Saturday, January 9, 2021


      I have been in medical practice for many years  and have seen very easy patients and diagnosis  and some patients who are difficult and some diseases which are difficult . I have sent some to Mayo Clinic for opinion and see what would they do in such patients. As far as i recollect I have not had any glaring change in my diagnosis or my decision in patients that I have sent there. This is GOOD for me and my confidence but not GOOD for patients as they did not get any different treatments . There have been some cases where I have disagreed with their opinion  and I do tell this to patients. But if they do not have any treatment option and I want to try something, I have told patient to try what I am suggesting and then decide in due course of time. But sometimes I come across patients that want second opinion and I know that there is no SECOND OPINION. This brings me to the story for today.

    I saw this patient who was sent to me by a surgeon who also does some family medicine practice . The patient was nonsmoker for many years and was not living close to me of the surgeon. He was in another area 2-3 years ago and had some chest discomfort and so he had a CT scan  and that had shown very tiny nodule and then he had no further work up. He had some cough and so the PCP did the chest X- ray and that was abnormal and so he did new CT SCAN  and that showed a mass - rather larger 5 cm size mass. So he was sent to me . I di explain it to him on the high possibility of cancer and did start the work up. I did PET scan and berthing test and also bronchoscopy . Even though the mass was larger it was not seen from inside at the time of bronchoscopy and the samples came back negative . I had expected that and I had told him on doing needle biopsy . I saw him in office on each time and also talked to him many times. He seemed to understand  and was ready and then I get a call from radiology that he has refused the biopsy  or did not want to schedule it . I talked to him again and he seemed to have agreed  and then he did not get it done  and I was told that he wants to go to Mayo Clinic. I feel that if he has cancer we are delaying the diagnosis  and the treatment  and I had also told him that if he feels he does not have cancer, we could repeat the CT scan  and see if the mass has reduced in size or not. I have seen some patients in which the tests point towards cancer but they are not good candidate for biopsy or they refuse the work up and the follow up CT scan shoes improvement. But it is rare. and the Mayo Clinic is not going to do anything different - either do the biopsy or wait and do new CT scan. 

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