The Procto-Blog

When a pseudoscientific remedy makes a patient feel better

remedy-bottleI was trained in Western Medicine where surgery and pharmaceuticals were all that was important.  Over the years my beliefs have changed and so have those of the medical community.  In many ways Western medicine is adopting the beliefs of the Eastern medicine philosophies which I feel is a big step forward in the right direction.

When it comes to benign diseases I have no issue with patients trying various non-Western medicine techniques (even pseudoscientific remedies) to help them.  I have many patients tell me that they cut out a certain food or switched to an ‘all natural’ ointment or supplement which helped to relieve or minimize their symptoms.  First I look up the ingredients of the products they are using there to make sure there is nothing detrimental in the ingredients (laxatives, steroids, etc.).  On many occasions I find that there is nothing in the products being used that I feel would be of any benefit.  Since the product is working I will tell the patient to keep using it as it doesn’t matter why it is working as long as it is working.  This is known as the ‘placebo effect’.

The placebo effect has been around for a long time.  The powers that be took this aspect of medicine out of medicine in the hospitals many years ago as it was felt that using a benign product with no treatment value on a patient was unethical.  I never understood this.  If a patient addicted to narcotics states that they felt better after getting a shot of a pain killer (actually saline as the placebo) does this really do harm to the patient?  A shot of saline is innocuous and it helped the patient feel better.  It also prevented them from getting one more does of an addicting medication.  If used correctly ‘placebos’ can be very beneficial.  Patients are using placebos everyday without harm.

Medicine is both an Art and a Science.  In my opinion 90% of medicine is an ‘Art’ and the remaining 10% is a ‘Science’.  The placebo affect is a part of the “Art” of medicine which over many years worked very well.   It is now gone in the hospitals.  If a patient uses a product that is innocuous but benign and it works for them (placebo effect) than in my opinion this is a good thing.

Dr. Rosenfeld

 

Doctors Care – The System Doesn’t!

caring_doctor

Doctors today are often accused of being uncaring.  It is what we hear on the television and cable networks and what we perceive in the busy waiting room as we wait to see the doctor to get only for a few minutes of their time.  While having lunch in the cafeteria I often hear from other doctor colleagues about how busy their practices have become and how unhappy they are with the way things are going in medicine.  They want to spend more time with their patients and help them as much as possible, but feel they aren’t practicing medicine the way they were trained.  As a double board certified specialist in proctology I often wondered what direction my career was going.  As my volume of patients increased I started feeling the same way.

The System of insurance companies (private or HMO) and government regulations forced us to become robots, dislike medicine and churn out patient volume.  The System for which we pay thousands of dollars a month to belong, does not care about your health.  Sure the commercials make you feel like they care, but they don’t.  Yes insurance companies do help many patients, but I am confident they hinder many more people than they help.  When a doctor orders a test the insurance company has to approve it.  Why does a doctor train 12 years (4 years undergraduate school, 4 years medical school and 4 years residency) to have an underwriter from an insurance company who has no medical training disapprove of the test?  It is because we have been conditioned to believe that doctors only order tests to make money.  Sure a small percent of physicians may practice this way, but the majority of doctors deeply care about your health.  When the insurance companies deny care, it is the doctor who tells the patient, so the patient hears it from us and not the insurance company so it looks like we don’t care.  If the insurance company or Medicare refuses to pay for a procedure it is the doctors who has to tell the patient.  Because the insurance companies are not on the front lines of the communication it gives the perception that doctors don’t care.   I am sorry to say that for most people, the ‘Affordable Care Act’ will only make it worse (sure it will help some).

Why are doctors so busy?  When re-imbursements continue to decrease for taking care of patients, doctors are forced to see more patients to keep their office open.  Seeing a large volume of patients increases the workload exponentially as most patients have labs, x-rays, surgery scheduling, follow up calls from other doctors, dictations of reports etc.  Each patient requires a lot of follow up from the aforementioned tests.  The increased volume places a burden on the workload.   More staff is needed to handle this workload which increases the overhead, which in turn forces the doctor to see more patients… and the hamster wheel keeps spinning.  If The System cared about your health it would take the large amounts of money you give to it every month and actually spend it on your healthcare.  With increasing deductibles the patient already pays a large portion of their bill while at the same time the premiums continue to be exorbitant.  Where is all the money going?  It sure isn’t toward your healthcare.

When I hit the fork in the road, one way going down the path of seeing more and more patients and the inevitable resentment of medicine vs. the other of seeing fewer patients and becoming the doctor I trained to be, I re-arranged my practice so I could become the doctor I trained to be.  I now spend as much time as necessary with each patient, never feeling rushed and treating people as doctors did in days gone by.  Listening to the doctors in the lunch room and knowing theirs is the sentiment across the country, I know now that I am the happiest doctor in America.

 

Dr. Rosenfeld

Too Young For Colorectal Cancer? Think Again!

Her pain is written on her faceI ‘m sure you couldn’t imagine getting a call from your doctor informing you that you have colorectal cancer.  I am sure it would be more unbelievable if you were younger than 50, 40, or even 30.  Unfortunately colorectal cancer is on the rise in younger patients.  As a proctologist I have had the unfortunate task of informing young patients (younger than 50) that they have colon or rectal cancer.  I hear more and more stories from patients who tell me of their close friend or relative, in their 30’s or 40’s, diagnosed with colon cancer.  Some have metastatic colon cancer.  I recently saw a 42 year old male in my office.  It was not his first visit.  I saw him, for the first time, 3 years ago at the age of 39.  When he first came in he complained of bright red rectal bleeding and pain.  I diagnosed a fissure-in-ano (anal tear).  I saw him a month later in follow up and advised that he have a colonoscopy because he had rectal bleeding.  Two and a half years passed and at the young age of 42 he was back in the office. On my desk was a stack of medical records.  As I reviewed his records there were reports of colon cancer, surgery to resect a portion of his colon, and x-ray tests showing cancer in his liver.  I checked my notes from his first visit and saw that we had a long discussion about a colonoscopy.   I went into the exam room and we talked.  He told me he remembered our discussion regarding a colonoscopy and stated he knew that if he had it performed he may not have been in this situation.

This story wouldn’t be so sad if it were the only case.  Unfortunately it has happened more than once.   Twelve years ago, a 42 year old successful woman came to see me for bleeding.  I treated her hemorrhoids and requested she come back in 6 weeks for a colon evaluation.  She showed up 2 years later, at the age of 44 with more bleeding.  I did a short scope in the office and found a large and almost obstructing, rectal cancer.  When I gave her the news that she had rectal cancer she was stunned and replied, “you know, you told me to come back to have my colon checked 2 years ago and I didn’t follow up as I should have”.  Here was a young patient with rectal cancer.  She underwent extensive chemoradiation therapy and then I performed her surgery to remove the tumor, the rectum, part of her colon and put the bowels back together.  She required a temporary ileostomy as the colon was sewn close to the anus.  She continued with 3 more months of chemotherapy.   After the chemotherapy ended I performed the surgery to reverse her ileostomy.  The whole process from start to finish took 12 months. Fortunately she is still alive and cancer free.  It will be 10 years from her diagnosis this June.

When I see a young patient with bleeding, even if due to hemorrhoids, fissures, or other benign conditions, I always recommend a colonoscopy.   It is never a simple decision for a young patient to undergo an invasive test, especially when they consider that they are so young and have such a small risk of cancer.  Truth is, we are seeing more colorectal cancer in young patients than in the past because young patients can have polyps which can lead to colorectal cancer.   I am not worried the young patient has cancer; I am concerned about colon polyps in young patients because it is polyps which can lead to colorectal cancer.  If polyps are found and removed during a colonoscopy, colon cancer is prevented.  I find polyps in many of my young patients requiring a colonoscopy.  Once removed their risk of cancer is very small and we repeat a colonoscopy in 3 or 5 years depending on the polyp pathology.

For any young patient who is unsure of doing the procedure I tell them, “you can marry the wrong person, buy the wrong house or buy the wrong car.  All of these poor choices will only cost you time and money to fix.  You can look back at these mistakes and say, ‘gee I wish I would have made a better choice’ and there is still no harm.  If you chose not to do a colonoscopy and develop cancer it isn’t just time and money which is wasted.  You can’t look back and say, ‘gee I wish I would have made a better choice’, because with a diagnosis of cancer, there is a lot of harm”.  Don’t ignore your health, it is the most important commodity you own, without it you have nothing!

Dr. Rosenfeld