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Posted 8/30/2010 11:43 AM (GMT 0)
its hard enough for us guys to pick a treatment but when we have chosen how do we know who is the best at it.very simple, after every op we answer a questionaire,at periods say after the op then at say 6/12/24 months.they could then be rated on success on ed, incontinence, general health etc then we would have some chance of getting it right .i went to a known name in harley st london but he could have had a terrible record i wouldnt know and nor would he as since i left hos i have only seen him once for a short time and no questions were asked.lets start to create a record then we can complement the best and shame the worst.the lawyers should have a good time.
Posted 8/30/2010 12:20 PM (GMT 0)
That sounds good. However, there are surgeons that supposedly cherry pick their patients. Result: they look good.

Mel

Posted 8/30/2010 12:40 PM (GMT 0)
Might not be a good idea to "rate" doctors by name in a public place such as this. If the comments got off target, or were not properly documented, the legal actions would start flying. There has been a lot of news recently about that happening in several cases in the southwest US.
It would certainly put the continued existence of the site at risk.

Perhaps using some of the larger insurance company "find-a-doc" functions would be better?
Posted 8/30/2010 2:15 PM (GMT 0)
If you name name heres, just leaving evidence handy for libel and slander cases, probably best not to do that.

As far as cherry picking, I believe the majority of "brand name" doctors and "brand name" centers of "excellence" do the very same thing in order to look good and gives them some credibility in their self promotion in their advertisement.
Posted 8/30/2010 3:20 PM (GMT 0)
Just my two cents: I think it might be helpful if there was a place for people to post the names of docs they had a good experience with. As long as negative information isn't posted there's probably no basis for legal problem. I don't think there's any value in trying to aggregate statistical information for three reasons (1) cherry picking, as others have said (2) information can't be verified (3) each information set is based o different assumptions and so not directly comparable.

If there were a list of docs that people had a good experience with, that would be a helpful starting point for people who are shopping for docs.
Posted 8/30/2010 4:27 PM (GMT 0)

Somebody said...
If there were a list of docs that people had a good experience with, that would be a helpful starting point for people who are shopping for docs.

That would be helpful! (by the way my surgeon was great so if anyone is in the Kansas City area I can give a recommendation)

I was fortunate in that I am friends with two men who had their RALPs done by the same Uro/surgeon so I got invaluable info that unfortunately most men never get and who have to make their surgeon decision less informed with just a referral from another doctor or someone that is just in their insurance plan list.

I would even suggest making a list by city or region of members who don't mind being contacted for a Uro/surgeon. And if the conversation is private, it doesn't have to be limited to just good experiences.

Dan


------------------------------------
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

Post Edited (April6th) : 8/30/2010 10:31:42 AM (GMT-6)

Posted 8/30/2010 4:33 PM (GMT 0)
Making lists of doctors is frowned upon by the owner, as any listed implies ranking of them and the perception that the owner and/or forum recommends them. It's been done in the past, but then docs who weren't on the list complained, and another list, of less than stellar docs resulted in lots of docs complaining and a couple threatening legal action, so any posted listing isn't allowed. Individuals can always make their recommendations of their favored ones, as long as a list doesn't form..OK? devil smilewinkgrin
Posted 8/30/2010 4:47 PM (GMT 0)

James:

Good point. Certainly nobody wants any threat of lawsuits. I would hate to lose HW.

You know, I think my doctor was excellent, but how do I REALLY know. My pathology was not that good. Do I blame the surgeon? Maybe he should have taken some nerves and cut a wider margin?

Hindsight is wonderful!

I'm sure if I had a fantastic pathology, I would think my surgeon was great (I actually still do think that).

Mel

Posted 8/30/2010 6:32 PM (GMT 0)
compiler said... ...However, there are surgeons that supposedly cherry pick their patients. Result: they look good. The more I read and understand about both prostate cancer, and the business of prostate cancer treatment, the more I believe this is largely patient myth . What we see is patients with not-so-great nomogram outlook who still wants to shoot for a complete cure...so they find a surgeon to take on their case.  This is not a majority of all cases, but we see it elsewhere and with guys right here on HW...and I might make the same decision if I were in their shoes.  This is a key factor behind the reason that overall radical prostatectomy outcome results of 25% of patients needing follow-up radiation.  The lower-risk guys which make up the bulk of all cases are typically no issue [see my note below on generalizing].  If the stats for these cases were bifurcated, the overall outcome results would be very different...not always, but typically.  When the more challenging cases come forward, the doctors who are at the top of their field have the guts to say to their patients, "no, I don't think this is the right path for you."  I am, of course, generalizing, but it is the generally occurring cases which set the trend .  So, for completeness, maybe I need to give the standard disclosure/explanation on understanding statistics:  nobody is guaranteed an outcome, but statistics & nomograms help us understand the likelihood of outcomes.  
Posted 9/2/2010 1:47 PM (GMT 0)

What...no counter opinions?  Everyone lining up behind this one?

I wasn't expecting such universal buy-in on busting-up the perception ("patient myth") of some RP surgeons "cherry picking" patients for the sole purpose of improving their outcome statistics (to make themselves look good).

Post Edited (Casey59) : 9/2/2010 7:54:24 AM (GMT-6)

Posted 9/2/2010 2:30 PM (GMT 0)
I would suspect that there is some indirect "cherry-picking" that happens due to money (or the lack thereof). We have seen postings here about some high-end surgeons who do not take insurance at all, while I have seen several in my journey who did not take Medicare, Tricare, and a long list of the smaller plans.

This isolates them to a patient base which is able to pay, likely able to take care of themselves prior to treatment, and to get treatment at earlier signs of trouble, which means they will weather most health issues with some additional plus on their side.

With my insurance, I could never have afforded to travel for treatment (they only pay if the care is not available locally), nor to go out of network, much less to a cash-out-of-pocket Dr/facility. That said, I believe so far that I got good treatment, and it was all with facilities and doctors well-respected in the area. If I were on Medicare, that would be a very different story.

 

Posted 9/2/2010 2:40 PM (GMT 0)
142,

Yes there are doctors who simply won't take insurance...but I think you'd agree that this is a different scenario than the proposition that doctors "cherry-pick" patients to improve their outcome statistics (to make themselves look good).  Right?

Some doctors are so fed-up with the costs and overhead needed to deal with insurance companies, they can afford to say "the heck with that...no more insurance."  What that really means is that most patients will recover less of their out-of-pocket costs (or conversely, will have greater out-of-pocket costs).

But, again, that's a different scenario...

Posted 9/2/2010 3:06 PM (GMT 0)
So, because "Dr" says there is no cherry picking , there is no cherry picking? Not sure I have seen an ego like yours. Cherry picking is not some kind of urban myth. Even the great Walsh has been accused of that for years. It seems to occur more likely at the "big name centers" and with the "big name" doctors and surgeons that tend to promote themselves a lot, for money and reasons of fame.

I have been denied being seen by a well known surgeon with Duke. The official reason, is that he feels I have too much radiation damage around my bladder neck/urethra, and that reconstuctive surgery would probably be a failure and highly likely to leave me 100% incontinent for life. That sounds official enough, but could it be that a case like mine could lessen his reputation if it went sour? The interesting thing, is that he has never laid eyes on me, its all been based on consultations between my uro/surgeon and him by phone.

No doctor/surgeon wants bad cases out there for others to see, that's plain human nature at work there. And with the big name doctors/places, they have more to lose with any bad data out there.

You honestly need to get the idea out of your head, that everything you say is a fact and the only way to think. You need to respect the variety of opinions, not automaticially reject those opposing opinions of being invalid.

David in SC

Post Edited (Purgatory) : 9/2/2010 9:13:25 AM (GMT-6)

Posted 9/2/2010 3:30 PM (GMT 0)
142,

I think you are quite right about the money aspect side of this subject. I have always been suspicious of doctors/clinics that won't take insurance up front. Most of us mere mortals don't have the means to pay up front, and get reimbursed later.

Another way of "cherry" picking, is to narrow down the criterial of treatment "x" to the point where only the best and most odds of curing a patient are on the list. I guess a doctor/surgeon has the right to be choosy on whom he will see or work on, does make you wonder where their heart is at.

While I have access to pretty good health insurance, throughout my PC journey, it still doesn't pay or allow me to fly all over the country seeking opinions from the "guru's" of PC, and having special testing that is outside the normal loop of coverage.

Having said that, I do not feel cheated out of having the best care. I am thankful and greatful for the care I have received.
Posted 9/2/2010 3:40 PM (GMT 0)
I tend to believe that when a doctor limits himself to seeing the Class A+++ patients (i.e. lots of resources) he is effectively refusing all of the rest, who, being limited by health/job or lack of job/insurance/location, are very likely to be those with whom he will have less stellar results. I've not seen many doctors lately who concern themselves with back-room billing issues - they (the ones I see) are in large practices which have outsourced that.

It is, regardless, a way of getting better clients, making more money, and in the end having better results.

Therefore, cherry-picking.

Not a different scenario, but an "acceptable" way of accomplishing it.

Posted 9/2/2010 3:41 PM (GMT 0)

Purgatory said...
You need to ... not automaticially reject those opposing opinions of being invalid.

Oops, did I do that?

 

If I said something that was not correct or not intending to be ultimately helpful, or if I automatically rejected someone's opposing opinion as being invalid, then I would apologize...but as I look back at what I wrote, I'm not sure I see what the hub-bub is all about...

 

In this case, exactly what I wrote was "The more I read..., the more I believe this is largely patient myth."  I recognized it as "counter-intuitive" thought (obviously, or else I wouldn't have written this morning's posting saying I had expected some counter opinions to be posted), but I also presented a plausible circumstance to support what I believe.  I know "doctor-bashing" can be a favorite sport, but I don't think it's nearly as bad out there as some would influence the scared newbies to believe.

 

So, anyone else have an opinion on my theory that doctors (surgeons) are sometimes doing the right thing by turning away patients?  Here's a copy/paste of exactly what I wrote:

What we see is patients with not-so-great nomogram outlook who still wants to shoot for a complete cure...so they find a surgeon to take on their case.  This is not a majority of all cases, but we see it elsewhere and with guys right here on HW...and I might make the same decision if I were in their shoes.  This is a key factor behind the reason that overall radical prostatectomy outcome results of 25% of patients needing follow-up radiation.  The lower-risk guys which make up the bulk of all cases are typically no issue [see my note below on generalizing].  If the stats for these cases were bifurcated, the overall outcome results would be very different...not always, but typically.  When the more challenging cases come forward, the doctors who are at the top of their field have the guts to say to their patients, "no, I don't think this is the right path for you." 

 

best regards...

 

 


Post Edited (Casey59) : 9/2/2010 9:52:14 AM (GMT-6)

Posted 9/2/2010 3:50 PM (GMT 0)

142 said...
...he is effectively refusing all of the rest, who, being limited by health/job or lack of job/insurance/location, are very likely to be those with whom he will have less stellar results....

 
Therefore, cherry-picking.

Ahhh, 142, I see your point now...sort of a "poll test" theory.  It seems like your underlying hypothesis is that men with the greatest amount of resources will present with less serious cases.  On a broad scale, I definately believe that to be true.

Posted 9/2/2010 3:54 PM (GMT 0)
Ok, to the "refusal with reason" line - I was told by two of the top clinics in the US that I was outside of the limits for their programs, and was sent the specs for inclusion.

That is not cherry picking, it is following a published and available standard they set at the start.

I was not told by any physician who was in my insurance network that they would not treat me.

I had to change GP practices, as the previous one refuses all new patients over 55, my GP left, and no remaining doctor would take me. They do not accept Medicare, nor anyone even close to it.

That is as close to cherry-picking as you can get without having the juice on your hands. Don't mess with the old folks, just the young ones with cash or cadillac insurance.

Posted 9/2/2010 4:06 PM (GMT 0)
Casey - I dont think you said anything wrong at all.   You simply expressed a view.  Others can disagree with your view, if they want to.  My own view is that whether a doctor is "cherry picking" (by which I mean turning down more challenging cases in order to make his "batting average" looks better), or is simply refusing to perform a treatment (say, surgery) on patients who the doctor thinks are not likely to benefit from that treatment -- even if the patient wants the treatment -- is hard to tell.  Personally, I would choose to give the doctor who refuses to do surgery on a certain case the benefit of the doubt.  I don't think a doctor should be required to do a treatment that a patient wants, if the doctor believes the treatment is not in the patient's best interest.  For example, I could see a doctor refusing to do surgery on a patient who has statistics that show a very high likelihood of metastatic disease.  Of course, another doctor will agree to do the surgery.  But under such circumstances, maybe the accused "cherry picker" is doing the right thing.    The issue of refusing to treat a patient population with lesser financial resources is a different issue, in my view.

Posted 9/2/2010 4:23 PM (GMT 0)

Casey:

I think my post started this discussion about cherry-picking cases.

I phrased my post this way:

" However, there are surgeons that supposedly cherry pick their patients. Result: they look good."

That statement is based on many posts I've read on discussion groups.

I am certainly not saying this is true for all or most.

But, here and there, I have to believe it happens. In fact, wasn't there a post here on HW where someone even said his partner is starting to do robotic surgery and is picking only the "good" cases to start with?

Perhaps it never happens or it happens so infrequently that it PRACTICALLY never happens. I'm not sure. But I bet some of the surgeons know whether this is true or not.

I suppose I will now be accused of doctor bashing, when I am doing nothing of the sort.

Mel

Posted 9/2/2010 4:34 PM (GMT 0)
Come on...ya gotta admit that a bit of doctor bashing does take place here, right?


Anyhow, Mel, any credibility (in your eyes) to the theory I put forward that when a surgeon turns away a high-risk patient it is more likely because it is not in the best interest of the patient (see my embellished paragraph above) than because the surgeon is trying to pad his statistics to "look good" (which was your original theory in your 8/30 post here).
Posted 9/2/2010 4:42 PM (GMT 0)
Casey:

My thesis was that some surgeons do this. Period. I'm not saying it's many. I already quoted my exact 8/30 statement.

I know that my surgeon, Dr. Menon, has turned a number of patients down and I believe 100% that it was because he felt surgery would not help them. I've personally spoken with some of these people. One is in my local support group.

So, I agree with your statement. You are a logical fellow. Surely you realize that my statement does NOT contradict yours.

Are you saying my statement is incorrect? Are you saying that no surgeons only take prime cases to pad their data.

Mel

Posted 9/2/2010 4:57 PM (GMT 0)

compiler said...
Are you saying that no surgeons only take prime cases to pad their data.

No.  I don't believe there are only "1's" or "0's" in large populations of data.  But this theory has been posted here many times, and I believe it is (as I wrote) largely "patient myth."  Nor do I believe (nor did I say I say) that surgeons only turn down patients when it is in the patient's best interest...but I do believe (based on the more I learn about PC and the business of PC treatments) that the latter is more frequent than the former...but in my observation the former mostly gets written about.  Thus my counter-intuitive proposition.

I also hadn't considered 142's "poll test" theory (my wording); but with it now explained, I buy into that as yet another contributor.

I personally believe doctors treating PC, and especially those recognizable names who are at the top of the field (Menon included), are mostly interested in helping patients above any deliberate strategy to "pad statistics."

Anyhow, sounds like we have largely converged...

Post Edited (Casey59) : 9/2/2010 11:07:22 AM (GMT-6)

Posted 9/2/2010 5:32 PM (GMT 0)

Casey59 said...
"... I put forward that when a surgeon turns away a high-risk patient it is more likely because it is not in the best interest of the patient ... than because the surgeon is trying to pad his statistics to "look good" ..."

You are very correct on this statement...I have never met a doctor that refused any kind of treatment based solely to personally look good. 

But I have met doctors that have turned me away for the exact reasons you stated...and that didn't make them "cherry picking"...just good doctor/patient communication.

Posted 9/2/2010 5:33 PM (GMT 0)
Geez, Casey, your posts sound more and more like legal proceedings, where you take pride on nit picking every word someone posts that doesnt agree 100% to your discourses. That's not offering good advice or support, seems more like an ego ride to me. Come back to earth, and see if you can really help someone in need. This place isn't meant to be a test of "wits and cleverly worded" phrases.

I understood what Mel and 142, there was no reason to read any deeper into the simplicity of their original posts and remarks.
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