Trust in Our Doctor

mitchden4 said...
This forum saved me from having surgery - telling me to get a second opinion from Dr. Epstein.

The second opinion advice has pretty much become standard advice on this forum. And while sometimes I worry that we start parroting one another too much, clearly it can make a difference, as it did for you. I also remember a guy here from a few years ago that had a low volume G6 that we encouraged to: 1) get a second opinion and 2) consider AS. He did neither, had surgery and his post surgical pathology showed no cancer. That's obviously an extreme example and the guy had every right to take the actions he thought best for himself. But a second opinion sure would have been nice.

BTW, I had the opposite experience as you--I got an upgrade from Epstein...

Michael_T said...

mitchden4 said...
This forum saved me from having surgery - telling me to get a second opinion from Dr. Epstein.

The second opinion advice has pretty much become standard advice on this forum. And while sometimes I worry that we start parroting one another too much, clearly it can make a difference, as it did for you. I also remember a guy here from a few years ago that had a low volume G6 that we encouraged to: 1) get a second opinion and 2) consider AS. He did neither, had surgery and his post surgical pathology showed no cancer. That's obviously an extreme example and the guy had every right to take the actions he thought best for himself. But a second opinion sure would have been nice.

BTW, I had the opposite experience as you--I got an upgrade from Epstein...

Michael, I also heard about the person whose post pathology was negative. I understand that pathologists don't examine the entire prostate so I wonder if there was a tumor that they could have missed.

I believe that about 30% of men who have prostatectomies get upgraded and a much smaller percentage (10%??) get downgraded. I also understand that about 25% of prostatectomies require additional treatment - SRT/HT. Those are scary numbers.

Michael_T said...
I didn't realize that the entire prostate was not examined following surgery. Interesting.

Michael, here is the link to the 2009 Harvard Prostate Knowledge Document on Positive Surgical Margins after Radical Prostatectomy. Scroll down to the section on Assessing the Tissue. That's where it discusses the post surgical biopsy.

Mitch

https://www.harvardprostateknowledge.org/positive-surgical-margins-following-radical-prostatectomy

CAdogsRus said...

fiddlecanoe said...
The problem of knowing whether to trust your doctor is similar to knowing whether to trust a car mechanic. Both the doctor and the mechanic know much more than I do and make recommendations about what I should do (or pay for). Both have some incentive to "overtreat" because they make money from treatments.

Do doctors at the major university health care systems really have this incentive?

Aren't they salaried and not getting more incremental $ from more treatments? Sure, indirectly more revenue to the "system" affects their salary over time, but I would think there's not the same over treatment incentive that might exist in a private practice.

Different in some ways, the same in others. The more they bring in, thus increasing their employers income and reputation, the more salary, benefits and power. I have not really seen it be much different at any of the different style of hospitals I have worked at. In fact, the highest salary and benefits I ever had was working at a government (county) hospital. We cranked out the cases at at least the same #s(considering size of hospital and towns located in) at an equal pace to any of the private hospitals I worked at. And the more volume a surgeon brought in, the more clout he had, the more the hospital supplied him with whatever he wanted. I did work at one small, very inefficient government hospital. And I have heard of some larger ones around. But others were just the same as the private hospitals in wanting to maximize profits.

Ultimately we do wind up trusting them with our lives--and most of them understand that and work with that knowledge. That's one reason for the so-called 'white coat effect'--they put on the white coat as their own emotional armor.

As to why do they not (many of them) stay 'up' on the latest research? It's really simple: they don't have time. After they work their 12 hour day, what do they do? Sleep sometime, eat, spend time with their families, etc.

Hidden in the question is this real question: How do we properly assess what is available on the internet and compare it to what our doctors tell us? Isn't that what we are really asking?

I also note that medicine, for all it's science in the background, is still an art. The final decision of where exactly to cut or point the xray machine, or place the seeds is a judgment call. Most of the time it works out, but sometimes it doesn't. Is that a deliberate thing? Mostly not. We trust them to make that decision based on their experience, knowledge, whatever.

It has been stated here before but take it from someone that has worked with physicians for almost 40 years. There is a huge difference between great physicians and good physicians. My urologist, is a good physician who sincerely believes that surgery is better than radiation in most cases. I have no doubts that he is a good man who would not do anything to take advantage of me. The point is, he doesn't know anything outside of his expertise.

My dad died of prostate cancer. It was agonizing to see him suffer. I wanted to find the best physician I could find to ensure the best result to avoid the same fate.
The difference in knowledge between the physician I chose and my urologist was hard to believe.

Paul