Why Do You Trust Your Doctor

Today I saw a new patient. She is female, educated, economically stable, about 54 years old. Several months ago she sought treatment for spider veins on her legs. She went to a … laser clinic. The clinic treated her with some injections and some lasers and they burned her skin and her spider veins remained. So she decided what she needed to do was go to a … vein clinic. That doctor did a Doppler test and told her the last doctor treated the wrong veins. What she has are varicose veins and his tests prove it and he can do surgery on her and all the veins will go away. Best of all he will bill insurance and he is sure they will cover her expenses. Today I examined her from head to toe. She is an athletic, trim, muscular female with not a single varicose vein in either of her legs. (For any who might not understand I conclude the vein doctor is guilty of false diagnoses, potential mail fraud, insurance fraud, and at the least patient abuse.)
Now I ask myself, “why would an intelligent person go to a laser doctor or a vein doctor to treat any problem?” Has anyone checked if there is board certification with special knowledge of the circulatory system for laser doctors or vein doctors? If I wanted a carpenter to repair my home and I knew he would use a hammer would I go to a hammer clinic to get help? If I wanted a plumber to repair my leaking pipes would I go to a pipe clinic to get help? Then why would anyone who does not like the appearance of spider veins on her legs go to a laser clinic or a vein clinic without even knowing what was wrong. OK, OK. So she figured out the vein doctor might be milking her for an ill-begot fee. Why was she there anyway?
Here we have a dichotomy of problems. More and more doctors are unethical. You have every right not to agree. It just happens to be true. More and more doctors “doctor” the diagnosis or “doctor” the treatment to get the most money they can from the insurance company or from the patient. When lawyers, politicians, judges, teachers, religious leaders and the rest of society are more and more overtly unethical should anyone be surprised that more and more doctors are unethical? Like the doctors at 2 of the major University Hospitals in Chicago who got caught billing for services that were never rendered and the government levied fines for Medicare abuse that you never read about. Like the doctors who hawk diet programs that at best don’t work or at worst harm people. Like spas that perform surgery (I never knew a spa could have a degree let alone a license to practice medicine).
And at the same time we have patients who do not want to take responsibility for their care, who do want something for nothing as in “bill it to my insurance”, and who do not want to be their own health care advocate. On the one hand patients do not trust the system so that they refuse to enter into cancer trials which save lives and on the other hand they entrust their welfare to gimmicky phrases like “laser clinic”, medical spa (an oxymoron?), and longevity clinic (are there doctors who do not promote longevity for their patients).
Now, I think I can explain the evolution of this problem. Trouble is, that does not solve the problem. So once again I suggest the best way to find a doctor is:
• Use the advice of other doctors whom you trust
• Use the experience of friends and family
• Research the doctor through the internet, the local hospital, the state
• Interview the doctor to make sure you communicate well with each other
• When in doubt get a second opinion from a doctor in a different community
Edward Lack MD

Facial Rejuvenation in 4 Days

Two thousand four hundred years or so ago, Cleopatra spent great amounts of effort preserving the legend of her infamous beauty. Such was her power that the succeeding Roman conquerors agreed to preserve her image in Egypt only after her nose was forcibly amputated from every remaining relic in her likeness. Cleopatra was apparently known for her mineral baths and one supposes her facial treatments consisting of products like milk (lactic acid), sugar (glycolic acid), wine (malic acid) and perhaps other ingredients known now to be alpha hydroxy acids.
While it appears she died around the age of 39, she nevertheless would have identified with the needs of our more long lived brethren, who wish to maintain a state of healthful appearance well into our 70’s. For this a multibillion dollar industry has arisen consisting of potions and creams, skin manipulations and therapies, devices, and when all else fails masks of make-up. Notwithstanding products and therapies which have been more or less effective, technology has, in fact, progressed so that skin and soft tissue rejuvenation is a reality which may only be limited by the amount of damage needing repair.
Enter the technology of fractional laser resurfacing. While resurfacing procedures have been around for more than 100 years (maybe thousands), the most common procedures of the 20th century were chemical peels and dermabrasion. By 1990 laser resurfacing became the gold standard in wrinkle removal and scar reduction. All of these techniques, however, were marred by a long healing period and frequent complications of color alteration which could last for many months. Add to this the problem of treating people with skin of color (this phrase was actually used in the 19th century) and all of the available technologies had severe limitations. In the 21st century non-ablative techniques using IPL (intense pulsed light) and infrared laser and heat producing devices were introduced as avoiding the necessary downtime of the ablative (destructive) techniques. Trouble was they didn’t work so well.
Ultimately fractional laser resurfacing evolved. Basically this technique uses an ablative (CO2 or erbium) laser to shoot microscopic holes in the skin leaving islands of undamaged skin between the holes. Several events quickly follow:
• The removed skin is replaced by new skin
• The surrounding islands regenerate new skin in a matter of a few days
• The inflammatory reaction necessary for healing continues to build collagen for months
The miracle of fractional laser resurfacing is that it can treat face, neck, and body; it heals within days and normal color returns within a few weeks if that long; it can be repeated for enhanced results; it costs significantly less than traditional laser resurfacing,; it can be done on a Friday with normal return to work on Monday for most people.
Good-bye wrinkles, withered vine
Sagging skin and aging signs;
Roll back the clock, sound the chimes
Fractional lasers erased my lines.

Edward Lack, MD

Facial Rejuvenation in just … Er…How Obama Lost the Health Reform Initiative

President Obama lost his initiative to reform health care in the United States when he abandoned his Midwest political base. As difficult as it is for Americans to understand the health care debate over the past year, it is virtually impossible for non-Americans to understand what has transpired. Consider the following:
• The United States is the only country in the industrialized world without universal health care
• In the United States 1 out of 3 Americans has no health insurance or are inadequately insured
Therefore it stands that the United States needs health care reform in order to:
• Provide access to health care for all Americans
• Reduce the escalating cost of health care which threatens to bankrupt the nation
• Improve health care outcomes in the United States
President Obama decided that the road to achieving these goals was to align himself with the West Coast liberals led by Nancy Pelosi at the expense of the more conservatively oriented Midwest voters. Consider that:
• The President owed his election to independent voters; non-aligned with the liberal faction of the Democratic party
• The President chose to support the wish list of the Trial Lawyers Association and lobbyists for medical insurance companies and hospital organizations
The President had a real opportunity to gain the support of the majority of United States citizens who are characterized by independent voters and Midwest political views if he had embraced:
• A program to reduce waste in the medical economic system now instead of advocating no change in the system until he gets the legislation he wants
• Eliminate purchasing of health insurance by employers and return the responsibility to the individual as it is with auto insurance, home insurance, etc. The burden on small business cripples the single largest source of economic growth in our country.
• Tort reform which would reduce the economic burden on the system from punitive damages
• Insurance company competition to provide adequate insurance. Citizens should be able to purchase health insurance from any state in the Union.
• Federal licensing of physicians and hospitals which would better insure uniformity of care and eliminate state by state profiteering
The President went down to defeat when he barely passed his politically biased package through the House of Representatives. There is virtually no chance he will achieve victory in the Senate. The stock market knows this. It is predicting a deadlock between the executive and legislative branches and there is little time for the President to re-group.
Next week: Facial rejuvenation in only 4 days.
Edward Lack MD