Wednesday, April 25, 2007

Those Who Know...Do What They Know

So, you've gotten the test results back and it looks like you have a health issue that needs to be addressed. It's a bit outside the scope of your general practitioner but you trust him/her enough to guide you on where to go next. Or, maybe you don't, and you go to someone recommended to you from elsewhere. Do you know that where you happen to land will most likely dictate your medical course of action?

My father has a history of clogged arteries in his heart. He has had two stents placed. Despite this history, it was still a shock when his GP informed him that he was developing a similar kind of blockage in his kidney's artery. While he was familiar with the workings of the human heart, dealing with kidney disease was well outside his knowledge base.
He began to see several doctors with different perspectives. The heart doctor was inclined to load him down with various kinds of blood pressure medications. At one point he was taking so many that he could barely stay awake.
When he sought the council of a nephrologist, he got a completely different view of his treatment options. They spoke with him about kidney transplants and dialysis. They even wanted him to sit through a tutorial on the function, cost and resources for in-home dialysis machines. In addition, they were adamant that he not bother with the surgery as the risks were too high and the success rate not very good. He left that office in shock and fear of these drastic options.
Upon the family's urging, he also visited with a top renal surgeon at the same hospital where I had my transplant. The surgeon strongly believed that he was a good candidate for this procedure and that this was the best course of action for his problem. The surgeon cited very high success rates and the ability to get off of many of the blood pressure medications post-op. In fact, he was astounded by the number of meds my father was currently taking and urged him to narrow it down to three, at most. His belief was that if the issues could not be managed on three drugs, then surgery was certainly the best option.
Three different doctors, experts in their fields, and three completely different ways to treat the same problem. My parents left each consultation with their heads spinning. One doctor seemed to indicate that my father was in serious renal failure while others indicated that he was only in the very early stages and had plenty of time to make decisions. Each one presented a strong case for why they felt it best to proceed as they advised, often at the same time discounting the treatment plans of the other practitioners. It was a very stressful and confusing time for my parents as they hacked their way through the information at hand and tried to make the best decision.

The Verdict:
Medical doctors typically believe in using medicine before surgery. Surgeons usually see the answers to your problems in surgery. A specialist will see you through that specialty's filter. When you walk into any particular office, you are walking into a certain perspective and a certain philosophy. For many medical issues, there is no concrete and universal treatment plan. Often, however, when you speak with a doctor who has a passion for what he does, it will be presented as if there is one clear choice. Although it may be overwhelming, it is important to shop around, gather up all of your options and decide for yourself which treatment plan makes the most sense to you. That may mean going with one doctor in particular and that may mean combining the expertise of more than one. As always, you are in the driver's seat.
No one would go through all the years of medical school and additional years to learn a specialty if they did not believe in what they were doing. Know that when you are getting a doctor's opinion, they are representing their training and their passion. They may have the answer for you...or they may not, despite their compelling views!


Lainey-Paney said...

Ahhh...the wonderful world of medicine & varied opinions.


Good luck to your dad!

OB Doctor said...

Another excellent post. Unfortunately, doctors want to use the tools they have in their toolboxes. I think this reality may illustrate the need for getting a "true second opinion" from a physician who has no incentive to agree or disagree with previously recommended treatment plans.