Dear Dr. Roach: When my doctor refers me to a specialist, does he have a responsibility to inform me of the various options and procedures? I have found, after doing my own research, that there were far better options available to me than just the specialist my doctor sent me to.
An example is when I was referred to a local brain surgeon to have a tumour removed. After some research, my wife found that a procedure was available using gamma knife. The gamma knife procedure was not available locally but was the procedure we decided on. Shouldn鈥檛 my doctor inform me about the different options, or does he feel that he needs to refer me to someone locally?
T.L.
Referrals by primary-care doctors to specialists are made usually for one of two reasons. One is that the doctor desires additional expertise in diagnosing the condition. In this case, the primary doctor has to decide what kind of problem it might be, what organ system is involved, in order to find an appropriate specialist to help. Your primary doctor should be looking for an expert diagnostician.
The second is because the specialist has the ability to provide a treatment not available to the primary doctor, such as surgery or radiation.
In both cases, your doctor ideally involves you in the discussion. He or she may know several different experts and may choose the most expert, somebody local and immediately available, or one whose personality and manner might work best with you. The primary doctor may lack the expertise to review the treatment options; in fact, that may be the reason for the consultation.
The specialist, on the other hand, certainly should have all the options for treatment in mind when discussing them with the patient and family. I was taught in medical school and still believe that the doctor is obliged to provide the information necessary for the patient to make the best decision, even if it isn鈥檛 what the doctor thinks is best.
Circling back to your primary doctor with your experience with a specialist can only help your doctor learn more about the specialist and know better whom to refer to that specialist.
听
Dear Dr. Roach: Do you believe that lycopene, which is found in certain foods such as cooked tomatoes, can help prevent prostate cancer?
C.R.O.
Lycopene, a vitamin A-like substance found in tomatoes and watermelons, was indeed thought to听help prevent prostate cancer. Unfortunately, further studies failed to support this.
What has been shown more substantially is that a diet of fresh fruits and vegetables helps reduce risk for and even helps treat prostate (and other) cancer. So it may be that lycopene by itself isn鈥檛 enough, but that all the different healthy substances found in fruits and vegetables are.
听
Dear Dr. Roach: I just read the question from 鈥淏鈥� on bacterial endocarditis. I had bacterial endocarditis seven years ago, and I鈥檝e also had a mitral valve prolapse heart murmur for decades. You advised 鈥淏鈥� that, if you鈥檝e had bacterial endocarditis, 鈥淵ou have to take antibiotics before any dental work that seeds the blood with bacteria.鈥� Didn鈥檛 the American Heart Association rescind or modify its recommendation on that several years ago?
I had stopped the prophylaxis a few years ago, on the advice of my cardiologist and my dentist. Should I resume my former treatment?
D.R.
The AHA did change its recommendations in 2007, and limited the people who should receive antibiotics to prevent bacterial endocarditis. Now the only people for whom antibiotics are recommended before dental procedures are people with a history of endocarditis, people with a prosthetic heart valve or prosthetic material used in surgery, people with a heart transplant and valve disease, and those with unrepaired congenital heart disease. Because of your history of endocarditis, your valves are at risk of infection, so you still should have prophylaxis, and for the rest of your life.
Mitral valve prolapse or other valve disorders are no longer considered an indication for antibiotics before dental procedures. Some doctors and听patients will be uncomfortable with this, but I听agree with the new recommendations.
