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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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The ProstateCancer.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Oriole00
    5 months ago

    I am lucky to have a PCP that never hesitates to have me see a specialist. I had hyperthyroidism when I was diagnosed with colon cancer in 2012. He talked to an endocrinologist and I had an appointment in 2 days with him. The endocrinologist got my thyroid under control for surgery. I still see him for adrenal issues. After a resection of my colon I now see an oncologist to keep tabs on me.
    My PCP also sent me to a dermatologist for something I was concerned about and I now see him every 6 months to keep things under control. I had a melanoma, basil cell and squamous cell cancers removed before they spread.
    I started seeing a urologist at the request of my endocrinologist because of blood in my urine. I started having annual visits with my urologist and started having my PSA checked. It was on the rise slowly and he was keeping an eye on it. It went up 2 points in 6 months and had another test in 6 weeks and it was up another 2 points. Biopsy last year revealed 1 Gleason score 3+3 in one core
    sample. Then my PSA dropped off. I was still scheduled for another biopsy this past spring and they found 3 cores with a Gleason score of 3+4. I opted for the robotic laparoscopic radical prostatectomy. My PSA is at a non detectable level and my next test is in January.
    Having a great PCP is a big help and has been an even bigger help for me. I can’t praise him enough. We laugh and kid with each other but I know he has my best health interests in his mind. Heck, he even called me at work 3 times one day to discuss my Vitamin D3 level and how he and my endocrinologist are going to proceed. I can not say enough for my care team of doctors over the past several years. I have the best of the best.
    Thank you for posting this as it does mean so much.

  • Richg
    12 months ago

    I’m fortunate. I believe my Primary care physician follows your philosophy. After the PA performed the initial screening, EKG, setting up bloodwork,etc and setting up follow up exam with my PCP. In that first visit we started with hypertension meds, discovered a mole and referred me to a dermatologist who biopsied it. It was melanoma. Caught in time and removed by a dermatology surgeon. A 2nd melanoma was discovered 2 months later and was surgically removed. I am examined every 3 months by the dermatologist.
    Atthe same visit he referred me to a urologist based on the PSA result. 5 months later RARP was performed.

  • Richard Faust moderator
    12 months ago

    Hey Richg. Glad they have you on the frequent follow-ups with the dermy. My wife is finally on the yearly check-ups (unless we spot something of concern).

    Studies really seem to be pointing to the robot-assisted radical prostatectomy improving results. How have your side-effects been? Best, Richard (ProstateCancer.net Team)

  • ninaw moderator
    12 months ago

    Wow, @Richg, sounds like you are in luck with your PCP. I hope he doesn’t ever plan on retiring! I’m so glad they caught the melanoma when they did. The risk of recurrence can be one of the most disturbing aspects of skin cancer. Grateful for multifaceted PCPs like yours. Thanks for commenting! – Nina, ProstateCancer.net Team

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