I don't get it: Hoo-Ha tests & Inflated Doc Egos

I'm sorry. I'm missing something. I'm not cynical here but I am skeptical.

I've been involved with multiple aspects of the medical and biomedical community all of my adult life.

I was married to a phenomenal researcher who publishes some knockout papers (and I proofed and edited a couple of them), her post-doc lab partner was one of the true MD prodigies in the world. My cousin is an MD who went to the top schools, my niece is a Ph.D. in P-Chem specializing in biological nano-technology who earned the unusual distinction of being published as an undergrad. I generally learn of true breakthrough technologies five years before the public does. I listen to them because they fascinate me.

Now I'm married to a nurse with 25+ years in surgery (cardiac, neuro, ortho, robotic, general, emergency). She's worked with surgeons who made more money than 75% of most Fortune 500 CEOs. She's been on cases where she's been told, "Sixty-minutes will be here tomorrow, keep your mouth shut." She knows the inside stories.

I've been to so many hot-shot doc dinners (where informal means taupe pants, white shirt, club tie, blue blazer and Gucci loafers) I wanted to run screaming. O-M-G! I won't mention that the nurses who grant big pharma access to your doc are getting treated to Chateau Mouton Rothschild and Mahi-Mahi Dinners plus the Chippendales revue a couple of times a year.

Oh, by the way I divorced the first wife because I wanted my own career, most of which has been medical marketing, and been doing it since it was legalized in this country. OK? I learned a lot in 30 years.

All of that before this little monster showed up.

You know what I've learned? MDs are no different than the rest of us, except maybe their egos are larger. I've seen some with egos so over-inflated they would cause the Goodyear blimp to scream, "Oh, the humanity!" Most of those egos aren't justified; a very few, maybe. And there are plenty of superb practitioners who are just as good, and as humble as a monastery full of Trappist monks.

There are some top-name joints I've seen thrown around in this forum with nasty reputations for doing what their medical conglomerate sponsors tell them do do. I see clinical studies thrown around that have all the scientific importance of a high-school science fair project. I see the average age of a PCa patient at Dx is 67, and his life expectancy at birth was 65 (do the math). Life expectancy for a male born today is 75, yet we read all these 10-year studies on 67-year olds (sharpen your pencil's again and check your math). And then there was that study that cited "10-year median time studied", which, if you remember stat class could mean 1 year, 1 year, 1 year, 1 year and five 10 year patients. My stat instructor warned, "When you see median cited in research it is most likely misleading." OK?

And then we have the latest and greatest scanning and test technology. CAT scans DOG scans. CAT & DOG Scans. MRI, MRI+OxClean the miracle whitener. And now we have Super Doppler Scans with your very own Storm Team & Weather Watch analysts. Wow! With all that research investment, we can be sure there aren't any MBAs in the wings worried about quarterly ROI, can we? And Dr. Prosta Corp. who just laid out a few dozen Bentley Continental Supersports for this wonder machine has no interest in at least paying the interest in this technology, no?

I haven't been this deep in it since I fell off my horse in a Western Kansas feed lot. At least, looking at some posts I feel that way.

So, tell me, after I've gone through all of these lay posts, tell me why my urologist, who gave up at $200,000 a year drilling rig engineer's job to go through half a dozen medical schools, each of which 99.9999% of our kids will never get into, and publish in journals, and go through so many surgeries. Tell me why he's such a freakin' moron and I'm a dope for choosing him?

I don't know if you realize it, but some of you guys come off pretty insulting in a very snobby way.

Candidly,

The Biker Guy

Biker,

I read your post at least 3x in a row, trying to follow what was leading up to your point. If your very last sentence was meant to be taken literally, I would say I agree with you. Or, did I miss your real point. With your inside knowledge of the medical "industry", I am sure you see the other side that most patients are never exposed to. I am certain that business is business, whether you are manufacturing toilet seats, or head up a major cardiac care unit. Probably better off for the average patient to never know that side, as it would be disheartening at the least. My wife too, is a very experienced nurse, and over the years, I have heard too many horror stories about how facilities of her type are really ran.

If I didn't get your point, could you spell it out to me, because I don't always get the obvious, cause I keep getting caught up in the details.

David

David,

I am seriously offended by posts that suggest only a few experts and the latest tests are the only true hope a patient has.

I find those posts toxic, self-aggrandizing and to some degree predatory.

Any time people prey on an individual's desire for self actualization as a way motivate action to satisfy the physiological need of self- preservation they are treading on very thin moral ice.

I see people doing that here.

Too many people are leaving their homes and families, incurring needless costs for tests and travel, and sacrificing happiness for worry when they can get excellent results close to home.

I'm here to read and share personal experiences of those who are on this same journey. The pseudo experts make me vomit.

Thank You,

Biker Guy

This is not a healthyplacefor me.

I did not goto Loan-ketteringor Johns Hopkinsor SarasotaorHenry Ford. And I did not have the fancy tests people here require. I just trusted my physicians and second opinions and that is not good enough and apparently I made bad choices.

So I will go delete my profile. Other threads here have caused me anxiety and many tears because my doctors are not good enough and now I am scared.

Whoa! Pull back a little bit Biker. It does not pay to come in too hard either for or against any particular hobby-horse (unless of course you're pushing something like POM or castigating red meat eaters). I do like to hear all sides of a discussion so hang in there and keep talking.
Mel,
why that post??
Bill

Bill, I do agree with Biker's sentiments, was just confused, why does it show him being a member of July 2012, I thought, if it's the same Biker, he had been here a long time.

I have said from the start of my journey here, that there are many great local doctors and surgeons that no one outside a local area would have ever heard about. And not everybody has the resources or time to travel all over the country (world) for 2nd and 3rd opinions. And I have always had a distaste of this short list of alledged national experts, and that if you don't use them, you are short changing yourself.

I think for those that promote that line of thinking, do a dangerous diservice to those new here. We don't need to get them starting to doubt the integrity or skill of their local doctors, or make them feel that they have to pass some litmus test among those at HW in order to show or prove that are getting proper treatment.

When are folks going to remember, there are no in-house experts here, and there are no doctors here. As a rule, we may represent fairly educated patients on all things PC, but that is not remotely a qualification for sound medical advice.

I still say we need to get back to more on the focus of support, rather than endless academic debates on matters that end up being more opinion than proven medical facts.

Let's leave that part to the true medical professionals. If that is what Biker means, than I for one agree.

David

David,
I thought that Biker had mentioned that he had not been here in some time and had forgotten his earlier username so had re-registered as a newbie. I think the biker you are thinking of is Jim aka Biker90, a long time and esteemed member (since 2006).

Mel,
Perhaps Biker after seeing his PSA rise in the last 12 months and subsequent scans showing tumour in the prostate bed, felt like venting his spleen.

Post Edited (BillyMac) : 7/25/2012 12:38:05 AM (GMT-6)

In my almost six years here I have seen various behavior and many points of view. We have it all when you sit back and watch through the years. I think however the value one can take out of an online discussion board depends on each individual. I certainly have seen the guilty of less than helpful posts and been guilty of a few of my own. And Bikerguy I saw quite a bit in the body of your post that I agreed with and laugh at. I have seen various ego's in the medical profession but that's really not any difference in my day to day profession. Or here at HW either.

I hope you stay. If your not getting anything out of the site then maybe you can give to someone through it. The general opinion of the site that I know and read about is how helpful it has been to each member. It has been invaluable for me to read the diversity and learn from it so that I can do the work I do with live meetings and memberships.

But the site is probably less helpful if you are here to hear what you want to hear...lol...That might happen, and then it might not.

Peace...

Tony

My cancer was discovered when I was 40 because of the good work of my local doctor (not a urologist). I will be forever grateful to him and look forward to catching up with him later in August now that i've returned to America.

I picked a surgeon who happens to be very visible because he left a great impression after my consultation with him. My decision was made with the belief that the more experience a surgeon has the better my chances to overcome side effects and to eliminate the potential for the crap to return. But of course there are no guarantees, we all know that.

After some 2 years reading posts here I think that personality issues aside, the vast majority of participants are very helpful and caring notwithstanding potential differences of opinion over treatment and meaning of this disease. In fact, there is really only one person who in my opinion is terribly didactic and like many others, I've had him on ignore for a while.

Biker - I've enjoyed your posts before. You sound angry and frustrated which of course is perfectly understandable. Even when things go well post treatment living with this disease or the memory of it is terrible difficult.

Taking a break is good and in fact healthy, but I'm sure you will recognize the good intentions of the vast majority here and the benefits this and other forums provide to many newly diagnosed men.

Although I think it's obvious that Biker's original comments in this thread were a bit over the top (but certainly entertaining to read), there are definitely some truths in what he's saying.  I know I can relate to a few things he mentions.

I remember a debate a year or so ago about this business of a "learning curve" for robotic surgery.  Some folks were setting the bar extremely high, claiming 1,000 or more surgeries were needed to achieve excellence in the techniques and procedures.  I still see that claim being made.  At the same time, I was finding studies from reputable sources that showed surgeons generally are as good as they're going to get after a fraction of that number.  I was shouted down and even ridiculed a bit because my surgeon only had done about 50 procedures, yet my outcomes have been excellent, my recovery uneventful. 

I felt then, and still do, that my experience, while not optimal, represents a minority view that may be of comfort to the thousands of guys who for various reasons must rely on theit local uto/surgeon and trust his good reputation.  By and large, they will probably do just fine following that path, but we sometimes perhaps make them feel stupid for doing so.  Even though, as Purg has pointed out, we read just as many less than ideal outcomes involving "name" surgeons as we do small practitioners.

I also recall being told I was not very smart for listening to the opinion of my daughter-in-law's mother who is an Operating Room technician and who told me of my surgeon's excellent reputation, and even to my wife, and R.N. with 40 years of experience who knows the doctors here in the county and who are the better ones.  A few guys here said people like nurses and O.R. techs only know gossip and personalities and can't be trusted for reliable information about surgical qualifications.

Like Biker, I found some of these comments distressing and even hurtful.

However, all that being said, I've found HW to be a wonderful site that has been of enormous help to me in dealing with this "crap," and every time I'm at church, I take care to say a prayer that all of us who have been touched by this cancer find the help we need to deal with it, and that, if possible, we might be restored to good health and live long and happy lives.

If some guys have the money and resources to travel the country, visiting the premier experts on prostate cancer, I say more power to them.  I certainly don't resent that and how can it be anything other than a good idea?  Unfortunately, not all of us can do that, and I guess we do need to be sensitive to the majority of men, who live in small town America, on modest means, fighting this cancer with the means available to them.

 

Biker,

I tend to agree with a lot of your comments, but was having trouble coming to a wrap up. Sort of like looking at a building site - good materials, wonder what it will look like when they finish?

I don't agree with your comment about moderators. We are volunteers, and contribute what time we can to keeping things spam-free and to a dull roar instead of something worse. That said, we have lives, obligations, and at least in my case, a 12-hour a day job that provides enough insurance to see a local uro. I also have my issues with the high priests of PCa, but as a moderator, I try to be balanced.

Want to volunteer as a Moderator?

Others,

The Troll comment, made in the context it was, is actually a pretty flagrant rule violation (no flaming). If you see reason to believe that someone is not what they pretend to be, please email a mod and/or flag the post to Peter.

biker, your manifesto was hard to follow.   You seemed to be asking whether outcomes from all doctors are equal.   They are not.   Experience is a factor, and has been demonstrated in repeated examinations about the robotic surgery learning curve (there is no industry standard definition).   Are all radical prostatectomy surgical techniques the same?   No.   Dr Patrick Walsh introduced the nerve-sparing RP on April 26, 1982, and over the next 29 years until his retirement (performing his final RP on June 29, 2011) he made 28 major changes to his surgical technique and has continually improved his results.   Are these improvements instantly implemented by all of the community urologists?   No; there is a trickle-down over time.   Does it mean that all patients going to a less experienced surgeon will have bad outcomes, and all patients going to an experienced surgeon will have good outcomes?   No.   Taken as a whole, some men will have good experiences, and others will have bad experiences from lesser-experienced doctors, and other men will have good experiences, and others will have bad experiences from more experienced doctors.   But this factor is significant enough that finding an experienced surgeon has become one of the fundamental “rules of thumb” for those seeking surgery and wishing to stack the odds in their favor for the best possible outcome.   Does every HW newcomer know this “rule of thumb” immediately?   No.   Is it valuable for HW veterans to inform newcomers of this and other “rules of thumb?”   Yes.   Are you tired of hearing about the “rules of thumb?”   I don’t really care; if you don’t want to provide helpful support to newcomers at this site, then don’t participate in the threads aimed for newcomers…skip over them and participate in the threads you can add value to.   Just because you go to a party with beautiful people doesn’t make you one of the beautiful people.  

Wow!  I usually try to read all comments in a thread, but somehow I missed the sentences Tudpock just posted from Biker's comments.

I've been hanging around this forum since September 2010 and like Jim, I find those remarks totally unjustified, and even moreso for their attack on our moderators. 

It's kind of like walking into a friendly tavern and insulting everyone there.  Uncalled for and very unfair.  "hateful people"?  "An environment of spiteful prejudice"?  Seriously?