Thursday, April 30, 2015

Second Opinion

Previously on MondoBlahBlah...
Even more previously on MondoBlahBlah... (is the reverse chronology working for you?)

It's in there somewhere...
I'm an educated consumer. I don't just buy the first product I see on the shelf at eye level, the brightest packaging, the first one to come up in a Google search. I subscribe to Consumer Reports, I read Amazon Reviews; especially the bad ones. So of course I'm going to get a second opinion when told I have cancer and should have one of my organs either blasted with Fukushimatic levels of radiation or ripped out by the roots. Following my meeting with the NIH Multidisciplinary (Multi-D) Team, I took all my reports and images back to the urologist I've been working with for the past couple of years; the one who ultimately sent me to NIH in the first place.

My intent was to get some independent feedback on the recommendations and treatment options presented by NIH. I figured as a urologist, Dr. X (not his real initial) would have worked with patients who had undergone the suggested therapies and have a sense of the outcomes. I was hoping he would be able to help me know what to expect both in the near term and in the future. I hope to live for several decades after the cancer is cured - what can I expect? What will it be like to live without a prostate? How will my quality of life be altered? 

I was more or less ready to be told, as I was, that the surgical option had a very minor advantage over the radiation/hormone therapy for a relatively young man such as me (born as I was, in the late days of the Kennedy administration). What I was not prepared for was Dr. X's assertion that I should not have the surgery performed by NIH. He thinks I should have him perform the surgery at my local regional hospital. It turns out he's part of a collaborative group of urologists who specialize in robotic surgery. This was news to me.

What a lovely shade of lavender my cancer has...
So, of course I asked him why not NIH, one of the nation's premier institutions. His response was tentative and completely lacking in any objective criteria by which I could make a decision. It boiled down to, "I do this a lot. Trust me." Let's just say I found the good doctor's explanation less than convincing. I'm not really the trusting kind when it comes to who to let remove my organs. And I guess my skepticism showed because he referred me to his mentor for a reference, the guy who taught him the da Vinci system.

Look, I like Dr. X. I feel he's been honest with me up 'til now, and I genuinely appreciate that he has persistently pushed me to get the right tests to catch this as early as possible. Nevertheless, I want to make sure I'm making the right choice for the right reason. I can't ignore the fact that the man is in business and has even exhibited a certain entrepreneurial flair. I mean, did you see that website? Pretty slick, right? I have to ask myself if his recommendation is motivated by genuine concern for my well being, or for his desire to make money from treating me. Aside from the good doctor's understandable certainty that his private urologist's surgical skills are superior to those of some GS-15 gubmint doctor, could Dr. X have an ulterior/profit motive?

Well, let's see...

It's a living...
Dr. X is trying to talk me out of socialized healthcare at the government facility that finally found the cancer after another world class university institution failed to do so. Plus he wants to do the surgery at a hospital ranked by US News & World Report as #15 in Maryland and #13 in Washington metro area (43.4/100 in Urology and 25.5/100 in Cancer). Interestingly enough, one of the key ranking criteria under Cancer is that the hospital is an NCI-designated cancer center, and he's trying to talk me out of getting treated at NCI itself. Curiously, NIH is one of the very institutions cited in the Why Choose Us section of Dr. X's own website as a location at which his team received their training. Has the student surpassed the master? If so, Dr. X couldn't articulate it in any sort of meaningful way.

He could be expected to make anywhere from from $4000 up to about $19,000 in fees for the procedure. That's a drop in the bucket for someone likely making upwards of $300,000 per year, but I presume every bit counts. And I note that both he and his mentor practice in a system in which the CEO makes upwards of $2 million per year. So is Dr. X's opinion influenced by economic considerations? You decide...

Join us next week for another exciting episode...

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