"C" Means See Your Doctor

Patients are, if nothing else, intelligent consumers. About 80% of Americans research health issues on the Internet. They are hungry for information to help them make decisions about their health. I find these patients refreshing, as I feel like I can add a teaspoon of knowledge and a touch of wisdom to their thoughtfully prepared and ready-to-bake medical decisions.

One Bad Grade

It’s also the reason that I am proud of the Feds’ new proposed guidelines for prostate cancer screening, the most common cancer in adult men. In 2012, the USPSTF came down hard on our use of the prostate specific antigen (PSA) blood test to screen men for prostate cancer, giving us a “D” grade—essentially rejecting it completely. Were we as urologists losing it? We thought it saved lives, and it could detect bad cancers before they got out of the bag and spread elsewhere. But we were told that it cost the system too much and wasn’t worth the few saved lives.
Urologists were furious at the federal recommendation that we stop PSA screening for prostate cancer. Personally, I hadn’t seen a patient present with spinal cord compression from end stage prostate cancer since the test was introduced in the early 1990s. That alone is worth its weight in care. True, we were giving men another number to worry about, and often rattling their cages with it to the point of prostate biopsies. Also true is that most of those biopsies showed no cancer. But we were slowly working it out, using the PSA smarter, such as focusing on men 55-69 years of age but not those younger and not older. And we were developing newer, more precise genetic tests too. To put the kibosh on PSA testing was seriously deflating.

Good Recovery

But what goes around comes around. Urologists held their ground, continued to innovate and examine studies, and learn from their mistakes. And the Feds revisited their recommendation recently and backed off from completely dismissing PSA screening to say that it can be considered in men 55-69 years of age with informed consent from patients. The newest draft of the screening guidelines gives it a “C” instead of a “D.” Although you might not be patting your kid on the back for this grade change, according to urologist Dr. David Penson from Vanderbilt: “It’s a ‘C’ now so see your doctor, as opposed to ‘D’ don’t do it.” That’s a pretty big difference in my book! And I think that most of us agree on this.
The era of “trust me,” patronizing medicine is over. Patient trust should be earned and not assumed by physicians. The old school, patronizing clinical approach requires patient compliance, but does not necessarily lead to patients being informed. By discussing the pros and cons of PSA screening with patients, and any other health care issue for that matter, decision making is truly informed. And being informed leads to better decisions and better compliance with decisions. And, at the end of the day, with all of this comes engagement, empowerment… and hope. And that’s what practicing medicine is all about.