The medicine has evolved and we have much more today as help and problems than what we had 20 or even 10 years ago. And I ma not talking about modern day technology or new procedures or medicines . We have started this new thing which is customer oriented medicine. To add to that we have DR Google. Then all the big medical centers and universities have their web sites 'educating' general public. This adds the help to understand the disease but also adds more questions and problems when we are treating patients. I am not against educated patients , but I feel that half knowledge is more dangerous than no knowledge.
To add to this we have AI and the branches of medicines that NEVER EVER SEE PATIENT but give reports .e.g. Radiology , Pathology . These physicians usually do not see patients but give reports that are available very easily and sometimes even before the ordering physicians have seen or received the reports. That brings me to the story for today. I saw this new patient 68 years old who was having cough for 2 -3 months. As usual the PCP gave him antibiotics and some cough syrup and also tried short course of steroids .The cough continued and so then he had CT scan of the chest - lungs. I am not sure why it was done , but in span of less than 2 weeks , he had 2 CT scans. One with contrast and one without and again not sure what prompted primary care to do that - and yes I did see the notes from PCP and not mentioned as to why this was done . But in any case it was done. That added to the problems . The 2 reports were entirely different. The one report stated mild emphysema and some scarring while other stated no emphysema but Pulmonary fibrosis of UIP pattern and traction bronchiectasis and honeycombing etc. On top of that the radiologist never compared the old scan with new one even though they were done AT THE SAME CENTER and only 2 weeks apart .
The implication of UIP pattern fibrosis and honeycombing etc. is serious . If patient has what is called IPF- Idiopathic Pulmonary Fibrosis -the prognosis is not great and the treatment is expensive. The treatment does Not cure the disease or reverse it , nor the treatment halts it It simply REDUCES THE RATE OF DECLINE. Many patients with PROGRESSIVE PULMONARY FIBROSIS DIE IN 3 YEAR. Patient had already seen the reports. Again each case is different. So I called the radiologist. The answer that I got was not the best. They could not see one of the scans that stated all the bad findings. On top of that the radiologist stated that 'yes it could be some fibrosis'. This is due to not knowing the medications and the prognosis of IPF or progressive fibrosis. The cost is $30000 to 40000 . and has side effects in 30 % of the patients and as mentioned there is no cure or reversal or stopping the damage.
The patient has seen the reports and now I HAVE TO GIVE ANSWERS.
