LikeADoctorInTheFamily.com

I have been 'asleep at the mouse', again, but only as regards these postings.

I have been very busy developing a website that helps patients and their doctors, manage diabetes on-line.

I have been busy, as well, writing a book called 'Exam Room Confidential' , a novel full of mystery and intrigue and exposing the pettiness and politics that surround the everyday practice of medicine. Advanced, pre-publication, orders are now being accepted.

And now to the point of today's posting given by the above title.

I have collected too many medically-related advertisements with claims that are either misleading, deceptive, incomplete, or patently false.

Many ads mislead, or omit, the credentials or qualifications of the person or organization offering the services. Some of these, as in the case of cardiologists, suggest the doctor is qualified in all categories of cardiac care when indeed their skills are limited or restricted to specific areas.

Some healthcare providers, and facilities, have 'catchy' names intentionally suggesting they are more than they are as when the word 'Institute" is attached to a one-doctor office or a facility that offers only routine, hum-drum services. Where I come from, 'Institute' implies a center of higher learning where scholars conduct state-of-the art research, and house educators, scientists, laboratories, and the like. Why the need to create false images?

Other ads suggest, or blatantly state flat-out, that what they offer can change the course of a disease, when there is no proof whatsoever that they can. The case below regarding Parkinson's disease is a prime example. To offer false hope to patients and families of this disease is cruel. But, who is watching over these ads? No one.

Sadly, the area of 'truth in advertising' in medicine extends to the monetary incentivized recommendations for treatments or procedures by doctors themselves who know what they offer will only help their bank accounts.

How is a patient to know?

Sadly, in most cases patient's are the least able to determine the facts as to whether a treatment, either advertised in the newspaper or offered face-to-face by their doctor is appropriate, necessary, and the least risky and most beneficial of all possible treatments for their condition.

Most doctors know, and most patients do not, that many disorders get better without any intervention and that thoughtful waiting is the best choice.

SOME EXAMPLES WHERE the 'AD CZAR' is needed: (President Obama, are you reading this?)

In the July 28, 2009 issue of the Health & Fitness section of the Sarasota Herald Tribune, on page 8E was a half-page ad from Sunshine Therapy Associates with the headline:

"A New Therapy for Parkinson's disease"

The ad went on to say that that their program, called 'LSVT BIG', as regards the course of Parkinson's disease, can:

"..delay progression..." (of Parkinson's disease)

Their headline claim is misleading in that it could be interpreted that they possess the knowledge and competence to administer a new treatment for Parkinson's that will alter the severity or course of the disease itself, not just symptoms or signs of it.

In fact, as the ad states beneath the headline, what they offer is a program of physical therapy.

Though physical therapy of any kind may or may not be beneficial in this disease and if recommended by a physician could be tried, my concern here is that the headline suggests a lot more than what is offered.

Their second claim, that their therapy can ' delay progression' of Parkinson's Disease is false as the physical therapy administered by this group has not been shown in independent, controlled, double-blinded scientific studies to delay progression of Parkinson's Disease in humans.

I personally spoke with the company that sells LSVT BIG Parkinson's disease physical therapy packages to end users such as your neighborhood physical therapist or Chiropractor and I was impressed by their professionalism and response to my concern. They communicated with the above mentioned local group and the group was eager to correct any misunderstandings and will place an ad clarifying what they can do and can do not do as regards Parkinson's Disease.

LSVT BIG is sold nationally so ads such as the one mentioned above may appear in many newspapers across the country.

Physical therapy is just one modality of treatment for Parkinson's disease and should be part of an overall program of care prescribed and supervised by a specialist in Parkinson's disease.

"MY SON, HE'S A CARDIOLOGIST." "YEAH, WHAT KIND?"

What kind, indeed? Many people have cardiologists, but are all cardiologists created equally? The answer is 'No'.

You would think any Board Certified cardiologist could take care of your heart attack by snaking in a catheter and expand your narrowed artery or put in a few stents if needed. Taint so.

In fact, Cardiologists come in different flavors, and if you're looking for chocolate and you get plain vanilla, you may be disappointed, particularly if you are in the middle of a heart attack and your cardiologist tells you 'well, I don't put in stents, I need to refer you to a cardiologist who does.

Now, here is where the truth in advertising comes in.

A cardiologist who only diagnoses heart artery disorders (the kinds that causes heart attack) by testing methods that DO NOT include cardiac catheterization and treats cardiac conditions ONLY MEDICALLY (does not do angioplasty or places stents) is called a "non-invasive" cardiologist.

A cardiologist who diagnoses heart artery disorders (the kinds that causes heart attack) by methods that does include cardiac catheterization and treats cardiac conditions ONLY MEDICALLY(does not do angioplasty or places stents)is called an "invasive-non-interventional" cardiologist.

A cardiologist who does all of the above AND is trained to diagnose and treat heart artery disorders by performing angioplasty and placing stents to open heart arteries is called an interventional cardiologist.

There is nothing at all wrong with being a non-invasive or invasive-non-interventional cardiologist and not an interventional cardiologist, but shouldn't you know up-front what your cardiologist can and cannot do when selecting one?

Many people develop heart rhythm disorders such as atrial fibrillation or ventricular tachycardia. Very often these people wind up in the hands of cardiologists not specifically trained in heart rhythm disorders. That may be a big mistake.

These sub-specialized cardiologists are called 'cardiac electrophysiologists' and should be considered when rhythm disorders are an issue.

If you open the Yellow Pages and look under 'Cardiologists' it is unlikely you will be able to tell cardiologists apart in terms of their skills and training. Why is that?

Below is a lengthy, but interesting, description of these categories, including their salaries which are now likely much higher:

"Training and Education for Cardiologists: Again, cardiologists start by training as internists, including 4 years of medical school, plus three years of residency training. After completing the internal medicine residency, a prospective cardiologist may enter one of many different types of cardiology fellowships. Cardiology fellowships are 2-3 years depending on the type of fellowship.

Non-Invasive Cardiologist: A non-invasive cardiologist primarily runs an office-based practice, seeing patients to prevent and manage potential heart problems. The average non-invasive cardiologist sees about 25-30 patients per day in the office. Non-invasive cardiologists do not do procedures; they mainly perform diagnostic tests to identify heart problems. If the problem is treatable with diet or medication, the physician will prescribe the appropriate drug therapy or dietary regimen. However, if the heart problem requires any type of surgical procedure, the non-invasive cardiologist will then refer the patient to another physician. Non-invasive cardiologists perform tests such as ECHO’s, stress tests, and EKG’s (electrocardiograms). Another more recent development for non-invasive cardiologists, which has been a lucrative advancement for them, is nuclear cardiology. Nuclear cardiology involves a high-tech special “nuclear camera” which is used to take images of the heart after the patient is injected with radioactive dye. These nuclear images are much more effective than other tests for diagnosing a number of heart issues.

Compensation for Non-Invasive Cardiologists: Approximately $400,000 per year, according to the MGMA.

Invasive, Non-Interventional Cardiologists: Invasive cardiologists do all the things non-invasive cardiologists can do, plus a bit more. Invasive cardiologists are trained in a diagnostic procedure called cardiac catheterization, which is used to find blockages of the arteries. Therefore, the non-invasive cardiologist’s time is split between office visits and time in the “cath lab” doing these catheterizations. If a blockage is found, and an additional procedure is needed, a non-interventional cardiologist can't intervene to fix the problem. Therefore, the non-interventional cardiologist would refer the patient to an interventional cardiologist for the angioplasty or whatever procedure is needed.

Compenation for Invasive, Non-interventional Cardiologists: The average invasive, non-interventional cardiologist earns about $454,000, according to the MGMA.

Interventional Cardiologists: This type of cardiology requires additional fellowship training, of 1-2 years in addition to the 3-year cardiology fellowship. The interventional cardiologist is able to perform more advanced procedures than the invasive and non-invasive cardiologist. Interventional cardiologists will spend most of their time in a hospital performing procedures such as balloon angioplasty to open blocked arteries, or placing tiny mesh stents into narrowing arteries. Most interventional cardiologists also spend some time weekly in an office, following up with patients after procedures, or consulting with them prior to the procedures. Interventional cardiologists typically complete hundreds of procedures per year, including up to 300 catheterizations and up to 100 angioplasties.

Interventional Cardiologist Compensation: Averages about $545,000 per year, according to the MGMA.

Electrophysiologists (EP): Yet another option for cardiologists is to complete an additional 1 to 2-year fellowship in electrophysiology, which is the study of the bio-electrical impulses of the heart which control the pace of one’s heartbeat. When the electrical impulses are not functioning properly, this can cause a heart arrhythmia which can be fatal if left untreated. Not long ago, the only remedy to correct irregular heartbeats was to insert a pacemaker. Now, although that is part of what EP’s do, there are also a variety of other surgical procedures such as ablation which essentially disables the part of the heart which is malfunctioning, and drug therapy to manage complex arrhythmias.

Electrophysiologists compensation: EP's earn about $480,000 annually, according to the MGMA.

PRACTICE HEALTH DEFENSE:

Read ads carefully and if they make claims that don't pass the 'smell test', move on.

Ads that claim cures or alter disease states should be viewed with skepticism.

When offered treatments where the benefits do not clearly outweigh the risks, get other opinions.

If you have a cardiologist, or about to select one, ask whether they are of the non-invasive, invasive / non-interventional , or interventional type.

If you have a cardiac rhythm disorder consider seeking out a cardiac electrophysiologist.