Have you ever wondered whether the surgery or procedure your doctor is recommending is necessary? Are you getting conflicting information between visits about the details of your condition, or the necessity for surgery or a procedure? Has it crossed your mind that money may be a factor in overstating the seriousness and urgency of your condition? Or, as my grandmother would say, are they just drumming up business? You don’t doubt that there is a problem, but is it severe enough to require intervention now?
For those of us who grew up in a generation where blindly placing trust in your doctor was the norm, these thoughts, feelings, and doubts are uncomfortable. And, that discomfort may sometimes lead you to ignore them. Are your suspicions warranted? In some cases, they may be, and in others, they are not. However, do not worry about overreacting. Better safe than sorry!
In my recent case, the doubts were warranted, and getting a second opinion was the right thing to do. After my experience, I am convinced that a second opinion is always justified. It appears that there may be some doctors (although I am sure they represent only a small minority) who don’t seem to have a problem asking patients to undergo unnecessary procedures or surgery. Or perhaps, the money incentive lures them across the line between doing what is right for the patient now or bringing more money into the practice now? If you are having doubts, don’t ignore them, get a second, third, or even fourth opinion even when you have the slightest doubt.
My case had to do with recommended leg stent procedures that would open blockages and improve the blood flow to my legs, alleviating the discomfort that I was having when I walked more than a half of a block without stopping to rest for a few minutes. I began to have doubts when I was told by the Doctor that I had an 80% blockage in one leg and a 60% blockage in the other. But I was previously given different percentage information in the follow-up visit after the testing procedure and also given different information by the Nurse Practitioner when I asked what the percentages of blockages were. I was so confused; what percentage of blockage did I have?
I hated having to doubt my doctor, but after finally convincing myself that I was not overreacting to my doubts, I finally went for a second opinion. I was told that my blockages were around 30% in both legs. The second doctor also informed me that the procedure was not necessary now. Instead, 45 minutes of walking each day was recommended and would likely diminish the pain that I was having. I was so relieved that I could put off the recommended procedures, perhaps permanently. But this sense of relief did not erase my feelings of being misled, confused, and not knowing who or what to trust anymore. And like always, when I don’t know what to do, I read and do some research.
Here is some of what I was able to find in a Wall Street Journal article titled Doctors Sound an Alarm Over Leg-Stent Surgery, written on September 10, 2019, by Sumathi Reddy. The author, who is a reporter and columnist for the Wall Street Journal, states that “Johns Hopkins researchers analyzing Medicare data say they’ve detected physicians performing what looks like unnecessary vascular procedures in the form of unnecessary leg stents.”
The article states that in letters to CMS (the Centers for Medicare and Medicaid Services), and the Society for Vascular Surgery, Marty Makary, a professor of surgery at Johns Hopkins University School of Medicine, and Caitlin Hicks, an assistant professor there ‘noted concern about outlier physicians and the harm they may be inflicting on patients.’
Dr. Hicks states that “performing unnecessary leg procedures like stenting can make the vascular disease worse, creating a blockage in narrow arteries or causing an artery to rupture. She says patients with early leg pain have a 1% to 2% risk of limb loss after five years. But aggressive procedures increase that risk to 5% to 10%. “
However, the key seems to be to determine how severe the leg blockages are, and in those cases that are severe enough for intervention, which procedure is recommended: bypass or stenting. In an article published on John Hopkins Medicine Website on August 6, 2016, researchers in a small study concluded that “minimally invasive stents show some advantage over bypass in opening blocked leg arteries.” The study also found that “compared to open bypass, stenting keeps circulation flowing longer in some patients…”
I am not a doctor, but from my own experience and research, I have concluded that leg stents can be preferred over a bypass, but only when the blockage is severe enough to warrant intervention. And, since the level of severity seems to be open to the interpretation of the doctor, or the alternate means of testing, always get a second and even a third opinion before you subject yourself to what may be an unnecessary procedure, even when you have complete faith in your doctor. It certainly can’t hurt.
