Do You Get What You Pay For?

When I first practiced medicine, a visit with my internal medicine partners, was scheduled to last 20 minutes.  During that $9 visit, our standard of care called for taking the patient's history, performing a significant physical examination - including looking at the skin, checking for enlarged lymph nodes, examining the heart, lungs, abdomen and breasts, performing a brief neurologic examination, and preparing a chart note which listed significant items and findings. Because there was continuity of care, with patients not changing insurers and doctors every year, we knew our patients well and recognized important changes in their histories or physical examinations. We noticed unusual moles and lumps and masses and though we did not have electronic records, computers, or the extraordinary array of lab tests now available, we had the standards, skill, time and interest to establish early life-saving diagnoses leading to curative treatment for many.

When patients visit their "primary care providers" now, there is neither time nor interest nor a standard of care supporting the performance of anything other than a "focused" examination. The patient is asked what the major reason for the visit is, and anything else is likely to receive not even cursory attention. Ask yourself -  when did your doctor (or non-physician health care provider) last ask you whether you had noted any changes in a mole and actually had you remove sufficient clothing so that a skin examination could be done?

The June 6, 2011 New York Times front page features an article titled "Two New Drugs Show Promise In Slowing Advanced Melanoma" which describes two new drugs [also reported in the June 2, 2011 New England Journal of Medicine (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00019682)) which offer a short window of response to advanced melanoma skin cancer. The article is well written. But  my readers, need to understand that if the melanoma had been found at an early stage in a routine office visit by a health care provider with sufficient professional standards, skill, time and interest to actually look at the patient sitting there on the examining table, that melanoma might have been diagnosed at an early curable stage when it would never require drastic new treatments with significant side effects which offer only short-term respite at enormous patient and societal cost.


So the next time you go to your doctor for a "focused" visit, ask that the doctor (or other provider) to spend enough time to actually look at your skin.  Maybe this simple request will save your life.

The adherence to professional standards, professional skill,  interest and willingness of my doctor during a recent visit, to look for, find and recommend treatment for my melanoma - hopefully - will save mine.