Wednesday, September 26, 2007

Men's Health Advocates Doctor Shopping!

In a troubling column by Men's Health writer Adam Baer, the author describes his recent one year search seeking a diagnosis for a puzzling set of symptoms. The author was a Hodgkin's Lymphoma patient as an adolescent. As a 29 year old man, the author began experiencing some vague neurological complaints but no focal neurological deficits. Anyway, he presented to his PCP and the physician did the appropriate work to rule out any serious complications of his previous lymphoma as well as any new, acute and organic health problems.

After ordering blood work and appropriate imaging no explanation was found for the symptoms. The physician, completely appropriately, asked the patient to follow up in 6 months. This is where things fell apart and the likely anxiety from the patient's past diagnosis likely took over better reasoning.

The patient, unsatisfied with his physician's management plan, began to doctor shop. After receiving the same response from doctors in his area, he branched out. Over the year, the patient traveled the country seeking a "definitive diagnosis". After one year of this, the patient did find an explanation (at least partly) for his symptoms and started treatment. Thus, the author concludes, that it is important to "doctor shop". Yikes.

The basic problem with this is that the original physician would have likely gotten to an appropriate diagnosis at follow up - likely quicker than 1 year and certainly much cheaper than the cost of traveling the country. Without developing a relationship with a primary care physician, it is impossible to know a patient's baseline health status and to follow changes over time.

The other disappointing aspect of this article is that it short-shifts a more important point - namely that adolescents and young men do have poor relationships with physicians and are certainly under-served populations leading us to miss rare but serious disease in those groups.

Anyway, I wrote a reply to Men's Health regarding the article that follows below. We will see if they publish it in some form.

As a soon to be physician (I graduate medical school in May) and a young man, I read the recent article by Adam Baer (October 2007, pp. 106-111) with much interest. The article noted the difficulties all young men face with finding adequate health care and the special situation of Mr. Baer that involved dealing with a serious medical issue as an adolescent and adult. However, there is some very troubling advice offered in this article that I would like to address.

First of all, I will commend Mr. Baer on noting a very real problem – lack of satisfactory coverage in adolescent and young adult populations. Certainly we, as health care professionals, do need to work harder in addressing preventive health and illness in those groups. As the author points out, even young healthy people sometimes get very sick.

The problem is that, when Mr. Baer noticed changes to his health, he was unwilling to work with one physician to solve the puzzling symptoms he brought to the clinic. His first physician acted appropriately by ruling out an immediate life threatening condition and asking the patient to follow up to evaluate any further changes.

Apparently, the author was not satisfied with this conclusion and proceeded to travel around the country from doctor to doctor. It is true that one year later the patient did, indeed, receive a diagnosis. However, if the author would have developed a relationship with a physician, appropriate follow up may have led to a quicker, and certainly cheaper, realization of the diagnosis.

The author encourages readers to doctor shop until you receive a definitive diagnosis. This advice does not help us get any closer of solving the original, very real, problem that the author first described – namely, that young men need to develop a relationship with one primary provider so that a long term relationship will lead the physician and patient to appropriately explore any changes in health.

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