Yesterday I was contacted by Dr. Eileen Consorti’s office. (Dr. Consorti is a surgeon to whom I was referred a few years ago, after my primary-care doctor noticed I had a tiny hernia — so small I hadn’t noticed it.)
“Can I ask a favor of you?” her assistant began. The favor was to remove her name from my blog. Why? I asked. Because when someone googles her, he said, what you have written comes up, and it isn’t favorable. (When I googled her name yesterday this was the first result. When I googled the same thing today, it was the seventh result.) He said nothing about any inaccuracy. I said if she has anything to add, I would be happy to amend what I wrote. He asked if I had any “further” questions for Dr. Consorti. No, I said. The conversation ended.
Then I realized I did have a question. During my discussion with her of whether or not I should have surgery, I had said that surgery is dangerous. Dr. Consorti had replied that no one had died during any of her surgeries. She had said nothing about the likelihood of other bad outcomes. That struck me as incomplete. My question was: Why no mention of other bad outcomes? I phoned Dr. Consorti’s office, reached the person I’d spoken to earlier, and told him my question. He tried to answer it. I said I wanted to know Dr. Consorti’s answer. Wait a moment, he said. He came back to the phone. He had spoken to “the doctor”, he said. She wasn’t interested in “further dialog”. She would contact a lawyer, he told me.
Dr. Consorti, if you are reading this, I am happy to publish verbatim anything you have to say about this.
Thanks to Tucker Max.
More On November 18, 2011, soon after I posted this, Dr. Consorti asked me to post the following:
Dr. Fitzgibbons from Creighton published a prospective study comparing repair of inguinal hernias versus watchful waiting in men with asymptomatic inguinal hernias. At five years twenty percent of the patients in the observation group crossed over to have surgical repair. By the way, I only get reimbursed $300.00 dollars to repair a hernia not thousands of dollars. I hope you asymptomatic always, thanks.
Even after all this, Dr. Consorti has described the Fitzgibbons study in a way that makes her recommendation seem more reasonable than it was. As I said, the results of that study do not support her recommendation. Its abstract says: “Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe.”
If there’s one thing I’ve learned from dealing with the healthcare industry, it’s this: you have to do your own research and take charge of your own situation.
About ten years ago, I was diagnosed with a parathyroid adenoma (a non-cancerous growth of glandular origin). My endocrinologist referred me to a surgeon whose office was in the same building. The two doctors were buddies, as I found out later.
When I went to my initial appointment with the surgeon, the first thing I noticed was that his waiting room was filled with posters, flyers, pamphlets, etc. all about breast cancer. I saw no information about any other type of cancer. This fact immediately made me suspicious.
When I met the surgeon, he told me that his plan was to do an operation to take a biopsy sample, and then go back at a later date to excise the growth. This strategy made absolutely no sense to me. Surgery in the neck is complicated and risky, and there didn’t seem to be any reason to do it twice, when you could remove the growth the first time.
I went to my local medical school and looked up a bunch of articles and textbooks. I couldn’t find anything that corroborated the surgeon’s recommendation.
I asked my endocrinologist to refer me to a surgeon who specializes in endocrine surgery. The second surgeon basically confirmed my suspicion that the first surgeon was nuts.
I had my surgery with no significant complications.
You need to do your own research.
So the medical profession wants tort reform so they won’t be sued (if the potential payout is low enough, it won’t justify the expense of bringing the case to court), but if you put factual information about your experience with them and it happens to make them look bad, then they’re happy to call a lawyer.
Very interesting and important story, Alex.
David, yes, I completely agree. As Robin Hanson put it, what does “first do no harm” actually mean?
The synchronicity of this blog post/comments with the book I am reading right now is spooky.
I already mentioned it to Seth.
https://www.amazon.com/Bad-Medicine-Doctors-Doing-Hippocrates/dp/0199212791/ref=sr_1_1?ie=UTF8&s=books&qid=1264921360&sr=1-1
@Alex
You’re 100% right about doing your own research.
My son had repeated strep throat infections over the course of a year. We were referred to an ENT doctor who suggested tonsillectomy. I researched tonsillectomy for strep with no tonsillitis and found that on average in the year following a tonsillectomy patients like my son get one fewer strep infection. Surgery with it’s risks, and ten day recovery, seems like a steep price to pay for one fewer infection. I brought my son to a naturopath who made some supplement and herb suggestions that we followed and my son has not had strep since.
Andrew, by “thanks to” I meant “thank you to” rather than “due to”. I asked Tucker for advice. He was in a similar situation: Someone threatened him with legal action if he didn’t take down something he had posted.
If you ask a surgeon if you should have surgery most of of the time the answer is going to be “yes” because that is the solution they are trained to provide. Surgeons cut and sew and, if they spend time thinking about their profession, it is more likely to be about how to cut and sew better, not how not to cut and sew. So, in a case where you have doubts that surgery is necessary, it may be better to consult with a non-surgeon.
This doctor apparently accepted the conventional thinking of her profession (i.e. cut out everything that could grow to be a problem) as fact, even though research may not exist to back up that thinking in this case. In reality, much of medicine is practiced is practiced this way. (As an example, check out this recent article: https://www.nytimes.com/2010/01/26/health/26child.html?ref=health) If medicine purely relied on scientific fact and not on cultural norms, one would expect to see less variance in the way things are done from city-city in the U.S. and between countries.
Too bad the system isn’t more objective and transparent when it comes to treatment outcomes and we are left to scour the internet to find some clues.
Alex: I suspect you would have been better off with the biopsy, and then maybe no excision. Why excise what doesn’t need to be excised?
Nathan, the parathyroid adenoma was causing me to have high levels of calcium in the blood (this is how I was first diagnosed), so it needed to be removed regardless. All the references I found recommended removal of the adenoma.
The neck has many delicate structures, particularly nerves. A fairly common complication of neck surgery is damage to the laryngeal nerve, which can cause hoarseness (sometimes permanent). Doing neck surgery twice, when once is enough, doesn’t make any sense. My first surgeon seemed to specialize in breast cancer, where taking a biopsy sample is more routine.