Re: Malpractice-- was The Unfortunate Demise of the Case Study in Medicine

[Guest guest]

Regarding Active Surveillance

(in my opinion),

It is important that the

physician use the right choice of words to avoid a lawsuit: When

explaining the treatment options to a patient, Active Surveillance would be an

area in which the physician explains to the patient the result of the pathology

report from the biopsy diagnosing prostate cancer, and that with a Gleason 6

and one or two tissue samples with low percentage cancer presence, that the

patient can include Active Surveillance along with other options for which his

diagnostics qualify. Rather than “directing” Active

Surveillance, the choice is up to the patient.

When you get right down to

it, I would see a urologist should always use more care when advising the

patient that he “should be” scheduled for “surgery”

ASAP, rather than recommending the patient also visit a radiation oncologist

for an explanation of radiation options, as well as discuss other options such

as Cryotherapy, or if merited, androgen deprivation therapy. The same

would apply to a radiation oncologist to not tell the patient that he “should”

have radiation ASAP. Options should be provided and explained the patient

and the choice become that of the patient.

Actually, when intending to

prescribe a medication, that medication and its purpose should be fully

explained to the patient rather than just prescribing. Androgen

deprivation medications, for example, should be explained. Just what is

the purpose of the LHRH agonist? How often is that LHRH agonist

administered? What are the side effects? What can be done to ease

those side effects? What is the purpose of the GnRH antagonist? How

often is the GnRH antagonist administered? What are the side effects?

Explain antiandrogens, their purpose, dosage, and side effects. Explain

5Alpha Reductase (5AR) inhibitors, their purpose, dosage, and side effects. If

intending to only prescribe an LHRH agonist or GnRH antagonist as monotherapy,

explain why an antiandrogen is not being prescribed to block androgen receptors,

since without blocking the androgen receptors, adrenal gland testosterone is

still being produced and will have free access to the cancer cell nucleus to

convert to the more powerful stimulant to cell growth, dihydrotestosterone

(DHT). The same should be explained to the patient for any medication to

be prescribed. It is then the choice of the patient if he wants to accept

that medication. No medication should be prescribed without an explanation

of purpose, dosage, and side effects.

Unfortunately most people,

when diagnosed with an ailment, are only concerned that it be treated.

They fail to ask about medications or even consider advising the physician of

other medications they may be taking. The physician could be remiss if he/she

fails to ask about other medications, and if being taken, insuring any

medications to be prescribed are not contra-indicated to those medications.

Thus, the physician is

somewhat between a rock and a hard place with any treatment he/she “directs”

without consulting with his/her patient.

Chuck

Always as close

as the other end of your computer to help address any prostate cancer concerns.

" What you

leave behind is not what is engraved in stone monuments, but what is woven into

the lives of others. "

(Chuck)

Maack/Prostate Cancer Advocate/Mentor

Wichita, Kansas

Chapter, Us TOO

Biography: http://www.ustoowichita.org/leaders.cfm?content=bio & id=1

Email: maack1@...

Chapter Website

" Observations " : http://www.ustoowichita.org/observations.cfm

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Stan Leake

Sent: Monday, October 18, 2010 12:19 PM

To: ProstateCancerSupport

Subject: Malpractice-- was The Unfortunate

Demise of the Case Study in Medicine

Along the lines of Larry's first point regarding

malpractice, I have wondered if worry regarding lawsuits is an issue

in reluctance of some doctors to recommend active surveillance in cases of

low-risk PCA findings (i.e. GS 6, <5%, etc). Does anyone know if that is the

case?

Stan

..

[Guest guest]

Stan Leake wrote:

>Along the lines of Larry's first point regarding malpractice, I have wondered

>if worry regarding lawsuits is an issue in reluctance of some doctors to

>recommend active surveillance in cases of low-risk PCA findings (i.e. GS 6,

<5%,

>

>etc). Does anyone know if that is the case?

>Stan

I don't know if that's a factor or not. However, if so, in the future it

should be less of a factor. The various health authorities and experts

are all now saying that overtreatment is a problem. If a man meets the

generally accepted criteria for active surveillance, the burden of proof

may turn the other way with a doctor having to justify why he operated on

the patient - especially if the patient suffered significant side effects.

At least I'm hoping that will happen.

However I also recognize that many patients will continue to demand

treatment, even if the guidelines suggest they should wait.

Alan

[Guest guest]

Just a comment about Vitamin C IV and my oncologist walked out of the room. He was comunicative before. Tom W.

To: ProstateCancerSupport Sent: Tue, October 19, 2010 12:19:21 AMSubject: Malpractice-- was The Unfortunate Demise of the Case Study in Medicine

Along the lines of Larry's first point regarding malpractice, I have wondered if worry regarding lawsuits is an issue in reluctance of some doctors to recommend active surveillance in cases of low-risk PCA findings (i.e. GS 6, <5%, etc). Does anyone know if that is the case?

Stan

[Guest guest]

Oh while I am here whether it works or not anyone know a site for Vit C IV treatments. I am doing what I can even though it might not work while my Lupron keeps it at bay.

I read all of your post as an avid student and admirer of you guys. Thank you so much for bringing order out my choas.

Tom

PS although you do not respond to my post albeit sometimes they are pretty assinine.

To: ProstateCancerSupport Sent: Tue, October 19, 2010 1:54:09 AMSubject: Re: Malpractice-- was The Unfortunate Demise of the Case Study in Medicine

Stan Leake wrote:>Along the lines of Larry's first point regarding malpractice, I have wondered >if worry regarding lawsuits is an issue in reluctance of some doctors to >recommend active surveillance in cases of low-risk PCA findings (i.e. GS 6, <5%, >>etc). Does anyone know if that is the case?>StanI don't know if that's a factor or not. However, if so, in the future itshould be less of a factor. The various health authorities and expertsare all now saying that overtreatment is a problem. If a man meets thegenerally accepted criteria for active surveillance, the burden of proofmay turn the other way with a doctor having to justify why he operated onthe patient - especially if the patient suffered significant side effects.At least I'm hoping

that will happen.However I also recognize that many patients will continue to demandtreatment, even if the guidelines suggest they should wait.Alan

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There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

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