?
10
After being told I had a disease for 10 years, the oncologist said I couldn’t have that disease because my bone marrow was beautiful. And he didn’t know what I had.
I know you said some negative things about Dr. Google but in my case with my researching I found out what I had. The next time I saw my set of doctors I asked them could I have this? Each one said yes I think you have that. Unfortunately then there were no direct tests for it or buy illuminating other possible look-alikes I was told in fact yes you have that disease.
The reason I’m writing this is to say don’t always put down Dr. Google. Some people are great researchers and are analytical and can make the diagnosis themselves. Unfortunately the 10 years of misdiagnosis left its mark and I am disabled now.
17
@Jamie I have benefitted from impartial web research several times over the years. Surely an intelligent person can distinguish between reputable sites like the Mayo or Cleveland Clinic and the latest herbal potion claiming miracles at a hefty price. Doctors today are rushed and, often, long past their training years with little time to research current thinking or discoveries.
8
@Jamie I have also benefited from web research into my conditions. I'm so sorry this happened to you.
2
Thank you so much.
1
Re: LW3: As an advisor to a law school's labor rights clinic for almost a decade, I was consulted about dozens, if not hundreds, of people who were made vague promises about their job that were never fulfilled. It happened more at lower levels of employment, but it happened to professionals as well. There is almost no way for the organization to recover from the lack of trust that such loose promises create. In this case, I agree with Dr. Appiah's advice, which is essentially to be as honest as you can, and try to work out a new, mutually satisfactory arrangement. However, the employee will almost certainly have lingering resentments, and will definitely have them if the new promises are not fulfilled, even if there is a good reason. I would be prepared to find out that the employee wants to leave, and perhaps the LW should even suggest that the employee look for other work (with good recommendations from the organization). This is a delicate situation, but having a disgruntled employee in an important position can affect the morale of the whole organization.
7
Re: the last question. I am a doctor who has been lied to by my employer. When I tried to talk to the new administrator about it I was blown off. So I quit a couple years ago and they haven't been able to replace me. The physician admin might want to take the doctor shortage into account and do the best he can to keep his doc happy.
14
After I broke my wrist cycling, i saw several orthopedic surgeons, none of whom would tell me what to do, they would only tell me the options. I finally pressed the last one, asking what he would do, or what he'd tell a family member to do. When he said he would go the surgery route vs. months in a cast, that's what I chose. But I felt that it really took pressure to get a definitive answer.
15
Doctors have a legal obligation to inform patients of the treatment options and the risks and benefits of each option so that patients may make an educated decision—I.e., informed consent. This is also required by the AMA code of ethics.
12
@MainLaw Nowhere in his letter did the writer indicate that the doc had not given him this information. He simply said that it was up the the patient. The patient finally asked the doc what he would do for his family, and the doc told him. What's the problem?
4
The best course of action is to go to one of the top cancer centers in our country and meet with a surgeon and a radiologist. Then you can make an educated decision based on the expertise of the specialists.
5
@nowadays
Unless it is a rare type of cancer, each type of cancer has 'standard of care' treatment regimen based on the cancer cell type, lymph node involvement and whether there is metastasis or not. These treatments, like all modern medical care, is based on the results of replicable research and clinicians, the dispensers of care, simply follow this 'evidence based care'. Why, during this day and age, one must feel obligated go to a 'top cancer center' to get appropriate care when the standard of treatment should be readily available no matter where one is seems rather illogical. There are companies now profiting off of entering your cancer data into an algorithm in order to determine your best treatment option. They charge patients around $3000 for this.
2
Because of a persistent throat clearing situation, I was referred to an Ear, Nose and Throat whose diagnosis was Silent Acid Reflux. I asked him why could it be and he said it was “my diet” and I should follow a strict antacid diet and take strong long term daily doses of Proton Pump Inhibitors. I never had before acid, and no one in my family ever did, so I Googled my symptoms and found out that the bacteria H Pylori was often responsible for sudden Acid Reflux, so I asked that doctor for a test. He reluctantly agreed and, sure enough, the results were positive. H Pylori responds to antibiotics, so after a strong course of these I came back and asked him to stop the Antacids. He refused to, telling me I had to remain on those for 1.5 more years “to teach my stomach to make acid again.” 3 more doctors, including 2 GI specialists, had never heard of the need of such a long taper period. To make a long story short, I ended up with a precancerous polyp. By the way, untreated H Pylori leads to cancer. If I hadn’t done my Google homework, who knows what would have happened to me.
13
@Don Upildo
I doubt that untreated H. Pylori simply "leads to cancer". I suggest that it increases the risk of cancer, by how much I don't know, but it seems you should get more precise information.
In my opinion, the urologist may not have acted unethically, but he certainly let down his patient with prostate cancer, and didn’t do his job.
I am a physician who was diagnosed with prostate cancer in my mid 50s. Despite the fact that I could read as much literature as I wanted, and had physician friends who could offer some guidance, I was still terribly conflicted for some time on what course of treatment to pursue. In fact, I asked one of my doctors the same question as the patient did, and got the same answer- “I can’t tell you what to do, do your research “.
I feel that our job as doctors is to present treatment options, but ultimately give our opinion and advice, which the patient may choose to take, or not.
The few times in my career that I honestly haven’t been able to tell a patient what I think is the best option, I feel that I have let that patient down.
22
I learned from Google that I had Lyme Disease. I had consulted with 2 doctors but neither could find what was wrong. I finally went back for my 4 th doctor visit and asked to be tested for Lyme. Thank you, Google.
24
Many years ago, I was sure a physician I saw was using drugs. I was uncertain about how to follow up and didn't want to accuse her if I was mistaken. A year or so later, I learned she was disciplined by the State of Maryland for abusing drugs. She lost her license.
7
There's nothing wrong with using Google to look up info about medicine and health--as long as you know enough to stick to sites maintained by major hospitals and foundations (e.g., American Heart Association).
Doctors memorize the textbooks in med school, then go into practice which requires that they listen to symptoms then spit out a diagnosis with treatment (per the textbooks). Robots can do as much--probably better, in fact, what with human error in medicine being a leading cause of death in this country. The sooner robots take over from doctors the better, and the info out there on Google for us all to access is a good start down this road. (Hopefully the robots will save us money, too. Even accounting for student loans, doctors' salaries are ridiculously high--especially when you consider that medical bills are the leading cause of bankruptcy. )
Name Withheld: You're better off with Google! Even your doctor knew enough to know that. Hope your recovery is swift and complete.
5
@EB You are forgetting something. A robot or google can only work with the information someone feeds to it. The doctor is working with ALL of the information available to him or her, including the memorized textbook, not just the bits that have been added to a google search.
3
@EB
Medical practitioners are also taught (well they are in my country) how to read and evaluate the evidence based literature. Google does not teach anyone how to determine what is valuable literature and what isn't. Lifelong learning is required in my country both by specialist colleges but also by our regulator. Memorising textbooks during medical school is not enough in any country where I have practised or visited and your understanding of medical practice and information is quite strange.
12
Watson, IBM’s artificial intelligence creation that won at Jeopardy!, also diagnoses disease. https://www.ibm.com/watson/health/
1
Once the urologist *offered* the two courses of action, he had a DUTY to explain the procedures, and the risks and benefits of each, so you could make an informed choice and give your informed consent to the procedure you chose. That is his JOB.
Maybe it is time to find another urologist.
30
Joan you are mistaken. The referrals satisfy the urologists duty. He knows enough to refer but not enough to fully inform the patient and get his consent to either or both courses. That will come from the consultations with the surgeon and the interventional radiation therapist. They are the ones who know their specialty and can give the information the patient needs to chose between or have both (surgery first, radiation after), perhaps with chemo on top of it all through a yet to be consulted oncologist. Welcome to medical specialization, like it or not. The days of Marcus Welby, MD patting your hand and seeing you through it all are long gone.
5
@Ben
According to the LW the urologist did not provide a referral, or even suggest he would be able to get the information he needed to make up his mind after speaking to the surgeon and radiologist. He told him to "do your research", and "be glad it isn't a brain tumor(!)"
No one is suggesting Marcus Welby will make any kind of comeback (if that kind of doctor ever existed in the first place).
This urologist did not want to be bothered to explain anything. He refused and failed to do his job, and the patient should fire him when the time is right.
2
Reading this account makes me wonder if the doctors discussion was possibly not fully understood or even heard— a common finding when delivering a cancer diagnosis to patients, particularly a more aggressive cancer.
However, if the patient account is correct, It would be bad practice. No doc should leave a patient hanging without a clear understanding of what next steps to take, referral to an oncologic surgeon and a sense that they are being taken care of AND that they have choices based on the best and most current information. Period.
Doing so involves patients in decision making which serves to not just educate them about their disease , but as well will improve understanding of risks/benefits that their likely to face, particularly when surgery is involved. And yes, it hopefully can lead to less anger and litigation if adverse events happen. It’s just a fact, but it actually is a good thing when the communication is done right.
16
We are missing a key piece of information in this story, which is whether his doctor is primary care physician (PCP, such as an Internal Medicine or Family Medicine physician) or a Prostate-cancer specialist (such as a Urologist). If it was a PCP, the patient should have been referred to a specialist for this challenging medical problem. Prostate cancer therapy is completely out of the realm of a PCP' scope.
2
Physicians have a professional obligation not to "abandon" patients. The doctor should have referred him to a cancer center or combination of an oncologist and radiologist to go over treatment options, costs and side effects. No referral can be considered abandonment - call the state board and ask them if this applies where you live. If it does, report the guy, he has as much empathy as a toilet seat.
22
The physician did not remotely abandon this patient. That is a silly accusation.
The physician did not give a recommendation.
When the options are one or the other you can only choose one. Though I would imagine that this patient’s 10 second description of a 45 minute conversation is not entirely accurate, I do however believe a physician should help guide the patient to their decision. The problem with this patient is that neither option is obviously the right choice since both options have a high failure rate with significant downsides. In this case the patient really has to decide which side effect worries them the most and chose the option without that complication.
Dr's may not like Dr. Google, but that resource gave me enough information to self diagnose a serious metabolic disorder before my PM got blood results back. Had I not done my research and pressed for tests, I could well be headed to an early death. I'm less concerned with Dr,'s feeling second guessed than with the reality of overworked physicians who don't have the time to spend with their patients.
24
LW1: A second opinion is not what is needed since you didn't get an opinion from a urologist and I say good for him/her. A urologist is not qualified to outline your choices. You need to consult with an oncologist who specializes in prostate cancer and get at least two opinions about treatment options. I've had urologists recommend "watchful waiting" when an oncologist recommends further diagnostic tests and ultimately aggressive treatment.
20
Urologists are surgical oncologists and ARE the correct person to discuss urologic cancers. Radiation oncologists treat prostate cancer with radiation. Medical oncologists treat prostate cancer when surgical or radiation treatments fail. They certainly can give opinions at the time of the original diagnosis but typically (VERY rarely) don’t treat prostate cancer patients until local treatments fail.
10
@DLP
Are ALL urologists surgical oncologists? If not, referral seems the right course.
1
Where is the medical Board in this equation?Before retiring 15 years ago, I had licences to practice medicine in Massachusetts, North Carolina, and in Connecticut. The boards of licensure in Massachusetts and in Connecticut seemed incapable of disciplining the practitioners, being underfunded and understaffed, (apparently the license fees went to the states' general fund.)
As long as I held a North Carolina licence I periodically received the board's newsletter, which included an impressive list of its disciplinary actions: who got on probationary status, who was required to practice under supervision, who got suspended, and who got reinstated after satisfactory rehabilitation. the vast majority of disciplinary actions were triggered by alcohol abuse.
15
When I had invasive breast cancer and had choices to make about radiation and chemotherapy after surgery, my internist said if he were in my position, he would call every doctor he knew and ask their opinion. I hesitated to be so aggressive but since he said so, I did it. Each doctor (three or four as I remember) was thoughtful and helpful and took time to talk with me. One of the most important was my lung doctor who advised against radiation because the cancer was too close to my lungs, and recommended chemo. This was at Columbia Presbyterian in Manhattan, in 1995.
32
As a surgeon I strongly feel that patients are owed a full discussion of the risks and benefits of various treatment alternatives and an opinion as to which alternative the doctor favors, if any, and why. If the physician feels incapable of doing that the patient must be referred to someone who can do it. Second opinions are of course advisable when there are fairly equal alternatives.
The correspondent has likely summarized what was likely a much longer and more nuanced conversation, but taking the summary at face value I agree that the patient was right to be disappointed.
36
Apologizing in advance, I suggest that the urologist response was appropriate. A patient would need to see an oncologist a radiation oncologist and a surgeon to find informed advice on his cancer. If there were no referral given, there would be basis for a formal complaint. While the urologist's reply might seem unsympathetic, it was sound advice. In a broad practice like urology, this doctor would have limited study of and limited experience with prostrate cancer.
My experience with cancer is even more limited but I'd like to advise anyone with a diagnosis to have the DNA mutation of the cancer analyzed and check out the proton centers before deciding.
13
Regarding LW2:
Without a doubt, intoxicated people should not be allowed to drive. Either they should be driven, keys taken or authorities notified. Recent cases held the alcohol providers liable for negligence when they know, or should have known, a person was unfit to drive. Not hard to see where medical professionals could be liable for not acting even if they aren't the ones poring the drinks.
Alcohol metabolizes at differing rates depending upon age, weight etc but a large glass of wine can take 3 hours to metabolize. Just because a doctor didn't put down his/her wine glass just as he/she entered the exam room doesn't rule out impairment. Let's not forget that alcohol is a psychoactive drug.
7
In 2017 I learned that I had very early stage breast cancer. While stunned and anxious initially, I had the benefit of a solid relationship with the surgeon and the opportunity for a second opinion on a plan for treatment. The process of seeing several experienced medical people over a period of weeks, plus my own conversations with other women who had dealt with such a diagnosis, helped me to make decisions which have given me quality of life.
In the midst of follow-up treatment, the surgeon left the practice. The woman who took over my treatment and periodic check-ups has been excellent. She listens, explains and works with me. Through this ordeal I have learned how to be a "partner" in my own health care.
14
When I was diagnosed with prostate cancer, about sixteen years ago, the doctor gave me the choices of watchful waiting or radiation. He strongly recommended against surgery. He did tell me that the choice was up to me; but he also said to get a second opinion before I made my choice.
24
For several years now, Shared Decision Making has been one concept in vogue in various medical settings. I understand the theoretical concept. But what is the value of going to a technician rather than a physician? The really good physicians I have seen over my decades or working in health care are the ones who expertly mix art and science, listen to and understand their patients and capitalize on their hard-won experience. This combination seems pointed more in the direction of healing an individual person rather than moving on to the next case.
17
There's something about urologists that is different from all other physicians. I'm an older man who has a large number of health problems, dating back to childhood, and I have seen many different specialists. I have sometimes gone to a different doctor of a particular specialty to find one I like. But regarding urologists, I have never had so much difficulty finding one I like. I like the guy I see now, well enough, but he is the 7th one, and I still prefer all of my other specialists over him -- but he is better than the 6 I saw before and I'm done shopping around. Can't explain it, but that's my experience.
19
@Ken Regarding the alcoholic physician, I think we are too much of a risk adverse society. True, you don't want to allow someone who is flatly dangerous out on the roads or in the operating room. But step back and consider -- 20 years since the first complaint. Other than being annoying at parties, what has the person done that has harmed people? He's worked as a physician and he drives a car. That's a pretty long span of time of observed safe behavior. You should take that into account.
9
@Ken It takes only a single drunk driving incident to irrevocably change lives. Note, I do not call driving drunk an accident. It is totally avoidable.
3
Regarding the (probably) alcoholic physician: It's not he this time, but his friends and colleagues who need an intervention. If you feel compelled to act, get them together and point out to them their collective obligation to their friend/co-worker.
10
If you see someone who drank to excess go off to drive a vehicle, call 911, give them a description of the car, the licence plate, the name of the driver, his probable destination, everything. That is all.
4
I am horrified to read that your urologist sent you to do your own research, and added a parting shot about the chances of anyone having either brain or pancreatic cancer. He should have recommend an oncologist and other medical sources (a radiologist for example) with whom you could talk about your options. I hope he was not your surgeon. This kind of treatment is what gives surgeons a reputation for being cold and without empathy.
31
I think you say if I was your brother what course would you recommend. Once he has what he perceives is a hypothetical question he is far more likely to give an answer
I also,would change doctors. Get the youngest one you can find. The older docs are often burned out. Managing your doctor is part of being a patient. Many doctors of the elderly hate to answer questions from their adult children. They are not used to having to give reasons.
However, let’s face it, few physicians have good people skills. There is no personal interview to get in medical school. And who would do the interview anyway? Another doc who lacks people skills.
12
I whole heartedly disagree. Interviews are integral to medical school admissions and some of my favorite ones were with lecturers who were not clinicians.
4
I have found younger doctors less likely to be engaging or willing to answer questions. It’s as if they’re afraid they might be wrong and might say the wrong thing. I see several specialists—give me the middle aged ones any day. Thank you very much!
5
@Harry Schaffner I ask the same thing: what would you recommend if I were your sister. Also works well with good mechanics.
And, totally agree with you on younger physicians.
I realize this might not be helpful for LW1 and may be why you didn't mention it, but for the sake of other readers who might find themselves in this position, you should have stated the obvious: get a second opinion. In a situation like this, a doctor can seem to have a lot of power over a patient; no patient owes any allegiance to a doctor.
29
" I was recently given a diagnosis of prostate cancer by my urologist....I was told I have a Gleason score of 8, indicating an aggressive form of the cancer. I had been going to this doctor for years and felt I had a good rapport with him. On the day of the diagnosis, I asked him for advice on which of the two courses of action he offered — surgery or radiation — I should take."
Three details about this story strike me: First, this patient refers to the urologist as "my urologist." And he has been going to him for years. A urologist is a specialist; what condition does the patient have that he sees such a specialist for years? Second, good rapport means meaningful conversation or dialog. What were they talking about all those years. Third, the Gleason score of 8 just suddenly appears after years of care?
20
@Dennis M Callies
The Gleason score is determined by a pathologist following a biopsy. This may have been the first biopsy, or the first biopsy that showed cancer results. The biopsy needle needs to sample the cancer clusters in the gland. Cancer is a slippery target.
My choice of treatments was made when I looked at the possible after effects of the treatment. For my case surgery seemed to have the less onerous after effects. Every case is unique. Pick a doc you trust and stick with them. Prostate cancer does not have a well established treatment matrix. And, mine went very well.
5
In your situation (upon asking for some advice before embarking upon a scary trail), I certainly would have said "Wow. Thanks for the advice Doc". And hit the road for some one else.
Anyone who would turn you over to the Internet at such a stressful & dangerous time in your life is certainly a useless Quack in my eyes.
I once asked my longtime Doc "why do they call it a practice? Is it because you are still practicing?" He didn't think it was too funny, but it was great to have a Doctor / Patient relationship of maybe 35 years so that we could actually talk. He would have been horrified to hear what you Doctor said to you.
I would hate to be a Doctor at this point, as the entire world they live in has been blown up & destroyed by Greed & the Insurance industry.
13
Couldn't agree with you more. Our health care group in the city of Stamford CT incorporates within their courses for physicians "how to keep the mouth shut"@Dheep'
Your age enters in here. If you are in your 80s, it might be best to do nothing. If you are 60 and have a score above X you might choose surgery. Check out experiences of those who chose radiation.
Several colleagues who retired in their 60s died shortly thereafter due to trying to tough it out to save their sex lives.
Oh, and get a second opinion.
17
@Bartolo
Sadly your colleagues might have opted for surgery or radiation and still died from prostate cancer. The various treatments definitely have unpleasant consequences. Whether the treatments are life saving vary from case to case. After he removed my prostate the surgeon said “ you’ll never be what you were.” I asked if I would have died from prostate cancer if I had chosen to do nothing? His response was I don’t know.
3
LWl. Well, he's right, but he's also mean and cruel! Yo do have to do your own research. When my gunecologist told me that I had ovarian cancer, she left me hanging. (Harvard, BTW) My husband did several days of intensive research and we talked to a few friends, one of whom referred us to a wonderful. gynecologic oncologist.
18
Re: Prostate cancer case. A second opinion - even if you have to pay out of pocket - is worth its weight in gold. My hunch is you unfortunately have an MD who is more concerned about his malpractice premiums than the care of his patients.
I'd be actively looking for a new physician.
9
"Promises are not worth the paper they are not written on." If you don't get a promise in writing, you cannot expect it to be kept - probably not by the person making it and certainly not by his/her successor(s).
11
I'm a general practitioner. I got the diagnosis prostate carcinoma gleason 9 and PSA 100. The first urologist told me: no surgery possible. We don't do this from PSA 20 up. So I went to a Prof urologist and told him: take the prostate out. I had the MRT with the result: the tumor is inside prostate and probably in the glandulas up the prostate. The Prof told me: You want it, ok I'll do it. The result: the tumor was at the edge of the bladder and on one side on some nerves. So the prostate, the glandulas, a small part of the bladder were taken out and the Prof did a Neurolysis. What happened: My family told me: We don't want you to die. You are too young for it. So I said, ok. I'll do my best. I'm since a long time vegetarian, but from now on, I took I very strict regime with food, drinking, doing all against any possible complications.
After 2 months the PSA was 0,17, my bladder was o.k. I had no pain, I'm strict on regime. After 3 months all blood tests (hormons etc) are o.k., the PSA can't be measured, it is under 0,07. Therefore no radiation and no androgen deprivation therapy (you will say chemotherapy) are necessary in that situation for now.
Today I'm at that point 3 months after operation. I'd give you the advice: Do what is the best for you. A strict regime, have fun, do exercises, be happy, say to you: my future is on the best path possible. Have normal weight etc. Take the best advices from the web. You can find all especially for you. Good luck
17
Always at least consider getting a second opinion! It can be a life saver no matter how much you basically respect the first doctor
15
I read this first article early this morning. I discussed it at lunch with a group of friends. And now,., I’m reading it again. I find it so very upsetting. I understand that ultimately the decision I make is mine... but share with me some knowledge...and guidance. Having gone through my own life changing medical issues... I dealt with physicians very similar to this. One told me that there was 3 drugs I could begin taking... and to select which one. Coumadin.. Eliquis... or Xarelto. Laying in a hospital bed...having had a stroke 2 days prior. ... I was clueless. Where is Dr Google so I can start researching... and make a decision. Frightening world we live in sometimes when we are most vulnerable. Amen!
14
Your doctor was right in not advising you on a course of action. Here’s the problem: there are a half dozen courses of treatment available, or you could decide to take no action at all. Add to that the almost universal conflicts of interest among urologists and even your primary care physician, and you have a real dilemma. Almost every doctor you consult will have a financial stake in a course of treatment he recommends. As a non medical professional, but someone who has had prostate cancer TWICE IN A DECADE, I have a few tips for you.
Invest 50 hours of your time using Google to research treatment options. Put in the work. Learn the pros and cons of each treatment. And be sure to check with your health insurance company to see what they will or will not cover. Don’t rely on them for advice. Their primary interest is in keeping expenses to a minimum.
I selected Proton Therapy at Loma Linda Medical Center, an excellent large hospital 50 miles west of Palm Springs. At the time they were the only facility west of the Mississippi River that offered this approach. Setup and treatment takes about 3-4 months. You have to move there unless you live within a 2-hour drive. Great people. Top flight treatment. No sexual impairment or incontinence side effects. However, I developed a new strain of prostate cancer 6 years later. At that point I selected laparoscopic computer assisted surgery. Been clear 4 years. All surgeons are not equal. Dr. Chris Kane in San Diego is tops in SOCAL.
13
#1 Was the physician ever asked why he wasn't doing a referral or suggesting a course of treatment? Is he a GP, internist who doesn't treat prostate cases?
Am shocked that a physician would tell a client to do their own research and decide for themselves what the best course of action was, rather than refer the client to a specialist who would be able to give treatment choices available.
9
This sentence says it all:
"Your own primary obligation is to the health system you help administer"
As a retired MD my primary obligation was to the patient.
Nationwide there are 9 "Healthcare Administrators" per doctor. Their parking slots at the hospital are always empty after 5 pm. No night or weekend or holiday call.
Feel nostalgic for the flawed healthcare system as it was and even as it is now. Think back on the nationwide dropping life expectancy ..Doctors are resigning and retiering early. Try finding a doctor who is taking new patients. Wait for an appointment after referral to a specialist. Ask the health store clerk what s/he thinks. Read those columns in the New York Times. See if that cosmetic dermatologist (who doesn't take insurance) can help. etc, etc. You can't blame a non-existant doctor.
Ah, where is your personal primary obligation?
Good night and good luck.
26
In December 2006 I faced the same diagnosis, with a Gleason score of 12. The way to ask your urologist the question is, "OK, what would YOU do given my diagnosis and the options available?" He thought for a moment, and said, "If I were in your shoes, I would have the surgery." At the time, a robotic laporoscopic radical prostatectomy using the DaVinci machine was the most promising option, so that was the route I took.
10
LW#2: Regardless of whether you report him to the medical board or not, if you and others are sober at an event where this MD is inebriated and going to drive himself home, you MUST offer him a ride. You and everyone else at the party who knows he's headed out to drive drunk would be ethically (if not legally) culpable for any harm he did to others. Don't turn a blind eye to this behavior! And if he refuses a ride from you, then help him find one with someone else or call the man a cab. If he refuses all of these and is determined to drive himself home, call the police and let them know. You cannot knowingly let people drive drunk. They will kill innocent people.
30
Yes yes yes please call 911. I cant believe Mr. Appiah is so cavalier about this.
3
I am a cancer survivor advocate and my spouse who is an educator/caregiver have developed a Health and Wellness Seminar to educate people and provide them with an orientation to what’s involved in being a patient with a possible life-shortening disease/illness.
The Title of the seminar is “Be Your Own Advocate: The Job and Work of Being a Patient: How To Advocte for Yourself And A Loved One: Itʼs Your Most Important Job, Your Life Depends On It!”
Topics Include,
!. Searching for and Obtaining Informtion and Knowledge About Your Disease/Illness, Diagnois, Treatment, Side Effects, Outcomes/Research, Physicians and Healthcare Organizations/Medical Centers/Hospitals
2. Communication and Interactions with Healthcare Providers, Family Members, Friends, Colleagues, Government, Insurance and Financial Systems and Organizations;
3. Learn the Difference Between the Medical Disease Narrative and the Human Illness Experience Narrative;
4. Manage Emotions and Learn How to Deal and Cope with Change; What is Emotional Intelligence and How to Acquire;
5.Identify Family and Personal Illness Beliefs, and Learn the Difference Between Facilitative and Constraining Illness Beliefs;
6. How to Learn and Become Competent in Problem-Solving and Negotiation Skills.
We know from experience, as do most patients, that being ill requires a great deal of work. It’s a full time job!
11
I think that I would have asked the doctor what the advantages and disadvantages are of surgery and of radiation. If he didn't answer that, I'd have looked for a new doctor.
13
As a nurse I can understand the reluctance of the urologist to make a recommendation regarding treatment for specifically prostate cancer. There have been most unpleasant events, including lawsuits and even murder, when a recommended treatment caused impotence.
On the other hand, perhaps there is something about the questioner. Is he likely to blame others when things don't turn out rosy? Has he ever sued a doctor, even for good cause? Lists are
made for doctors to consult.
7
As a urologist, I have treated prostate cancer for the past 30 years. With slow growing cancers many of the treatments options are successful, but with differing complications. I would educate, guide and answer their questions to the best of my ability, notwithstanding, it is always the patient's decision. Some did not hesitate, while others labored over the decision for months. The doctor/patient relationship only thrives when both can listen effectively and suppress bias.
24
The problem with the doctor with the drinking problem that may or may not be affecting his work (not clear from the letter, but it probably is) is best handled not by agonizing over whether family/friends should do an intervention at some point, but by the letter writer's either stopping the man from driving drunk after these social events or, if that's not possible (his keys can't be wrested away from him?), immediately calling 911 with his location, license plate, and destination. I'm stunned that physicians at a social event would be complicit in this man's drunk driving.
40
If it were me, I'd be looking for a new doctor. Every treatment is going to have pros and cons. The doctor can point you towards the Internet, but you haven't gone to medical school and have not been in practice. It's like asking a non-lawyer to decide the legal merits of a complicated case. Your doctor won't give you any guarantees, but could have suggested what he feels is the best approach for you.
25
I handle the MD's advice thing differently and have never regretted how it has always turned out. BTW, I'm a PhD, not an MD or DO; before the PhD I was a nurse, so I knew the parlance of medical and surgical care, and have always been clear that I'll listen to any pitch about any treatment, but the decision is mine, always ask questions, and promise I'll let him/her know. That's easy to do nowadays on-line and promptly (and it's welcomed). I had one of those occasions recently when the MD said he'd like to start me on a medication. I was skeptical. After a visit he emailed and said what the med was and the dosage he thought was appropriate, and he reiterated why he wanted me to take it.
What I decided hinged on two things: my trust of him, and his trust in me. I had another appointment a week later and asked him NOT for his advice (for a bazillion reasons all of which revolve around liability, I never have and never would ask that) but did, have, and always do ask this: "If you were me, what would YOU do?"
At first glance, that may seem like the same thing as "asking for advice"- except that it's NOT asking for his/her advice. Inherent in my question is the statement that I trust their education and their personal judgement as much as their professional judgement. To date, and from every physician I've ever asked it of, the answer has been accompanied with a smile on their face, and some variation of, "I would do exactly what I think you should do."
16
I specifically do *not* recommend asking one’s provider “what would you do if you were me?” It’s a hypothetical excercise with too much room for bias. Knowledge of one’s own comfort level with risk and of one’s own values are important resources the patient brings to the consult. The provider may have a very different temperament, life circumstance or values system.
The patient *is* the ultimate arbiter, however not everyone wants to engage to the same level. A skilled and compassionate provider can accommodate this. In this case, the prostate cancer patient’s provider appears disinterested in shared decision-making - to their patients’ detriment. Worse yet was the “be glad you don’t have XYZ diagnosis” comment. Wholly inappropriate!
6
@Eve Harris
I agree with the spirit of your first paragraph, but I would like to draw a distinction. If the doctor tells you what he or she would do in your situation, the doctor is applying his or her own values. I agree that that advice is probably irrelevant. However, if the doctor knows you, and tries to apply your values, the advice could be very relevant. I would not follow the advice slavishly, but I would be very interested in the doctor's analysis. Unfortunately, my experience in similar situations is that most doctors cannot get beyond what they would do for themselves, so your recommendation is probably better than drjillshackford's.
1
I was diagnosed with cancer in December 2013. The first time I heard the doctor say it was CANCER and there didn't seem enough time, I could also hear the blood rushing in my ears. Nothing makes sense. The doctor made the decisions- surgery and then what to do on opening me up (more complex than suspected). We just kept signing consent forms. We didn't know better and didn't have time to seek professional opinions at other hospitals.
Through subsequent relapses, we had made ourselves more informed, but only for what was past and therefore familiar. Again clueless at the new turn in the road and cancer does move in mysterious ways. Again doctors made our choices for us.
I have just ever refused one specific drug they proposed because of potential side effects, but they chose the alternative. My drugs and doses have been changed multiple times. No way could someone as untrained and under as much emotional stress as I or my parents could research our own solutions. What is a doctor for then?
We expect to be informed and involved, but not left to our own devices.
32
What the doctor could have/should have responded regarding the patient's prostate cancer diagnosis: Here are the names and phone numbers of a radiation oncologist, a chemo oncologist, and a surgical oncologist. I recommend you talk to each and decide upon the best path forward. That's what my urologist did, and I think it is the best way to go.
60
My doctor left it up to me to make my decision about whether to have chemotherapy. Research shows that if you're Oncotype score is above a certain level, chemo will likely help. If it's below a certain level, it's probably not worth doing it. But there' a middle ground where doctors just leave it to the patient to decide. I can't say that I blame him for leaving it in my court.
4
I will never forget my diagnosis of Diabetes type two after I lost feeling in my feet, felt constant numbness in my hands, ED, and after passing out with the slightest amount alcohol. He said, "You have Diabetes." Upon my question of what does that mean, he said, "There are some classes you can take". Period, end of doctor visit. Used a fish line to poke at my feet. Never recommended a test for A1c or anything. After much research, never heard of Diabetes type two, I changed uncounted behaviors to get it under control.
I never forgot the spare pronouncement and "next!" Kaiser. He retired soon after. Diabetes doesn't recover, it just gets less worse.
17
I had a Gleason 9 and the same choices for treatment. My doctor would not make the decision for me, but he convened 7 doctors for me: oncologists, radiation specialists, surgeons, side effect specialists, etc. and they all have their opinions about the pros and cons of each treatment choice. It was like a medical school course. I decided on surgery first, but was very grateful to all of these doctors for their time and sharing their expertise so I could make an informed decision, which really did have to be my decision. But, I couldn’t have made that decision without all the facts, which my doctor provided.
92
@johnwoodallmd That is because he cared and was prepared for this question. Most likely other patients had asked it in the past. All doctors should be as thorough and kind as yours was.
21
@johnwoodallmd
What terrific care you got; so glad to hear it. My husband was lucky enough to have a similar response to an unusual health event and we were very grateful for it.
10
Years ago when my teen-aged son had testicular cancer, I asked his oncologist to recommend articles I could read. The physician knew I was I a Ph.D. health psychologist practicing at a local hospital. He sweetly said "Why don't you leave the reading to me." I later asked the urologist at my hospital the same question, and he gladly furnished me with many articles and much support during my son's treatment. While I respected both physicians, my trust in the oncologist was diminished.
it's too bad that some physicians, even today, won't enlist the patient and his/her support system as members of the team.
63
@Susan D
Why did you continue to respect a physician who "sweetly" dismissed you as a professional, an intelligent woman, and the mother of a son with a very serious condition? He treated you like a "dingbat" (Archie Bunker's expression when he belittled his wife Edith), yet you maintained respect for him as a professional?
15
@Susan D
your message is confusing. a Ph.D is not a physician. Physicians have either a "M.D." or a "D.O"
1
@Robert Herman, M.D.
Ph.D. s have much better capacity to learn new info and apply critical thinking--we were not trained lockstep via moronic chants.
2
There are unique things about prostate cancer that make the doctor more willing to allow the patient to make the choices. The fact that is it usually not fatal is important. But one thing not mentioned are the potential side effects. There is a possibility of impotence after the surgery and studies are contradictory about how often this occurs. With most cancers, it is an easier call as the doctor knows the patient wants to survive. But for a questionable surgery with the potential to end a man's sex life it is a very different situation. If the cancer is not advanced or aggressive, the doctor is doing the best thing for the patient when forcing the patient to be responsible for the decision to risk losing the ability to have sex again. The opposite problem is also common. The doctor promises the risks are minimal and tells the patient the standard line: there is a risk of never having sex again, but this diminishes over time. The real truth is that the likelihood of ending the man's sex life is very real and for too many men it is ended for good. If the loss of a sexual life is at all important, only the patient can make the decision if the risk is high enough to gamble. Even the PSA tests are undergoing scrutiny and may be doing more harm than good.
24
Stephen, that is not a valid argument for refusing to discuss treatment options (or making a referral to another doctor who can and will). It is an argument for a frank discussion of the potential side effects of the different options, so the patient can make an informed decision.
27
Six years ago my husband was diagnosed with low-grade prostate cancer. Two urologists each gave us three options: surgery, radiation or "watchful waiting" (since my husband's cancer was low-grade, unlike that of the letter writer). When pressed for personal recommendations, one said radiation and the other said watchful waiting, but that they would support whatever decision my husband made. He chose radiation, has minor residual side effects, and is cancer-free.
Most importantly, we were given full information about all of the risks, benefits and alternatives of each of the options. These are the essential parts of informed consent (or refusal) for medical treatment. My experience in medical practice was that people who would say, "Just do what you think is best, Doc" weren't really absorbing the information I was offering. Perhaps they were so terrified by the diagnosis that they couldn't process complicated information, or they were in a hurry to get it all over with. Maybe they were overwhelmed by statistics, so I should put it in simpler terms: "Treatment A has fewer risks but Treatment B is more likely to cure you. Which is most important to you?"
A patient who does not understand at least the basics of the risks, benefits and alternatives to any proposed treatment cannot give informed consent. To treat is unethical, risks lawsuits, and could even be assault. For the letter-writer's, referral to another urologist for more information would have been appropriate.
52
My husband was diagnosed with prostate cancer at 52 yo after an elevated PSA and a biopsy. After 'research' he chose watchful waiting. He had PSA tests regularly as well as digital exams. Fast forward several years, the highly competent urologist sent him for a parametric MRI, which ultimately showed a sizable tumor, but the MRI results got lost in the electronic medical records' weeds. Whose responsibility was that? The patient who trusted *the system*? Or urologist's staff didn't insist on results of the MRI asap? 5 months after results surfaced in the e-files of the PCP, Husband opted for radical prostatectomy surgery despite radiologist oncologist sales' pitch for radiation and hormones. Prostate cancer can spread through the body and create havoc. We were lucky, his bone scan came out negative, but urologist fully expected worse.
Be informed. Be vigilant. Take a buddy with you to the office to listen to each Doc. Cancer diagnosis is so overwhelming, patients might not comprehend all the info. I regret not accompanying husband to 'routine' visits. He definitely needed an advocate.
50
@One Moment
Yes, be aggressive about getting those MRI results.
Bug the urologist staff right away. Don't worry about making yourself a pest. Have an advocate if you don't have the energy to do it. A Power of Attorney for Healthcare has a lot of clout. We can no longer be passive with the health care mess we are now in.
15
When I was diagnosed with prostate cancer I had the opposite experience. My urologist referred me to a radiation doctor who gave me a very-high-pressure sales pitch on his "seed" treatments. I felt so uncomfortable with this that I then went for a second opinion (which I highly recommend for anybody facing a difficult medical situation). A radiation oncologist at a major cancer center told me that radiation should be the choice only when all other options have been excluded because once you get radiation treatment you can't do surgical removal if the radiation doesn't cure you. So, I went to see the surgeon, and based upon my particular situation, we picked "watchful waiting" for my treatment plan because my cancer was NOT aggressive, and the side effects of any aggressive treatment plan are considerable. (I also found out my insurance would not pay unless I was sicker than I was.) But the best advice for anybody facing a serious medical condition is GET A SECOND OPINION!
101
I am 81 years old. Have not been subjected to, so far, any onerous medical procedures, except a successful vasectomy over 35 years ago. For me, four male children were sufficient. A daughter was not about to appear. The HMO hospital had available, for the general public, a loose leaf notebook with the professional CV of each physician. I had a choice of four physicians that were designated to perform the procedure; two male/two female. I chose the oldest practicing female; equating age with acquired experience. My other criteria, based on a study, published in a magazine not devoted to medical issues, that females generally have better manual dexterity because of small muscle development.
During a routine physical, I was prescribed a statin to reduce "bad" cholesterol. Coincidentally I was to begin a pill regimen to eliminate toe nail fungus. An intuitive, gut feeling, insisted that I should research on the web the compatibility of the two medication. They were incompatible. I contacted my physician. First, treatment of the fungus until it was deemed cured, then the statin. This made me realize, that it is almost impossible to keep up with the myriad of medications. It's a crowded highway of drugs. The crash of incompatibility is bound to happen unless experience and vigilance is maintained.
50
@First Last - I am surprised that your pharmacist did not call and warn about complications. I remember a doctor writing a prescription for me and within an hour, I had gotten two calls from my pharmacy asking if my doctor was aware that this medication can cause seizures and that I have a seizure disorder? I replied that we had discussed that at length with my neurologist and everyone thought it would be okay. Still, they went through everything that could go wrong just to make sure I understood.
5
@tom harrison...I was already taking the statin and had not acquired the fungus medication. My research was pre-order.
The fact that a urologist would place the burden of deciding on a treatment plan for aggressive prostate cancer is completely unacceptable and a strong sign of incompetence. The decision involves more than just surgery or radiation. With a Gleason score of 8, there are good reasons to consider both surgery as well as radiation if they find any evidence of the cancer cells having spread to the tissues or lymph nodes near the prostate gland. Chemotherapy might also be appropriate.
Complicated treatment options for prostate cancer require a team approach from the surgeon, radiologist as well as oncologist at a major medical center of excellence.
108
@A Goldstein My thoughts exactly. Assuming the account of the interaction is accurate, the doctor should have referred him to an oncologist - immediately.
29
@A Goldstein
A confounding factor may be that the urologist may have a financial interest in a radiation and/or a chemotherapy center. There could even be a positive spin: If he is an owner, perhaps he didn't trust his objectivity . Poor excuse for leaving the patient in such anxiety.
6
Your doctor did you a favor by telling you that your prostate cancer usually isn't fatal (like the other diagnoses he mentioned). Some patients with prostate cancer adopt a "watch and see" attitude. Many, many men of a certain age will get prostate cancer. Doctors nowadays are sometimes going along with patients who choose not to treat it. Many patients with prostate cancer die of another cause.
Definitely, your advisor should be an oncologist. Maybe this doctor is an oncologist, a specialist in the treatment of cancer. And I would choose an oncoloist who specializes in this TYPE of cancer.
Doctors may be hesitant to tell you NOT to treat your cancer (for fear of litigation, as mentioned). But if you come to that conclusion on your own, that's different. I think your doctor should have discussed this "Wait, Watch, and See" plan, which is becoming more common, with you.
I believe that any patient with any condition or symptom would do well to do as much research as possible, whether it's on Google, at the public library, or elsewhere, whenever they have any health issues.
10
When I practiced neurology, I dealt with carotid artery disease and stroke. I knew the probabilities of stroke with and without surgery. I also knew, because I had reviewed the records, the outcomes of the surgeons who did the surgery. I told the patient these numbers, and what I would recommend. I also told them the probability that my recommendation could be wrong. It was the patient's decision, but he was given all the facts as we knew them. Most followed my recommendations, but a few didn't. That was their decision, and it was best for them. To me, it's not fair to tell the patient to read about it. Patients come for recommendations, and it is our job as physicians to give them. That isn't being paternalistic. It is part of being a physician.
Physicians have to remember what the literature says and what transpires in their community may be two very different worlds.
96
@Mike S. Some doctors abandon their patients just when they are most needed.
You took the time to consult with the patients you served. This doctor seemed uncomfortable with this aspect of his job.
8
Re: Scenario 1...The Canadian public health care system, which is my experience, certainly has its problems. It might, for example, take weeks (months?) to see a urologist depending on the severity of the issue (not who’s next or who can afford it). I have not however had the experience myself or heard of the hands-off decision making you describe. There are several physicians amongst my friends and family, and I’m quite sure physicians I know would think this situation as handled was an abdication of responsibility. I think this is less likely about the age of the physician, how they’re trained or the influence of Dr. Google, and more about the money aspect. As our system is public and therefore “free” (don’t get me started) the doc benefits not a whit by suggesting one treatment over another. Even with respect to being paid (by the government/taxpayer) for procedures- physicians here aren’t sitting around looking for customers. I can honestly say I’ve never heard of one that wasn’t jam packed. Obviously the patient still has to make the final decision armed with all the information - but in Canada in terms of ‘who benefits’ from either or any choice, it really is only the patient. I wonder how the conversation changes when the physician isn’t, or can’t even be seen as, selling anything.
18
The doctor might have explained the merits/demerits, complications to be expected, financial burden, availability of suitable hospitals with expert specialists in the field, of both radiation and surgery . He might have added other options from the so called Complementary and Alternative medical systems. Since he knows the strengths and weaknesses of the organs of this patient's body, his suggestions carry more weight. And the patient might take the final decision. It is unfair to doubt the sincerity of a family physician albeit we have heard of occasional careless professionals.
3
As a retired physician who has been on both sides of cancer, I would recommend the patient find another Urologist. My method was empathy---I gave options, but ended it with it's your decision ultimately. When the tables were reversed, my question to my Oncologist was what would you do if you had my cancer? I got my answer.
143
Regarding prostate cancer, when I was diagnosed 10 years ago my urologist convened a round table of specialists where all options (surgery, chemotherapy, radiation, "watchful waiting") were presented and pros and cons discussed including the specific side effects most associated with each approach.
I felt fully informed and comfortable with my decision, and prepared for the side effects of my choice. 10 years later and cancer free I can attest that being fully informed leads to less second-guessing and regrets and allows me to take responsibility for my decision instead of leaving it to a single doctor.
80
Fewer and fewer doctors are making recommendations to patients these days. Medical students are now taught more about the "collaborative relationship" with the patient than how to provide expert advice, which is what the patient wants and needs. No matter how many google searches they do, patients come to us for the best answer we can give them, and as a physician myself, when I have taught students, I have urged them to be comfortable with giving advice. After all, we are the experts! We trained for this! I wonder how old that urologist was, and I'm guessing, young. An older doc would have provided the unfortunate information that a Gleason 8 is a dangerous tumor that must be treated immediately. If the doctor didn't know to whom to refer the patient, then the patient should have consulted his insurance company, which likely requires treatment at a Center of Excellence. In my opinion, it is unethical for a physician not to render an opinion, but times have changed since I went to medical school. I still think it's unethical not to do this, but younger docs, and perhaps younger patients too, seem to want something different from their physician. Ethical or not, I think it's a mistake.
155
@Ellen Tabor You're the kind of doctor I would want if faced with what a frightening diagnosis. Yes ultimately I say which way to go but I sure want the benefit of a doctor's expertise especially one who know me.
50
@Ellen Tabor
While prostate oncologists might want to recommend surgery because it's the safest choice for cure, good docs know that quality of life can be just as vital to a patient's health and well-being. Since impotence and/or incontinence are two frequent consequences of surgery, the pros and cons of other options should always be on the table. In my own experience with cancer, and since I usually had a little time before I treatment was an immediate must, I usually did some research so I had questions, like" if I do this option, what are the possible consequences?" "What are the odds of them happening?" and "Given my age and overall health, is there an option you feel is better?"
After waiting until my fear is as much under control as it's going to get, I go with my gut preference, even when my "head" may say something else. Remember, you can always ask a doctor: "If I were your father, what would you be telling me to do?" Then see how your gut feels about their answer!
12
@Ellen Tabor When I read this letter, I wasn't sure exactly how things happened. Sometimes, patients hear things differently than what their doctors actually said or meant. So a doctor who doesn't make a strong suggestion but leave decisions up to the patient might strike some as offering no suggestion or information at ll. Also, the letter writer might have written more and it was condensed for the NY Times.
Taking the letter writer's words on face value, I agree the doc should have given more information. At least outlined some of the questions the patient should think about, the options and the pros and cons. It also may not hurt to ask how much the patient wants to know and gauge whether this person wants the doctor to be more or less paternalistic. Faced with a scary/ confusing/ urgent situation, some otherwise independent people prefer a more paternalistic approach.
I hate it though when people ask me what I would do if they were my father, mother, etc. It's not a fitting situation because they AREN'T my relative. My relatives and I hold personal values which may be very different from theirs and this is what I say. Then I turn it back to them and try to find out what's important to them.
4
“Please do not confuse your Google search with my medical degree.” We realize the medical degree and experience brought us to the point of the diagnosis (and FWIW, a Gleason 8 doesn't happen overnight, so possibly this doctor is uncomfortable with the fact that his patient got to Gleason 8 without being caught at Gleason 7), but one may reasonably expect a doctor to give us the benefit of his experience. If the doctor recommends patient research, he should steer the patient toward responsible information with emphasis on what to avoid - like any other diagnosis, there are people out there who will tell you that if you just avoid gluten and take probiotics, you won't have to go near the nasty knife. Over 30,000 men die of this every year, and, "Let me know how you'd like me to treat you" is unacceptable. A doctor might want to avoid suggesting surgery to avoid appearing "knife happy", but he could certainly recommend a second opinion from a doctor with no potential financial stake in the process. This is one of the very few situations where the M.D.'s offer the direction of care to the patient. They never ask you if you would like penicillin or tetracycline
35
@John
Only "offer direction of care to the patients" because said patient is male and possible side effects are thought catastrophic to both.
I don't trust MDs as far as I can throw them--not far now.
1
LW#2 (possibly impaired doctor) struck a chord with me. I was delivered in 1955 by an interne who had no idea what to do about a breech birth, and the forceps damaged me. Another doctor (now long dead) helped my heartbroken parents get me repaired at another hospital, and though I was too young to remember him now, he was my paediatrician for the first few years. My parents were surprised and saddened when he lost his medical license for writing himself narcotics scrip -- evidently a longstanding problem. Even after his fall, they always spoke highly of him.
The interne who botched my birth was clean, sober, and incompetent. The junkie doctor who fixed the damage was competent. I know which doctor I'd rather go to. And which doctor I'd sue (though my parents didn't; back then the authoritarian view of physician as 'M.Deity' was the norm and my mother, a former nurse, was reluctant to challenge the authority figure, even a mere interne).
Doctors are like any other worker: may be fine on duty, awful off. And like police, they close ranks and cover for each other against the 'civilian' world.
Of course, if Doc's driving (or operating!) drunk, that changes everything. You *have* to turn him in.
20
@ACW Thank you for telling your story. It adds to our overall assessment. This has been a part of your life story for your whole life. That says a lot.
4
The priest who put our diocese millions into debt was celibate. The one who got us out was schtupping his housekeeper in a consensual way. He was kicked out. Go figure.
1
Regarding the patient with prostate cancer: my husband had prostate cancer and I went with him to the urologist.
One of the main ways radiation and surgery are different is in regard to potential side effects, ie, potential bowel problems vs potential impotence, among others. That's not a decision a physician can make for a patient.
Regarding the physician who drinks a lot at social events: why is the letter writer the only one who seems to notice or be concerned? Aren't there friends or family who'd be in a better position to say, you're not driving tonight? If patients well-being involved, it doesn't seem like something a colleague would report.
And what would you report and to whom? The county medical board? "Dr X drinks too much as social events and gets loud." The police? "Dr X drinks too much at parties and then drives."
Maybe the letter writer is just super-cautious but there's an undercurrent of something besides that.
Regarding the promises made by someone else to a physician--I think you need to be honest with him. Tell him that the promises were made by other people under other circumstances and that no one is getting what he's asking for (if that's true. If some people are getting what he's asking for, maybe you should try to get those things for him as well).
7
In recent years, I notice a lot of doctors won't give advice, but instead ask me or my family members to "decide what we want to do." They'll say: "It's really up to you!" They give very little background, pros/cons, etc., despite my questions. It's bizarre, and I believe they are shirking their duty. They either don't know, don't care, or are hoping you will chose the higher priced option. I respond by saying something like "Oh, actually I am not a doctor, and that's why we are here seeking your professional advice. We need your advice and direction." Sometimes that will get their attention, but there's definitely a trend of doctors not wanting to advise. Btw: I have 2 special needs kids, so we see a lot of specialists, and it's particularly infuriating as a parent to get this type of response...or rather non-response....when seeking healthcare for a child.
70
@Kay Day
Unfortunately, a lot of people do not want advice or an opinion. They simply want what they want and will disregard an opinion from someone who is not familiar (i.e. famous) or, heaven forbid, tells them "no". Because only famous people, like Donald Trump and Kim Kardashian, are reputable sources.
1
Doctors are inclined to apathy and laziness (plus substance abuse problems) like everyone. However, a bigger problem is that they are caught in a corrupt health care system and are afraid of insurers. However, if I had a urologist like the one described, I would report him and find another urologist.
Putting up with such "care" only reinforces it.
Sooner or later you realize that people, including doctors, have many personal flaws--including those that interfere with their profession. Just don't put up with it.
21
Um, if someone is driving drunk, report it immediately to the police. Nothing like a little shame and a DUI to help wake someone up.
35
Prostate Cancer - all sorts of people will claim that it is overtreated, but as far as I know,none of them have PC. That.Changes.Everything. There is an organization called USTOO.org where people share information on prostate cancer treatments. NY Times ran a series of articles about a man who I believe had advanced cancer originating in the prostate - try Googling it. I believe the doctor failed the patient by not providing introduction to an oncologist and surgeon and explaining to the patient some of the considerations of each path so the patient knew which questions to ask. When I was going for my treatments (Gleason 7), there was a great deal of waiting room medical practice with men sharing the information they had accumulated. Since it was a 10-man urological practice group, we had the additional benefit of getting information about the treatment patterns of several doctors. I was very fortunate - I had my own doctor, several nurses and P.A.'s available for questions and suggestions. I was ok for surgery, but the urologist and oncologist together thought I would benefit from radium implant and radiation therapy, and they explained why. That was about 15 years ago.
33
I am a bit disappointed in all three opinions expressed by The Ethicist here.
First, it is clear that after making the diagnosis, and informing the patient of two treatment options, the urologist had done his job and it was up to the patient to talk to the radiation therapist physician as well as the surgeon to hear them both out on the latest information in their specialties on the details of both options in his specific case. (of course I'm assuming the urologist had an office practice and would not have done the surgery...I know he would not have managed the radiation therapy). The urologist's opinion would be of limited value and the decision was for the patient after talking to the specialists with the best information. The patient needed to put on his "big boy" pants and talk to the people with the information he needed.
As for the alcoholic Doctor I was OK with the story-teller until I read that it was him who reported the same Doctor twenty years earlier. Red lights began to flash in my head that something else is likely going on here. The writer is telling us that absolutely no one in that community has eyes to see or a mouth to speak except our hero? I don't believe it. What was the outcome of the complaint twenty years ago? Is there a grudge here we don't know about? I'm betting against the credibility of the letter-writer. If the problem is real (and I seriously doubt it) it's somebody else's turn.
As for the practice manager just tell the Doc the truth.
11
@Ben
IMO a doctor in the habit of telling his patients to "pull up their big boy pants" deserves every lawsuit that is (almost certainly) coming his way.
60
@DW That doctor deserves to lose patients to other doctors. I'd put my physical and emotional energy into dealing with the cancer not suing anyone.
1
I am disappointed each week but I keep on reading him. Ethics is Human Nature 101, fascinating. Often, it appears to me the letters are contrived. They have similar tone and are found to lack sufficient context for expanded ethical recommendations. This leaves the so called or self proclaimed Ethicist to stretch and err due to the lack of a wide base and details.
1
LW#1 Get a second opinion from a urologist that is not part of the same system as Dr. Snarky. Even if his assessment is basically correct he has failed you by his lousy bedside manner.
Having had 3 first degree relatives with prostate cancer and one who died from mets from PC it is not a a decision to be taken lightly.
31
Regarding LW2,
It seems to me that anyone witnessing a heavily intoxicated individual (as this doctor is described) preparing to operate a motor vehicle has an ethical obligation to attempt to stop them. Failing that, they have an obligation to notify the police. This can be done anonymously, providing a license plate number and expected route of travel.
62
@Jesse
This seems so clearly necessary. Dr. Obivious is dangerous, and the only interventions are personal (telling him not to drive, taking his keys, ...) or invoking the proper authorities. The police. A DWI will also most likely end up at the licensing board, but an alert to them is also showing concern for other potential victims.Others have emphasized that reporters are usually accorded confidentiality. Those who investigate such reports are most grateful for those with the courage of their convictions -- i.e. the ones ready to go on the record with their concerns. Now - that is walking the walk..
21
@Jesse. Another point - if the description of the doctor is accurate, he is under the influence of alcohol all the time. Who would want him as their doc, if they knew? Report him to the cops.
1
I've mentioned to doctors the studies reported on in the NYT, including those about the effectiveness and safety of taking Calcium and Vitamin D supplements. The first one said, Don't believe everything you read on the Internet. The second one said, So you get your medical advice from the New York Times?
When I mentioned the horrible side effects of two drugs I was prescribed in the hospital by two doctors who had never seen me before, another doctor, my "primary," said, Those side effects are very rare. (Hair loss, weight gain, feelings of doom, etc., etc.)
But I was experiencing many of them, several of which were admitted to in the pharmaceutical company's literature that accompanied the drugs.
I assumed that if both drugs were taken together that warned against the same side effects, I should pay attention. But my doctor blew off my concerns with a remark about the motives of the people who post comments about prescription drugs.
It's very hard to cut through the mockery. The doctor is too busy typing on her computer to listen to my complaints. She is too eager to recite her prepared deflection lines. Etc.
89
@Pecan
Fire her.
3
If your doctor declines to recommend one treatment option over the other it’s a safe bet that the science supports the least aggressive treatment. Contra the “Ethicist’s” unsupported assertion, his/her reluctance to state this clearly is a direct result of the fear of litigation or at least finger-pointing. Blame this on the lawyers if you like, but don’t overlook the role of professional associations (in this case the American Urological Association) which seem to have misplaced their copies of the Hippocratic oath under the piles of cash generated by performing procedures that—in aggregate—do more harm than good.
25
I google university hospitals and WebMD and they do better than my doctors.
I decided against my doctor wanting to treat my PC with a Gleason Score of 6 and he feaked out yelling at me.
I reported him - its been 11 long years and m local PC has shown no increase and I'm now 83.
37
Regarding LW3, how does the administrator even know that the doctor in question is accurately conveying the promises he now claims were made? Since nothing is in writing, and happened years ago, the claims are weak at best.
Additionally, I certainly hope that this writer is not actually relying on a newspaper columnist in order to determine a course of action directly relating to his professional responsibilities. If he gives this physician all he says he was promised the write may create new problems and obligations for his organization that would be improper or poor management. Mr. Appiah correctly prefaced his remarks by admitting he can't give legal advice, and that is what the writer in fact needs.
15
Surely the doctor has literature or other resources that outline the different courses of treatment. Why couldn’t he say, “Here are some options. Look them over, come back, and we’ll discuss.”?
Telling a frightened layman in a crisis situation to go to the Wild, Wild West of the Internet — especially for anything health related — is not a responsible piece of advice, and I’m not so sure that a fear of possible litigation wasn’t in the back of the doctor’s mind. A patient should be able to discuss — and a physician explain — all possible treatment alternatives, as well as the pros and cons, with the understanding that the ultimate decision lies solely with the patient. Surely the doctor knows that.
And the glib comment didn’t help — this is cancer, not a hangnail. It’s still a serious and life-changing diagnosis. Bad bedside manners.
The doctor, IMO, massively failed the patient. I hope LW #1 is now exploring his options for a second opinion, as well as for a new doctor — one who isn’t afraid to do his job.
My best wishes to him.
184
As someone with brain cancer i'm sorry to read the doctor's unnecessary and inaccurate ice cold remark that brain cancer is always fatal. Life is always fatal too.
214
@faerber3dca
I had pancreatic cancer in 2012 and I'm still here. It's not in remission, it's gone.
My advice to this patient: Get another doctor.
31
@faerber3dca Agreed ! MDs should refrain from over-generalizing. Theirs is a science we still understand very little to. Best of luck with your recovery, and don’t stop believing in your chances !
5
@faerber3dca
So glad you spoke up. Incredibly callous and as you say, inaccurate. Of course, 30 years ago, as a med student, an attending called me out for wasting time talking to a terminally ill patient, by saying "Do some real work and give up on that piece of meat"
3
Many states have mandatory reporting systems for health care professionals who have substance abuse problems. A call to the state licensing agency or to the medical society can help this physician to decide what path to pursue. Most states also have programs that are designed to assess the level of problem and help a health care professional recover (if needed) and return to practice while protecting the public.
17
@Diana P — Not sure, but I think the identity of reporters can be kept confidential, at least by the state medical board. Also, reporters are immune from liability if their complaints are made in good faith.
This doctor’s behavior can’t be ignored. He is a tragedy waiting to happen.
23
I am in awe of good doctors. The ability and self confidence to make life or death decisions on a daily basis for others is beyond me. That said, the first letter writer's doctor's response fell somewhat below what I would expect from a decent car mechanic.
129
@runaway
I am in search of good doctors - the elusive 5 or 10%, and only in awe at the number of doctors who should be in another line of work.
39
@Eli. Sometimes I have the impression that a promise of good salary is a major factor in choosing a medical profession.
13
@Max
I am a retired surgeon, but a word about second opinions. I do not recall a patient requesting a second opinion when I told them that they didn't need an operation. When they did request one, I suggested that they ask their personal physician to make the appropriate recommendation because, if I were not sure of my decision, I would have been the one to request it.
Incidentally, the definition of a camel is a horse that was designed by a committee!
11