If It Sounds Like a Duck, Is It a Quack?

June 21, 2010

I don’t expect primary-care physicians and other subspecialists to know all the nuances of diagnosing and treating endocrine disorders. After all, that’s my job, right? But quite frequently, I am puzzled, and sometimes appalled, by what patients tell me their doctors did or said.

I don’t expect primary-care physicians and other subspecialists to know all the nuances of diagnosing and treating endocrine disorders. After all, that’s my job, right? If they could handle it all without me, I’d be looking for another line of work (although there are certainly days when that seems appealing).

But quite frequently, I am puzzled, and sometimes appalled, by what patients tell me their doctors did or said. Now granted, some of that may be the patient’s interpretation of what was said, but there are times when it is clear that a doctor consistently tells his/her patients the same thing. 

And what am I supposed to say when patients say, “My doctor told me it must be my thyroid,” especially when they come with a written request for consultation or a copy of a visit note that shows that, yes, indeed, their doctor does think it is their thyroid? And what am I supposed to say when their PCP increased their dose of levothyroxine based on their last labs. You know, the labs that showed that their thyroid hormone levels were too high already.

And what about the patient who was taking “Thyroid Pill”, conveniently purchased from her physician? I showed her the ingredients that I found on the practice website: calcium carbonate, cellulose, gelatin, etc, etc. I didn’t say a word; I went about getting her history. She interrupted me midsentence, “There’s nothing in this!” OK, at least we were on the same page.

And what about the patient who wants human growth hormone because one of his doctors told him it would help increase his muscle mass? He even gave him a prescription. Only problem is his insurance won’t cover it unless his endocrinologist (i.e. me) sends a letter of medical necessity. Well, guess what, sunshine, that ain’t happening.

And what am I supposed to say about things I disagree with that aren’t in my specialty? Like the “Lyme specialist” who treats people for chronic Lyme disease with IV antibiotics for years. Or those diagnosed with chronic mono. Or patients who are getting vitamin B12 injections when their B12 levels are normal or even high?

When I think patients are in danger or if they are wasting their money, I tell them so. Sometimes they appreciate it, sometimes they dismiss my concerns. Whatever, they can’t say I didn’t tell them so.

I somehow feel partly responsible for letting these practitioners continue to do what they do, and there has been bad press about how docs protect other docs even when they are wrong. But what am I to do? Do I report them? To whom? For what? Boy, that would really make me popular in the physicians’ lounge, wouldn’t it?