Comments on: Why do doctors call it “practice variation” instead of poor care?

By: Felicia

Felicia — Sun, 03 Aug 2014 23:38:59 +0000

Dr. Moon performed multiple surgeries on my grandpa, all of that were unnecessary. This was the time period that he was being monitored by the FBI meaning he had to make it look like he wasn’t killing his patients. While he was being monitored, my grandpa got two heart surgeries because Dr. M had to prove that his patients were living. My grandpa didn’t need any of the surgeries he received. He was operated on because Dr. M knew that his surgeries would create complications that would soon lead to his death. He told my family that my grandpa would need a bypass surgery and immediately. My grandpa died during surgery. Not even 8 months later, Dr. M was facing lawsuits. It’s sad because my grandpa was my absolute best friend and he didn’t have to die. Dr. Moon is a sick man and if he can tell my 9 year old self that my grandpa was going to die, then he’d do and say just about anything to kill his patients. I wish that I could somehow get a hold of him and send him the picture of me and my grandpa moments before he went into surgery the day he died because I know for a fact he would remember my face when he told me that my grandpa, my best friend was dying. I feel nothing but hate for this man. No amount of money could change what he did to my family. I will never forgive Dr. M.

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By: Carolyn Thomas

Carolyn Thomas — Wed, 02 May 2012 23:22:45 +0000

This is appalling, Bev. Would you care to share with us what you learned from that journal article about those other factors that affect our dental health?

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By: Bev RN

Bev RN — Wed, 02 May 2012 19:24:46 +0000

Here is a loosely related story: I have encountered an alarming and disheartening number of incompetent doctors, but this goes beyond the medical field: Not too long after our economy went belly up, I was babysitting at the home of a dentist. I was at loose ends one night as the (very nice) couple was out late and I had neglected to bring anything from home with which to occupy myself.

I saw a professional dentist journal on the coffee table and picked it up to read. I turned to an article on how to survive the recession. It counseled that dentists should give ALL their patients their best care, and not just a select few! It didn’t say enough about what best was, but the idea that a dentist gave different levels deliberately to different patients was shocking even to me.

Then I discovered that there are factors in the diet beyond sugar and good oral hygiene which affect the health of teeth. (This was information which I only stumbled on, never informed of by my dentist.) When I asked the receptionist about it she said she’d be glad to make me an appt. so the dentist could give me that talk. (!) I can’t recall now how much my dentist (who I’d thought was one of the best, and perhaps he still is) charged for sharing this information but I do remember it was far more than spare change.

To think I was never even told there was such information out there, and then to learn I had to pay for my dentist to simply give me that information. Maybe I wasn’t one of the “select few” referred to in the dental journal!

This is a scary world for patients. All patients.

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By: Carolyn Thomas

Carolyn Thomas — Wed, 02 May 2012 12:58:14 +0000

Thanks for commenting here.

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By: Doctors on Call

Doctors on Call — Wed, 02 May 2012 05:36:42 +0000

I am really impressed with the attitude expressed here on The Nag: simple, open, honest, caring, hardworking and sincere, and all the discussion continues through blog comments. Very useful and unique.

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By: Carolyn Thomas

Carolyn Thomas — Mon, 23 Apr 2012 17:05:25 +0000

Your story is, sadly, more common than it should be. Most patients, unlike you, do not seek further information and thus feel compelled to follow the counsel of their physicians. Why wouldn’t they? Sometimes it’s only after the fact (as in the current controversies over stent-happy U.S. cardiologists – or conversely, when patients like me with textbook heart attack symptoms are misdiagnosed with indigestion and sent home from the E.R.) that many patients learn their diagnoses/treatments were not appropriate.

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By: Bev

Bev — Mon, 23 Apr 2012 15:51:43 +0000

For the whole horrifying story of Dr. Chae Hyun Moon and Dr. Fidel Realyvasquez in the introduction of this topic, there is a book published titled Coronary: a true story of medicine gone awry / Stephen Klaidman.
Publication info. New York : Scribner, c2007.

Carolyn, I am also concerned about receiving the care I need: no more, no less, within reasonable bounds of any doctor’s knowledge base. (No one, not even doctors, knows everything, even in their field.)

And how in the world can we know how well any physician knows their field? And how can we know how “honestly” they practice, even if they know plenty? How can we know whether they are reimbursed, so to speak, for doing procedures, necessary or not? The patients of the two doctors in the book above gave every appearance, to the patients at least, that they knew exactly what they were doing. (Doctors, nurses and ancillary staff were raising eyebrows and reporting concerns right and left but that’s another issue.)

For example, I was urged to have a major rotator cuff repair. This is an “iffy” surgery, which I only found out by searching and searching for information. Keep in mind much of the info on medical procedures online is put there by surgeons who do that surgery. I sought 4 (yep, four) opinions on what to do as I was getting conflicting advice and information. One surgeon insisted I needed the surgery on both shoulders. Another said, “no, just the right.” After a repeat MRI, he reversed that, and recommended surgery on only the left but emphasized that this surgery couldn’t wait long due to the nature of the tear.

I can’t for the life of me remember why, but the message was that this tear could cause even worse damage. I was all set to have the surgery, despite my pain disappearing, fearing what might happen otherwise, but I went back for one more talk since I was so confused. When this doctor found my pain was gone, his comment: “Then what are you doing HERE?!” Wow. I would have had that surgery for no reason at all.

And guess what? I have been 100% pain free for 3 solid years now! NONE of the four specialists mentioned this was even possible!

Again I ask: HOW do we know whether we are being treated appropriately?

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By: Carolyn Thomas

Carolyn Thomas — Mon, 23 Apr 2012 15:45:47 +0000

Yes, point taken. We’re seeing this phenomenon in cardiac stem cell “news”.

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By: Jose A Hernandez MD

Jose A Hernandez MD — Mon, 23 Apr 2012 14:57:35 +0000

Carolyn, I m glad you have addressed the issue of patient’s demands. But I was also attempting to address, rather clumsily, the academic world complicity in these calculations. For instance: How often have we seen “The Univ of ……. has a group of world renowned surgeons that have pioneered a new technique considered at the forefront of medical science for ….”?

I mean: Who would not want these experts to have a crack at what’s ailing you? And soon the patients will be asking their physicians if they know someone who can do this revolutionary technique that the university is offering.

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By: Carolyn Thomas

Carolyn Thomas — Mon, 23 Apr 2012 14:42:06 +0000

Hi Dr. Seth,
To most of us patients, it’s not so much about “more care” vs “less care”. It’s about appropriate care.

For example, when cardiologist Dr. Sharonne Hayes at Mayo Clinic was asked recently if the medical profession needs to develop different protocols for assessing/treating female heart attacks, she said NO – what we need is for doctors to follow existing guidelines for both men AND women – which is not the case now. So it’s not just us dull-witted heart attack survivors in the blogosphere who are asking why this is not already happening.
regards,
C.
PS UPDATE: See this Heart Sisters post on cardiac gender bias.

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By: DrSethdb

DrSethdb — Mon, 23 Apr 2012 14:06:14 +0000

Carolyn,

Great post

You answered your title question “Why do doctors call it “practice variation” instead of poor care?” with the question in the middle of the article “Is more care better care?” which of course begs the question “Is less care better care?”

The presumption of much of what is in blogosphere is that less is better but we don’t know. It’s also complicated by the messages that there are “variations and gaps” between genders and in certain ethnic and racial groups. If these concepts are both true (Less is better and there are group variations) then the groups getting less care should be the goal not the other way around.

For practicing physicians the health policy and health data is above our pay grade and dealing with the patient in front of us and following the great advice you’ve cited from Dr. Victor Montori is the best approach.

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