Sunday, November 8, 2020


     Now a a days one can find anything on Google . One can search any song, any information, any news and anything and everything in medicine. This has lots of advantages . I can tell patients to check out certain things . e.g. portable oxygen concentrator - the machine that absorbs room air  and filters out nitrogen and produces oxygen So when someone asks me about the brands or cost, I tell them to check it out. Same with CPAP cleaning device - CPAP the machine that is used for sleep apnea. Or even I tell people to check out cost of medicines in Canadian pharmacy. So it is not uncommon for me to see someone who has questions based on Google search. Now a days many patients are told to ask their physicians certain questions  and that is also OK with me . I will tell you that people have done studies and they have timed physicians interrupting patients every 20 seconds or so - I ma not be exact in time but it is seconds and not even a minute for sure . So I am aware of that . But I have also known certain web sites asking patients to get second opinion. Again I have no problem with that either but the problem is getting second opinion for certain simple things-where there is no possibility of SECOND opinion is waste of money for sur and may be at times WASTE OF TIME. Say if Blood Pressure is 180/95 That is High Blood Pressure  and there is no second opinion - yeas one may have difference of opinion on which drugs to use or dose etc. but not about the diagnosis . This brings me to the story of the patient . 

     I saw this patient who had some cough going on for 2-3 months , The PCP treated it with antibiotics and some other medicines and he did not get better. So he had chest x- ray . He has no old x- ray in several years . The x- ray was abnormal and he had CT scan as he was ex-smoker The Ct scan did show a mass . So he came to me .We talked for 30 mins  and I explained him that we have to answer 3 questions 1 Is it cancer 2 Has it spread  and 3 What can be done -if it is cancer or suspected cancer . 

    We di the work up. We did bronchoscopy and did PET SCAN  and the breathing test The pet scan did show increased uptake  and that was suggestive of cancer - not 100% and it is never 100% . The bronchoscopy did not give us the diagnosis. The breathing test was Ok acceptable if we wanted to do surgery to resect the part of the lung. So I discussed with him and told him that the high possibility of cancer though we can never say 100%. I told him that we have 3 options 1 see chest surgeon and get an opinion to see if we should do open biopsy and take it out .2 Do needle biopsy which has some risk of collapse of lung and the chance of getting the diagnosis was not 100%  and if negative for cancer I would still consider open biopsy which is only thing that can give 100% diagnosis.3 Do only follow up CT scan in 3 months and see if the the mass increases . 

    To me there is no other option and there is problem with each of these options . The open biopsy may show that it is not cancer and we have done UNNECESSARY SURGERY, The needle biopsy has risk and diagnosis is not 100% ( I have seen recently couple of people with complications that needle them to be admitted to hospital )And wait and watch approach - has problem too. If it is cancer then in 3 months it can spread  and may become INOPERABLE. So ONE HAS TO ACCEPT THE RISK IN EACH OF THESE APPROACHES. 

   The patient after listening to all these wanted to get second opinion. I have no problem with SECOND opinion and I thought that the surgeon - a chest surgeon will be the second opinion. ut he was convinced that one must get second opinion based on his RESEARCH .!

(Just a foot note - there are other new procedures that can be done  and the diagnosis is not 100 % with them either.)


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