Doctors have a built-in advantage when it comes to getting extra-special medical care. Their knowledge and connections help them to get better faster, and avoid unnecessary risks. But now, in their new book titled, “Special Treatment: How to Get the Same High-Quality Health Care Your Doctor Gets,” “Today” contributors Dr. Kevin Soden and Dr. Christine Dumas, are leveling the health-care playing field so that everyone gets the special treatment they deserve. They discuss the book on “Today.” Here's an excerpt:
UNDERUSE OF PROVEN THERAPIES IN HEART DISEASE
Physicians find it extremely difficult to maintain clinical competence when faced with the demands of a busy practice and the constant advances in medical knowledge. Believe it or not, many doctors often treat patients the exact same way that they learned when in residency training . . . and this could have been 10 or 20 years earlier. Can you imagine going to a mechanic who treated modern-day cars in the same manner as he did a car 20 years ago? Could you imagine an athlete today not taking advantage of modern technology and instead using equipment that was developed 10 or more years ago? We think not.
Unfortunately, many physicians are practicing “old-style” medicine and not taking advantage of the latest research. Here are a few facts that may shock you:
Despite the overwhelming benefit of a class of drugs called beta-blockers in the treatment of heart failure, only about 10 percent of heart failure patients are prescribed such drugs.
Following a heart attack, these same beta-blockers have been proven to reduce both complications and death if given at the time of discharge. Unfortunately, studies show that doctors prescribe the medicine in only about one-third of patients in the best studies and around 10 percent in studies with the worst results.
Patients with high blood pressure have their blood pressure under proper control only about 50 percent of the time because many doctors aren’t following treatment guidelines set forth by national organizations such as the National Institute of Health.
Only 30 percent of patients with heart failure are given the appropriate medicine for treating their condition. (It should be an angiotensin-converting enzyme (ACE) inhibitor in most cases.)
84 percent of diabetic patients did not receive blood tests for hemoglobin A1C to monitor the control of their diabetes.
Only 18 percent of patients with known heart disease and 40 percent of persons at high risk for it had their LDL or bad cholesterol under control.
Have we gotten your attention yet? The point we’re trying to make is that too many people are not receiving optimal medical care because their doctors do not follow the most up-to-date medical guidelines. And it’s not necessarily the case that these are bad doctors; even the best-intentioned doctors have a difficult time keeping up with the latest therapies. So what can you do? Educate yourself. Make it a point to research your own medical condition. It’s relatively easy today to find numerous Web sites that provide excellent patient education. You can’t always count on your doctor being up on the latest therapies, even in a condition as common as heart disease. Just imagine what could happen with a less common medical disease. Why take a chance? Be your own advocate; do the research, ask the questions, and make sure you’re getting the best medical care available.
EBCT SCANNING FOR HEART DISEASE: HOLD ON TO YOUR WALLET
EBCT (electron beam computed tomography) scanning is a form of computed tomography that is also known as ultrafast CT scanning or coronary calcium screening. It is used to detect calcium deposits in the arteries of your heart. Why is this important? The coronary arteries supply blood to the heart and they are considered diseased when cholesterol plaque accumulates in the walls of the arteries. The medical term for this condition is atherosclerosis. These plaques are initially made of soft cholesterol. Over time, the cholesterol in the arteries can become calcified, but not always, and that’s part of the problem and why there’s so much controversy associated with the EBCT test.
EBCT is designed to measure the amount of calcium in the coronary arteries, but just finding calcium in the coronary arteries doesn’t mean much. Because of our high-fat diets (especially our predeliction for fast food), nearly everyone over 25 has some calcium in their arteries. But these calcium deposits aren’t necessarily significant to your health. Just having them doesn’t mean you are going to develop heart disease. You will need more tests to determine its true significance. But proponents of EBCT believe that a positive test can get people to change their habits before things get worse. The data in smokers with positive chest X rays does not indicate this to be true. So are EBCTs a good idea or not?
Here’s the rest of the problem. If EBCT shows your arteries are free of calcium, it doesn’t mean that you are free of heart disease. You may have significant plaque that’s accumulated in your artery walls and is producing blockage, but unless it’s calcified, you’ll never see it on the EBCT. You’ll come away from the test feeling like you’ve gotten a clean bill of health when it fact you haven’t.
Now that we know more about the test, what’s the real issue here? Why do you even care? Well, here’s what’s happening that’s of concern to many doctors (we agree and that’s why we’re including this section in the book). Local clinics are now advertising EBCT tests directly to the public: “Come on down and get a quick scan over your lunch break to find out if you’re at risk for heart disease.” The advertisements and brochures advocating EBCT often target the worried well-people who are healthy and have no known risk factors for heart disease. These clinics make outlandish claims of how EBCT can save your life, and people who are worried about heart disease come running.
EBCT centers do not require a referral from your doctor and will cost you an average of $500 for this 20-minute scan. Most insurers will not cover the cost of these tests unless ordered by a doctor for a specific clinical indication. So is this test worth it? We think not, and most doctors agree.
Many doctors do not think EBCT is a good idea and it’s simply a moneymaking ploy on the part of those advocating it. It’s a test that’s been around for twenty years yet it’s still not accepted for widespread use. The American College of Cardiology and the American Heart Association issued a joint opinion on EBCT in 2000 that concludes that EBCT should not be used in routine clinical practice or to screen patients who have no symptoms. Need we say more?
Until there is more evidence based on good clinical trials, we advise you not to use EBCT unless ordered by a doctor for a specific clinical indication. It can be useful in following the progression of heart disease in some people and in people with specific known risk factors for heart disease. EBCT should not be used in people who’ve already had a heart attack, (because of the damage in their hearts, test results cannot be read as well); people who have undergone coronary bypass surgery or angioplasty; and women who are pregnant (because of the high amount of radiation two test puts out). What doctors know and you should too . . . see your doctor for a workup before heading for an EBCT. It will save you time, money, and further unneeded testing.
Publisher’s Note: The ideas and suggestions contained in this excerpt are not intended as a substitute for consulting with your physician. Excerpted from “Special Treatment: How to Get the Same High-Quality Health Care Your Doctor Gets.” Copyright 2003 by Kevin Soden, M.D. and Christine Dumas, M.D. All rights reserved. Reprinted by permission of Berkley Publishing Group.