A recent “New” Prostate InfoLink article reveals interesting data about
the nature of the influence one’s doctor has over the patient’s selection of treatment mode in low-risk PC cases: aggressive treatments versus expectant management (typically Active Surveillance)
. I would say many of our more experienced readers have likely suspected these finding to be true, but hadn’t previously seen supporting data. This is great peer-to-peer information for the “veterans” of HW/PC to share with low-risk newcomers…the bottom line, I believe, is that patients need to be their own advocates, and not
necessarily take everything their doctors say as pure gospel…the doctors in the community setting may be watching/prioritizing his/her own wallet, too.
Treatment decisions from patients coming out of two
different clinical settings were studied: the community practice (aka private practices), or the academic medical center. Here’s a little descript
ion of each, just to add clarity:
The most common model of community practice is a small corporation in which the physicians are the owners. A doctor joins as an employed associate. After a 2- to 5-year probationary period, the employed physician may be offered an ownership interest (i.e., partnership), and begins to share in the monetary failures and success of the corporation. Mechanisms for decisions about ownership, space, personnel, and finances are specified in the corporate bylaws. Decisions usually require agreement among the shareholders. Doctors in this setting generally spend their time seeing patients in the office, performing surgery/rounds, and (increasingly) dealing with insurance issues. Salaries depend largely on the patient services delivered.
Doctors working in the academic medical center are part of a hierarchical organization with many support functions. In addition to seeing patients in clinic, surgery and during rounds, they also conduct research and teach. Doctors are employees of the hospital, or more typically of a 3rd type of organization dedicated to a specific hospital. (For example in my area, the Northwestern Medical Faculty Foundation, NMFF, is the employer of doctors functioning at the Northwestern University’s medical center.) Salaries are structured, similar to many corporations, based largely upon training and experience, with opportunities for bonuses based on research grants, etc.
The InfoLink article highlighted that during the recent years of 2010-2013, low-risk PC patients who went to academic medical centers were 2.7 times more likely to be managed with some form of expectant management than those who went to a community practice.
That's a striking difference; beyond mere coincidence.
In the short time from 2013 to today, a lot has changed with a dramatic uptick in all low- and intermediate-risk cases opting for expectant management/Active Surveillance over aggressive (over-)treatments, and it would be interesting to have the most recent data on this, but as I said this data seems to confirm what many HW/PC veterans have thought likely to be the case about
the time period when many of us were diagnosed with PC.
Bottom line for newbie low- and intermediate-risk cases…for your own best long-term satisfaction with your outcome, educate yourself about
PC, and be your own best advocate while also considering your physician’s motivations.
Low- and intermediate-risk HW/PC "vets," think about
what setting you were in, and how hard your doctor encouraged AS or aggressive treatments…?
Post Edited (JackH) : 7/13/2016 11:31:48 AM (GMT-6)