What to do When Your Doctors Disagree

What to do when your family doctor has not helped you with your symptoms of menopause or low testosterone?

What should you do when you go to your family doctor who has not helped you with your symptoms of menopause or low testosterone and he threatens to fire you because you came to a different doctor who gave you safe and helpful treatment that completely resolved your symptoms.  One doctor who really helped you is being criticized and denounced by another who is threatening to refuse to treat you because you finally found the answer to your pain? This is a problem in our office all the time, because we are practicing cutting edge medicine based on relatively new research. When I hear what doctors have said about my very successful treatment with hormone pellets I am more than embarrassed for my profession.  When certain doctors feel the need to confuse, scare and make my patients distrustful of me when I have successfully cured their symptoms of menopause and andropause, I know that the other doctor is not putting the patient first in their critical comments.

The rules of professional ethics among doctors encourage us to be respectful of the work of other physicians and to realize that other doctors may have a different treatment focus or a different reason for the treatment plan they are following with their shared patient.  Sadly, I have found that this ethical rule is not followed by many physicians.  Explaining the issues and defending my practice position should not be necessary when my patient has obviously gotten better, yet that is what I am finding myself doing all the time.

I believe it is best to have a verbal conversation with another doctor who is concerned with my care (even if it is successful), but it is a challenge for doctors to find the time to speak with one another regarding the differing aspects of the treatment they are providing. Realistically they may have different agendas, different databases of information, different contracts with pharmaceutical providers, insurers, hospitals, and most importantly, different medical training, etc. Doctors’ schedules are quite busy and rarely match for phone calls to be practical outside of emergencies. Typically doctors were not trained to work together but to work as individuals, so they didn’t learn the talent of disagreeing without slandering the other doctor. Disagreeing without confusing a patient is also a typically unknown skill to doctors currently over 50. In the past, doctors treated their patients under their own specialty without much consultation because medicine was simpler and we didn’t know as much.  At that time we could act like only children and work on our own.  Now we must consult with other doctors because the knowledge base is so wide and we need the help of other doctors from different specialties.  Unfortunately, we are working without a map on how to resolve difference of opinion.  Our egos might be hurt but our patients are the real victims and they leave our office confused and unable to make a decision about whether to follow the treatment of Doctor A or Doctor B.

There are many basic reasons for doctors to interfere in another doctor’s therapy or treatment plan.  The two doctors may have completely differing philosophical approaches in their understanding of the goal of medicine and treatment planning. For example, some doctors focus on following guidelines, and basic standards of care (which is the lowest level of acceptable medical treatment) when treating a patient.  One doctor told my patient that he NEVER used any drug that was not approved for the specified use by the FDA.  That is rarely true, because we have all been trained with old generic drugs that are not approved for specific uses, like using terbutaline (an asthma drug) to stop pre-term labor.  The male doc who accused me of that was one of my residents and I know he used lots of drugs off label, he just didn’t know enough to realize that they were so.  Many doctors choose to treat to achieve “normal” lab values, but not the patient and her symptoms.  For hormonal treatment that ends up being a failure, because women in menopause are quite aware of their symptoms, and if these symptoms are not relieved, they won’t come back, when the doctor says they are just fine because their labs barely approach the normal range. Hormonal lab can only be judged based on other drugs a patient is on, their age, if they are menopausal or not, other hormone imbalances, as well as time of day.  Just looking at your lab tests and your levels fall in the “normal range” you should ask, ”Normal for who”?  In my world, lab normals are only considered that if they accompany the resolution of symptoms!  When doctors who look at only numbers but don’t ask their patients how they feel, clash with those doctors who find symptom resolution most important, then these two philosophies clash, and it is the patient who is the loser because they don’t know what is right and who to believe.

When you go to the doctor and are told you need a particular treatment that was not suggested by your first opinion doctor you should ask directly for the doctor to tell you what your directions are in order.  It is important that you ask for the treatment plan because you the patient are an average citizen without the specialized education of the physician, and you do not know what to do without a specific plan.  The next question is to ask how and why this varies from the plan of the first doctor. This will help you understand the most reasonable medical treatment for you. If this process raises the ire of your doctor or both doctors, you may have to seek out a third opinion to “break the tie”. As much as I like to teach over the internet, I do not think that a lay person without medical training should attempt to apply their own case to the information they read about on the web.  It truly takes a medical education to know all of the issues that might complicate your treatment, and to be able to discern the risks and benefits of various types of treatments as they apply to you.

In this week’s Healthcast, Dr. Maupin and Brett Newcomb discuss the mistakes that can occur secondary to difference of opinions between doctors that are fought through the patient.  This is like divorced parents who spar by using their children! One example refers to the difference of opinions associated with treatment of thyroid deficiencies they look at blood levels of TSH (the pituitary hormone that stimulates the thyroid gland), and T3 and T4 (two types of thyroid hormones) and shoot for a number they wish to reach with thyroid replacement. There are guidelines established by the various medical specialties (endocrine, OBGYN, family practice, cardiology, etc., relating to thyroid replacement and they are all different). Some doctors try to give just enough hormone to bring the patient into the normal range for TSH, but ignore T3 and T4, but ignore whether they feel better or not. Patients present with symptoms, doctors think as they listen “ this sounds like thyroid imbalance” and they decide to confirm their suspicion with blood tests in order to determine a baseline for TSH, T3 and T4 in the blood. This is a more complete and accurate method of determining if the thyroid hormone is deficient.  They then decide on a treatment approach, with the goal being to improve either the numbers on the blood test, or alleviate the symptoms the patient is experiencing or both. Conflict between these two protocols ends in conflict that make patients feel insecure, and uncertain who to believe.

The purpose of this week’s Healthcast is to discuss this situation in today’s medical world. We want to encourage you the patient to be aware of these problems and to be involved in the communication and decision making processes that go on as their various physicians work to insure your health.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author. www.BioBalanceHealth.com.