Why I Use A Healthcare Specialist
The idea for this article has been in my mind for a while, but two things spurred me to finally write it. First was a post recently by a Prostate Cancer (PCa) patient on how his PCP said a six-month jump in his PSA from “below 1” to 3.6 was normal, and now he’s fighting a battle for his life because the PCa was caught late. And then secondly, as I’m starting to write this, I’m sitting next to a pediatric PCP (aka a pediatrician) and a pediatric surgeon (my daughter and her husband, respectively), and both excellent physicians but with 3 years and 8 years of post-medical school training respectively.
The root of my belief
The reason I believe in using specialists for my health started in 1974. My first two jobs after getting back from Vietnam were as a pharmaceutical sales rep selling pharmaceuticals to doctors. One specialty I was calling on was pulmonologists (they deal with lungs and lung health conditions). I asked one I’d become friendly with what his success rate was in healing pulmonary diseases, and he replied — “After the PCP’s diagnose a pulmonary condition, their ego makes them try to deal with the condition until they realize it’s not working. And they see fewer patients with a pulmonary condition in a week than I see in a day. If I got them when the PCP first diagnosed them, I believe my success rate would be about 75%, but when their egos tell them to try to treat the pulmonary patients for a long time (a year or even years), they finally give up and refer the patients to me. At that point, the condition has advanced seriously, and my success rate is only about 25%.” I have insisted on going to a specialist for any health condition I consider possibly serious ever since.
What makes a good doctor?
We all need a good PCP, and I’ve been very fortunate that my last two Internists are excellent. But for me, a good part of the “excellent” rating I give them is that they haven’t hesitated to refer me to a specialist, usually without me asking.
And I believe strongly this is especially true for any cancer, including prostate cancer. There is some debate on whether men should even have the PSA test. To quote my urological oncologist, “that debate is strictly among PCP’s, and you won’t find a single urologist who agrees with that”. And as I read comments such as the one I note above and far too many similar to that throughout ProstateCancer.net, it just reinforces this opinion as it appears the PCP was satisfied his patient’s PSA was under 4.0 and didn’t consider the “velocity” (rate of growth) of the PSA. (With my PSA going from .6 to 2.6 in two years, it was that velocity that triggered my biopsy; caught what turned out to be a Gleason 9 PC that had just begun to metastasize; and saved me.)
Your doctor's training matters
And finally, while all doctors are brilliant just to get into medical school, their training after medical school varies significantly. Internist’s (the majority of adult PCP’s today) have a 3-year residency where they become generalists in 10 different disease categories, and urology is not one of those 10. A urologist’s residency, on the other hand, is 5 years of intense training basically on just urological conditions.
To put that into perspective, a general surgeon’s residency is 4 years, and to specialize in other surgical specialties requires even more years of training beyond that. I’m not aware of any PCP that will attempt specialized surgery, but many PCP’s will attempt to treat diseases with drugs that require a specialist. When it comes to being diagnosed with the possibility of prostate cancer and then treated for it if you have it, you need a specialist, no ifs, ands, or buts about it.
How much do you worry about prostate cancer coming back after treatment?