<p>I am concerned about a couple of phone calls my 76 y/o mom received from the orthopedic surgeon who has been treating her - not very successfully - for a herniated disc over the past 3 months. He discussed surgery with her, she saw a neurosurgeon for a second opinion, and scheduled minimally invasive back surgery (not sure of the procedure’s name) with the neurosurgeon. She didn’t especially like him, but has always heard that a neurosurgeon is a better choice for this kind of surgery. Apparently the ortho guy discovered this when she phoned his office to cancel a future appointment and told the office manager that she’d chosen someone else for the procedure. Yesterday this doctor called her twice to “discuss” her decision!</p>
<p>I think that he’s trying to manipulate my mom into choosing him to do the surgery instead. Apparently he started by expressing his “surprise” that she would choose someone else after all the time she’d spent under his care. Now, she didn’t even get in to see this guy until 2 months into treatment, after seeing his PA (who botched a cortisone injection) and physical therapist (whom she liked), and finally qualifying to have an MRI and a consult with an actual MD. He told my mother that the surgeon she had chosen would do a good job, but that he couldn’t say the same thing about every member of the practice. Is this ethical?</p>
<p>I think he manipulated her, too, by taking the time to hear her complaints about the way his practice is run and agreeing with everything she said about the long waits, over-scheduling, lack of concern for patients in pain amongst his office staff, etc. In fact, the second call was to respond to her points after talking to his staff. It looks as if he made the time to schmooze with her to try to save his surgical fee. This primary concern for the bottom line disgusts me. Am I wrong, or is it creepy for an MD to do this? My husband is an MD and says that it’s something he and his colleagues would never do, but he doesn’t think it’s a reportable offense.</p>
<p>My mom and stepdad are well-informed about medical care and very competent. She doesn’t need me to take charge of the situation in any way, and I’m 5 hours away so I haven’t seen either MD with her. My mother, though, hates to disappoint anyone. She’s also exhausted by dealing with the pain every day. She doesn’t want to look for another MD at this point – she wants to have the surgery. And now she’s leaning toward the ortho guy! </p>
<p>I would run in the opposite direction from someone who did this. I think it’s really surprising that the dr himself called her. I could see him having office to staff assigned to follow up with patients who are leaving. This smacks of a heavy sell job to me, and just the very fact of it would turn me off. It sounds like he’s too desperate for business.</p>
<p>But to cut him a break, he may have good reason to be concerned for your mom and that is why he was calling. There are some new procedures out there that are being pushed for back/disc problems that do not work, and he could be concerned for her. Usually done by anesth. via pain management and not neurosurgeons, though. </p>
<p>So I would cut him a small amount of slack, but he should not call again.</p>
I don’t see anything unethical in that statement since I’m sure the part about ‘couldn’t say the same thing about every member’ is true.</p>
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I don’t see anything wrong with taking the time to hear her complaints, talking to the staff, and trying to get to the bottom of the issues. I’d have a problem if he didn’t do this.</p>
<p>
I think these are conclusions on your part that aren’t substantiated with any of the facts you posted. </p>
<p>Look at it another way - what if this was any other business (auto repair, hairdresser, wedding planner, accountant, whatever). What if it was you? If your client who had been consulting you decided to switch midstream to consult with someone else and sought another business in place of yours, wouldn’t you be interested in knowing why so you could address the issues if there were any particular ones that turned them away (staff issues, unresponsiveness for appointments, etc.)? </p>
<p>And with doctors it’s common to seek another opinion before surgery (it’s recommended) and doctors do have opinions of other doctors. It’s not uncommon for them to state that another doc is a good one - has a good reputation. They also know the patient might move to the other doc for any number of reasons (feels they’re more competent, younger, older, better looking, more personable, has the same hobby as them). </p>
<p>I’d be more concerned if the ortho doc told your mom she doesn’t need a second opinion, the neuro doc was no good, there’s nothing wrong in his office with staff or waiting, etc. According to what you posted none of this happened.</p>
<p>On the back surgery - I keep reading articles that say back surgery is one of the least successful surgeries in correcting problems so I hope you mom does get at least a 2nd and 3rd opinion before submitting to a knife on it when other treatments might be just as effective depending one what her particular issue is. It’s actually very helpful if a family member can attend these consultations with the person - to be someone who can listen with less emotion and make some more sound conclusions as to the experiences. Sometimes the patient chooses a particular doc for the wrong reasons (as you’re concerned about).</p>
<p>Thanks, folks, for taking the time to respond. I find myself in agreement with tango and vlines - not so much with GladGradDad. I’ve been seeing MDs for a lifetime, as I’m sure most of us have. I’ve never once had an MD him/herself telephone me when I’ve left their office for another physician. In the 3 months my mother has been under his care, this guy certainly never phoned her, nor expressed an interest in
She was treated according to Standard Operating Procedure, which is at odds with his sudden concern. I doubt that excellent customer service is his priority, since he didn’t provide it until it appeared that he was about to lose a patient to someone else. His mediocre online ratings regarding service issues, which I did not mention in my OP, are also a problem to me. </p>
<p>It’s difficult to see how his phone calls yesterday were precipitated by anything other than his concern about losing a patient to another MD and, following as the night the day, the surgical fee she’d have paid him. If losing one patient is worth 20 minutes of an orthopedic surgeon’s time, I’m frankly suspicious that he’s acting out of a need to drum up business. I’m probably old-fashioned in expecting a certain kind of etiquette from my doctors. I do not expect them to contact me to discuss matters of benefit to them.
Yes, I’ve read some of the same articles, as has she. Those other treatments, or at least the ones Dr. Phone Buddy has provided, have so far been ineffective.</p>
<p>One should have a neurosurgeon perform any type of spinal surgery, not an orthopedic surgeon. My H has had two spinal surgeries done by an incredible neurosurgeon. Both of his surgeries (two different sections of the spine) were extremely successful. In both instances, pain was relieved immediately and the recovery time was minimal. Each time, he was back to work full time within a week.</p>
<p>Our MD showed his annoyance that I was being treated for a thyroid condition by a specialist. He said, “I could have taken care of that.” Indeed, he could have, if he had noticed it. It took my ob-gyn to do that, and she referred me to a specialist. Our MD also noticed that both my other doctors were Indian, and said “they stick together.” </p>
<p>Yeah, not very nice.</p>
<p>Bottom line, doctors can be competitive about getting your business.</p>
<p>I would try to compartmentalize this. I was always taught that you should have two surgeons agree on a procedure before proceeding. Has your mom received a second opinion from another neurosurgeon. I can totally understand that you are upset because this has caused your mom unnecessary stress. However, I wish that more doctors would reach out for feedback, especially when a patient leaves their practice.</p>
<p>^^^^ I left a physician once and was asked about it. But when that happened, it was requested anonymously, by a phone survey company. Not while speaking to the doctor himself on the phone.</p>
<p>Frazzled,
I agree with you and while it may not be unethical, it is walking close to the line. If as a practitioner, you are comfortable with your diagnoses, treatment plans and comfort level treating the patient for the condition, whatever condition it is, you should have no problem offering the patient a copy of their medical records and radiographs, CAT scans, MRI etc to get a second opinion. It says to the patient that your ego is not so great that letting ,“another set of eyes” examine the patient will damage your pride, especially if the patient chooses to use the specialist.</p>
<p>As to the question of who should perform spine surgery, it is not a question of a neurosurgeon or orthopedic surgeon. You need spinal specialist, which can be from either discipline! Both disciplines use fellowship training for spine surgery sub-specialties. Make sure your back surgeon did his fellowship in spinal surgery, not brain tumors or hip replacements.</p>
<p>A neuro might be the best guy in the world for a brain tumor and the ortho the best guy for a hip replacement, but that doesn’t make either the best person for spine surgery. In your town that may be a neuro or an ortho. </p>
<p>If you know any nurses, especially surgical nurses, on staff at the hospital where you will be going, they will definitely have an opinion as to which surgeon they would have operate on a family member for a particular procedure. In my wife’s case (we know several surgical nurses) it was unanimous - Dr X the ortho is who you should see for disc surgery. (The hospital has over 30 orthos and 25 neruos on staff.) My wife was carried into the hospital and walked out 6 hours later.</p>
<p>Bumping this to thank everyone who responded. I’m not happy about it, but my mom has decided to go with the orthopedic surgeon for the surgery because, she says, “He knows me better.” She wouldn’t have changed her mind about the neurosurgeon doing the procedure if the ortho guy hadn’t called her, so “mission accomplished” in his mind, I guess. As I said, my mom is not at all a compromised senior, nor is her husband, who supports the decision. So I just have to pray and remind myself that, even if I think the guy is an unethical sleaze, he could still be a very good surgeon.</p>
<p>I’m glad your mother has made a decision that she is comfortable with, frazzled1. My feeling is that the doctor calling her was not unethical; he had a relationship with her and he wanted to know what went wrong. He may truly have felt he was offering a better option for her. I may be biased, as I work with doctors, but I think it’s pretty obvious most of the time if a doctor’s agenda is not in line with the Hippocratic oath! I also want to echo what ChicagoBear said about choosing an orthopedic surgeon or neurosurgeon for spine surgery. What you want is a surgeon who has training and expertise in the care of people with spinal disorders and injuries. You may find that someone has special expertise in the care of a particular type of disorder (or in the execution of a particular new technique). I bet if you asked an uninvolved ortho doc or neurosurgeon he or she would say the same thing. Where I work, we have spine specialists in both fields. When we set up a center for people with spine problems, we brought together experts from both disciplines.</p>
<p>I’ve certainly thought about calling a few times. I guess I’m glad I didn’t </p>
<p>In fact, I’m pretty sure I HAVE called, at least once, but I think I’ve felt invited to. Something like “I’m canceling my appointment, call if you have questions”.</p>
<p>I don’t think I explained the situation sufficiently in my OP. I’ve mentioned this to several friends, including a former medical office manager whose husband and daughter are physicians, and who herself has faced many health challenges and has had to fire several MDs. Every single person I mentioned this to felt it was questionable behavior for an MD to phone a patient to ask why she chose another physician to do a procedure. My friend with much experience in this area thought it was especially disturbing. I’ll say again that my mother received much more time and attention from this MD for scheduling her procedure with someone else than she did as a patient under his care. His online ratings make frequent note of the cogs-in-a-wheel, in-and-out atmosphere in his office. If his patients’ opinions matter so much to him, why not ask them how they feel about his service while he is providing their care?</p>
<p>No matter now. As I mentioned, my mother has chosen the inquisitive doc and I am simply praying that all goes well and we won’t regret it. This is said to be a minimally invasive procedure, and he assured my mother that he can do it as well as a neurosurgeon.</p>
<p>I agree with GGD for the most part. I think doctors, just like any other professional, why the relationship didn’t work. I do feel that that’s the only way to learn how to fix something. I didn’t think it was unethical or manipulative, so long as he really did try to dissuade her from further appointments.</p>
<p>I sure hope that, now that your mom has rescheduled surgery with the ortho doc, she gets the attention she deserves, instead of this:
- for a herniated disc over the past 3 months. He discussed surgery with her, she saw a neurosurgeon for a second opinion, and scheduled minimally invasive back surgery (not sure of the procedure’s name) with the neurosurgeon. She didn’t especially like him, but has always heard that a neurosurgeon is a better choice for this kind of surgery. Apparently the ortho guy discovered this when she phoned his office to cancel a future appointment and told the office manager that she’d chosen someone else for the procedure. Yesterday this doctor called her twice to “discuss” her decision!</p>