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LIFELONG HEALTH- Rareness Is One Factor in Choosing a Specialist PDF Print E-mail
Written by Dr. David Lipschitz Creative Syndicate   
Thursday, 12 July 2012 03:18

Walking down the corridors of the medical school where I spent the majority of my working years -- the University of Arkansas for Medical Sciences -- is like being at the United Nations. Patients come from all over the world to see Dr. Bart Barlogie, a pioneer researcher and leading expert in treating multiple myeloma, a tumor affecting bone marrow.

Until recently, myeloma was universally fatal. Thanks to breakthroughs in the care of this disease, Barlogie and his team regularly see patients who have survived 10 years or more. And there is talk of cure. Many of the advances have come from the work of Barlogie, who not only treats myeloma but also has spent his career studying the fundamental mechanisms that cause bone marrow plasma cells to transform into a malignancy.

If someone has multiple myeloma, is there merit to coming to this medical school to be treated at a cost of traveling thousands of miles from home, spending time surrounded by strangers, living in motels and away from friends and family? In my view, if it is feasible, the sacrifices are worth it.

Myeloma is quite rare, and because so many patients come to be treated at a single center, greater experience and understanding of the disease are acquired. Barlogie's experience allows him to provide unique approaches to care, particularly for those patients where relapses have occurred and treatment has become more difficult. In these cases, care requires a physician scientist who truly makes the art of medicine a reality.

But should a patient travel to a special center to receive treatment for the very common illnesses that afflict us? The American Cancer Society reports that in 2008, 12 million people were diagnosed with cancer. Of these, 2.6 million had breast cancer, 1.1 million colorectal cancer, 2.3 million prostate cancer and 400,000 had lung cancer. Compared with those numbers, 64,000 were diagnosed with multiple myeloma.

Because of the large number of patients diagnosed with common cancers, every metropolitan center has specialists who can provide world-class, state-ofthe- art care for these diseases, making traveling to a faraway major center unnecessary. For other common illnesses such as coronary artery disease, osteoarthritis or back pain, every community has experts equal to those found in even the most prestigious institutions.

But how does a patient choose the right physician? Many insurance companies tout not requiring a referral to a specialist as a major benefit of their plan. Many of these visits are unnecessary, and frequently, the best specialist for the problem was not chosen. "My friend really liked him" and "I am fond of his mother" are not good reasons to seek an evaluation for a serious disease. Ideally, a patient should discuss the problem with a primary-care doctor and ask for a recommendation and then a referral.

Helping a patient choose a specialist is a serious responsibility for any primary care physician. "I really like him as a person" is not a good reason to use a specific specialist. The referring physician must ask: Is the specialist balanced and careful? Is he willing to address conflicts in the literature? Where does his medical care fit philosophically with him and his patients? Does the specialist have an excellent reputation and outstanding skills in the operating room?

With time, a primary care physician develops insights into the reputations and abilities of specialists who can provide the most appropriate assessment and treatment. Based on the letters he receives, discussions with colleagues and valuable insights from those who work with the specialist (especially operating room nurses), primary care physicians should develop their own cadre of specialists that they predominantly use.

In choosing a specialist, seek advice from your doctor, but also scour the Internet for information -- good and bad -- about a particular physician and make a choice that seems right for you. For every disease, you want a team that is as expert in a particular disease as Barlogie and his colleagues are for multiple myeloma. With careful research and input from your primary care physician, you will be assured that you are seeing a specialist truly skilled in the science and the art of managing your particular medical problem.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging."

Last Updated on Thursday, 12 July 2012 03:21