Hopefully I live to write this, my wife is a brilliant doctor and I have countless stories about her diagnosing everything from brain tumors to urinary tract infections from a thousand miles away without ever seeing or even talking to the patient but merely hearing my concerns about a friend or family member and telling her the symptoms. She is not engaging in malpractice, she was merely trying to calm me down, because I was upset, by telling me what was likely happening and what would be the likely outcome. In 100% of the cases when I spoke to that person days later it turned out exactly how she predicted. So to be clear I worship the ground that doctors walk on. PS and I better in her case.

So here is the problem as I see it. Specialization and insurance, and cost of technology, and the doctor’s time, to say the least. It keeps coming up. I recently explained to a few friends about which type of biopsy to do and what treatment to pursue for their prostate issues and or prostate cancer. Why am I more knowledgeable then their doctor? That makes no sense. Either I am delusional or the system is broken.

Well the system is broken for the reasons I just said specialization and insurance. Take my wife she is an ophthalmologist. In fact she did eyelid surgery on me when we first met. She also did Lasik for a number of years. But she will always refer you to the person that does the particular surgery you need every day. You wouldnt go to the lasik guy for eyelid surgery and vice versa. Get it? PS it doesnt end there, There are eye diseases and a plethora of other subspecialties. We are just speaking about ophthalmologist in this example.

Do you want the doctor doing your eye surgery traveling the world looking for the latest and greatest technologies? Or do you want him honing his or her skills every day so the surgery that they are performing on you is performed with impeccable skill?

Its your eyes so you want the absolute most skilled person performing your surgery. But you also want to explore the world to insure there isnt an alternative or better option that was recently discovered. In many cases the latest and greatest is debuted in other countries and the US is the last one to approve it.

Yet another dilemma. Do you want the latest most effective surgery with the greatest technologies and tools or do you want one that has been tried and tested and FDA approved? New drugs take about 12 years for FDA approval and new devices take about 7 years. And the third problem, the cost. So your doctor has his head to the grindstone performing what he does best, manual biopsies in this most recent example. He may or may not even know. Well its a stretch that he is not aware of MRI guided biopsies. But maybe he cant afford the cost of the new equipment. Its not like insurance is going to give him more than a few bucks for him or her to buy the ridiculously expensive equipment.

So you ask around, or if you are really diligent and resourceful you search the internet. But all you see are ads. Which one are you to believe. Well actually I hate to say this but it is a starting point. Whenever we get something really new, that no one else even has in New York we advertise it, why wouldnt we?

But you need not a grain but a 5 pound bag of salt to read between the lines. You can then go to PUBMED.GOV and look for the research vs trusting someone who is selling something, That is pretty much my approach. Example we have been talking about Metformin for over a decade for antiaging. When I saw that David Sinclair a renown Harvard AntiAging scientist was taking it I thought it was time for a deep dive. When I finally went to pubmed I found 7700 articles on it for everything from preventing Cancer to Parkinsons. So I wrote about it.

To close the loop in your thinking, I went to a highly recommended kidney doctor this past summer. We knew a lot of the same people. I had even hired a nurse that used to work for him. He recognized I was in the business and he said, “you do realize that everything that is available to me is available to you on the internet so you probably know more about this than I do” I forgot exactly what we were talking about at that time. Its not like law where you have to have access to certain documents and trial transcripts

Furthermore guess who has more time to research your issue? You. Its your life, your breast, your penis. Nobody cares more about it more then you do. Here is a really difficult quiz. Get into a very cerebral state before you contemplate the answer. Do you think your doctor is going to spend 100 hours over the next 2 weeks scouring the internet, PubMed and the world to see if there are any breakthroughs that would cure your issue? Or do you think they are going to be busy treating patients and finally getting some family time and not have one minute for research? Or is it more possible that you would have the time and the motivation? Part 2 of my question do you care how much the equipment or technology costs? Would you care if the newest most effective technology costs a million dollars? Would you leave your doctor to take advantage of the best possible alternative and outcome for your situation or drive 100 miles? Is my spoon feeding you helpful?

Wake up its your life. Doctors are engaged in an extremely difficult and competitive business. Every year goes by and the insurance reimbursements go lower and their expenses go higher, malpractice insurance goes higher, healthcare for their employees goes higher, the list is endless. Trust me I run a medical practice the overhead is astronomical. Why do you think you see so many large groups? Its just not worth it to have your own practice. Most of them have resigned themselves to be “employees” of a larger practice so they dont have to deal with the overhead.

And that is even worse. In fact legally a doctor is not allowed to be partners with a business person for that exact reason. But we are allowed to create MSO or management service organizations. Guess what businesses do? They dont buy the latest and greatest technology unless there is an immediate and predictable return on their investment. If you are 50% or 80% more likely to die because they are using outdated technologies or equipment. Thats just the cost of doing business. I dont know why my friend was surprised that his doctor was recommending hit or miss biopsies. I have a fairly good idea. I will let you know the outcome of that one.

Bottom line. With a mere 100 hours of research in the next few weeks you will literally know more about the latest breakthroughs for your concern than your doctor. Period that is a fact.

Just for shits and giggle here is a search on pubmed for prostate cancer right now in January 2024, over 213,000 results. Many of the studies were completed and posted this month. And a search for HIFU prostate cancer. And you dont have to be a genius to read this stuff. Here the study and the one line from the conclusion, I didnt really understand 90% of what I read, but the last line was all I needed to read.”HIFU treatment had a better impact on patients’ QoL with localized prostate cancer.”

Are you starting to get it? Men do you want to keep your erectile function. aka do you want to still have a functioning penis? Stop watching football or whatever season it is and spend some time caring for your self. No one else will do it. This is as close as it gets to someone trying to help you with no monetary compensation.

PS I dont even know who is playing in the Super Bowl but I just heard about Ultrasound for Alzheimers. I will spend at least 10 or 20 hours researching that. How exciting!!! I dont know what any of the popular singers look like. I cant name a Taylor Swift song and wouldnt know what she looked like if she wasnt on the front page of the news.