There is an article in today’s New York Times in which the author describes his thought processes as he went about first choosing a treatment and then a doctor after he was diagnosed with PC.  Trouble is the guy is a newbie who doesn’t know anything but thinks he does .  But didn’t we all?? I think this article is important to read because I see so many SMART men (and women) making the exact same (bad) choices. Here are some excerpts from the article, along with my comments.

In Prostate Cancer, Pick a Number, Any Number

By Burt Solomon, August 25, 2008

“I was counseled to pooh-pooh the higher-than-desirable Gleason score of 6, derived by adding the aggressiveness in every spot of cancer, because there was so little cancer in each.”

Get the facts straight. A Gleason score is NOT “derived by adding the aggressiveness in every spot of cancer“. Fair warning of what’s to come.

“I was only dimly aware of the evidence that most prostate cancers never become dangerous, even if left alone. But because nobody can tell which ones will and which ones won’t, the information was useless to me.”

Don’t make decisions when you’re “dimly aware”. And the information we have, although not precise, is not quite useless. You should have checked out all treatments before making a decision, including active surveillance.

“I quickly decided to have surgery to remove the prostate, but I had to choose between the two types”.

You should never decide “quickly” to have surgery. Buy now, pay later.

“I cared most about my plumbing returning to normal. But this was when the numbers really began to confuse things.”

Big mistake! Your first priority should be getting rid of the cancer. The plumbing comes in a distant second.

“One option was to go to Johns Hopkins in Baltimore, my hometown, where the older-style, slash-and-scoop surgery was devised. But the doctors there, my urologist said, cherry-picked their patients — no fatties need apply — to minimize the complications in getting the plumbing up and running again.”

Yes, they devised “slash and scoop” but also nerve-sparing surgery. And why talk trash about an excellent hospital because of what one doctor said?   Presumably sugeons who “cherry-pick” patients, i.e., choose the ones with potentially the most favorable outcomes in order to skew their results, do so to lower their rate of positive margins (a sign that they likely got the cancer out), rather than to “get the plumbing up and running again” ASAP.

“The other choice, called robotics, was newer and cooler. But the procedure has statistical distortions of its own. Some robotics surgeons have been known to exaggerate the speed of recovery by removing the catheter too early.”

Surgeons yanking catheters prematurely? I never heard of that. My husband had his cath in for three weeks!

“So both sides were skewing the numbers to market themselves.”

A bit pretentious for a newbie.

A college classmate, a physician with a low opinion of his profession, advised me to forget the numbers, to visit both surgeons, look them in the eye and decide which one I liked. Huh? Why should I care? I wasn’t drinking a beer with the guy. Partly, my friend said, a likable surgeon would respond if something went wrong; an arrogant one might not admit a mistake. And partly, well, my friend really couldn’t articulate it, but he felt certain.”

Look what happened to our country because we elected a president we wanted to have a beer with. Hiring a not-so-good doctor based on personality is the easiest trap to fall into! Empathy can be faked, but not competence. And remember, personality and character are not the same thing.

“Likable” and “surgeon” don’t ordinarily cohabit a sentence,

:-((  (What about Dr. Miles, Dr. Eastham, et al.)

but when my wife and I met with the robotics surgeon, we loved him. Patient, personable and the furthest thing from arrogant, he told us how his technique had improved from his first 200 operations to his second 200. (I was No. 431.) Only twice, he said, in Nos. 4 and 17, had the robotics failed and he had proceeded to the more intrusive surgery. His percentage of complications, he added, was as low as at Hopkins. I canceled my appointment in Baltimore.”

“We loved him”.

Remember, love is blind, so when you go see the doctor, check your hormones at a the door. Do you want a good doctor or the Dale Carnegie of the medical profession? By all means, if you find a doctor you click with, keep him/her in mind but don’t blow off the rest of your appointments (like we did).  And it’s always a good idea to consult with at least a few surgeons.

Also, you can’t believe everything a person says just because he has an M.D. after his name. Ask for proof. And in terms of experience, 430 is a lot but there are surgeons around who’ve done thousands.

“The surgery wasn’t bad at all, and my recovery was startlingly swift. Eight days afterward, I returned to have the catheter removed — none too early — and to learn if the cancer had spread. When I asked the surgeon if the pathology report was “positive” — meaning good news — he winced.

“The news was good: The cancer had not spread beyond the prostate. But 35 percent of my prostate had turned out to be cancerous, considerably more than a dusting. I had dodged a bullet; the numbers had lied again.”

Too soon to celebrate. Hasn’t even had his first PSA test!