Should you see Dr. Pheo?

A few readers have expressed interest in seeing me for a formal consultation. I appreciate their encouragement. I do often see patients from other parts of the state or country. Seeing an outside expert has some pros and cons.

Pro 1. Definitive answer to specific questions. By the time you feel the need of seeing an outside expert, usually you already have done a lot of tests and imaging and received various opinions. The outside expert has the vantage position of reviewing all of the information and your natural clinical course. Of course the expert is also most experienced on some specific diseases. Whether the answer is yes, no, or further studies needed, you will have an answer.

Pro 2. Getting the best diagnostics and treatments. The outside expert usually works in an academic medical center and works closely with other experts. They can see things that were omitted before and usually do things “right”. Further diagnostic procedures and surgical operations are usually carried out by expert physicians as well.

Con 1. An expert is an expert on certain diseases but not on all diseases. Sometimes my patients are impressed by my knowledge on pheo and other neuroendocrine tumors and they assume that I know everything. I always explain that I do know a lot about pheo and other rare tumors and I am a good general endocrinologist as well, but my knowledge on other medical conditions is limited. Thus an expert can give you definitive answer to your specific question but she/he cannot solve all of your health problems.

Con 2. Follow-up is challenging. Patients and their diseases are ever-changing. For chronic and non-emergent questions, you can easily communicate with the expert by phone or email. For acute issues, it is important to ask a local physician who knows your condition well. Remember that the outside experts usually have responsibilities in research, teaching, and administration, besides clinical care. The expert may go to a scientific conference or vacation. All these make accessibility an issue.

Con 3. Extra cost and insurance coverage issues. These are self-explanatory.

Based on my experience, I believe there are some general rules-of-thumb on whether a patient should see an out-of-town specialist and how the patient can benefit the most from an outside expert. Here are my recommendations:

1. Find a local doctor who you trust and like and who has some basic knowledge on your condition. For pheo-related diseases, an endocrinologist or an internist is a good choice. This doctor has to be open-minded and comfortable at learning new knowledge.

2. Either ask the local doctor to identify an expert or find one yourself. Ask your doctor to contact the expert, explaining why the patient needs to see the expert and what specific questions need to be answered.

3. Before you go, send all doctor’s notes, lab results, CT/MRI and other imaging studies on CDs (not just the reports) to the expert.

4. When you are there, remember the specific questions your doctor and you want to ask the expert. Be realistic about what the expert can do (give definitive answers to specific questions) and cannot do (cure all ills). The expert may already have arranged additional diagnostics and possibly sessions with a surgeon or other experts so that you will have more efficient use of time there.

5. After you return, work closely with your local doctor and make sure that the local doctor and the expert communicate. Carry out the plan laid out by the expert and consult the expert on non-emergent questions. For emergency questions, you have to be lucky to be able to locate the expert all the time. Your local doctor is your best help.

What about seeing Dr. Pheo? All the rules apply. In addition, I will ask you to respect my wish to be anonymous as Dr. Pheo. Of course you will know my real name before you actually see me but please do not divulge Dr. Pheo’s identity publicly. I will post one of my email addresses later.

By the way, I will be on vacation from late August to Early September and may not have internet access during that time.

Dr. Pheo