Is Your Doctor objective or biased?

[skunkworks]

The biggest issue of impartiality with regards to urologists and Peyronie's is how quick they are to want to get you on the operating table. That's their hammer, so all they see is nails.

[Frank55]

Interesting point Skunkworks. The urgency to operate is certainly another impartiality concern.

A Colorado urologist once told me the Doctors who work for a large Denver-based urology practice (multiple physicians located within their own building) actually have to meet a quota (revenue objective) to justify the high salaries they are paid.

Which also concerns me. Is the Doctor's approach in such a situation governed by what is truly best for the patient, or is their judgment influenced by outside "revenue pressure"?

So I understand your hammer/nail analogy, but I'd add that (some) urologists see another item as well. Revenue potential. Nothing brings in cash flow like surgery. Only so much revenue can be generated by office visits, medical tests (like MRIs) etc.

That concern is probably more pronounced among the physicians who work at the large group practices. Buyer beware, as always.

[Pfract]

Hey Frank/skunk: this left me wondering. Would it be feasible, both Timewise and data as well if we could gather the most commonly used doctors by people on this board on the US and made a small list to say who the best ones are?  

I didn't check peyronies doctors, but the biggest implant names are all there. Kramer, Eid, Perito, D. Knoll..could we determine if they have a preference for one brand of implant or not based on the data there? Or the financial payments from the manufacturers may mean something else?  

[tomas1]

My doctor leans toward AMS, but will use Titan on Peyronies subjects.

[Frank55]

Pfract - thanks for your post. Not sure how we would determine the "best" doctors are. I think we lack complete data to make a statement on that.

The most important piece of data (in my opinion) is something we will never have. That is the proportion (percentage) of surgeries performed by a given Doctor (whether it is a grafting, plication or implant surgery) that are a complete success.

Even the best Doctors have surgical failures. But some Doctors have a better "batting average" than others. That would be an excellent piece of information but it would require a representative sample of patients from each Doctor. Most of those patients have never posted here and many would be unwilling to take a survey. Many have also never been on this site. As Hawk has correctly pointed out, only a small percentage of the men dealing with this health condition access this forum.

For example, I'd bet that Dr. Eid has a higher percentage of implant surgery successes than most other Doctors. I'd base that on his innovative thinking and insistence on procedures that decrease the probability of infection. But you can bet that even Dr. Eid has periodic failures as well. No one bats 1.000.

This point does not make this excellent forum any less valuable. It has been and continues to be an enormous help and valuable resource. But it is not a representative sample.

In fairness, I should point out it was a Doctor who pointed me to the Propublica site. That was Dr. Joel Gelman in CA.

Note he does not accept "influence payments." I give him HUGE credit for that.

[Alibaba]

Look up assembly line implanters like Paul Perito of Coral Gables, Florida.  He sucks in $3/4 to 1 MILLION  a year from the companies purchasing him. Look up some of the other more respected implanters. Some get a free dinner from the sales rep, some comped a free implant or device of several types but nowhere near the $$ the mass installer factory type doctors get. Interesting part is some of the top docs and the factory setting doctors install about the same number of implants a year. I suggest it states something of the ethics of the doctor and the reason he does the type of work he/she does. Either they love what they do or they are in it to suck as much cash as they can.  I know two well respected doctors love their craft. I've asked because I though it showed and both stated they do. Choose wisely. Accept 1/2 assed, expect to get 1/2 assed results. Do you and your issues seem important to your doctor or do you get 5 minutes, shuffled to a nurse assistant and out the door after you have paid the bill to be buzzed out?  

[Pfract]

Hey Ali... I was reading through your post. I missed it somehow. You mention factory type doctors.... Are you saying high volume implanters here? Or just Perito in particular?

[Alibaba]

You nailed it. Cheers buddy.

[Frank55]

Ali - I just looked up Paul Perito. That is almost funny how much he is raking in. Sort of funny, anyway. But I wouldn't go anywhere near him for a procedure of any kind.

I had one other relevant experience during the early days with this condition (fall 2015.) At the time, I was living in Denver, CO. I went to a local urologist (who has since retired) and we were discussing potential peyronies treatments.

I asked him about traction devices and his appraisal of their straightening effectiveness. He scoffed at that equipment and said it was a waste of time. I pointed out that Dr. Levine in Chicago was an advocate of traction and he is a recognized peyronies specialist.

He looked at me and said "Dr. Levine is paid to advocate such devices." I was skeptical of his statement at the time. Now I'm not so sure.

[Pfract]

Impressive that your doctor at the time made such remarks! Normally they hold it back! But I think it would be a matter of running a search or two on him and see what pops up?  

[Frank55]

Hi Pfract - Yeh I did look him up and there was nothing of note. A $300 payment in 2015 was the last item listed.

As I said he has since retired. He was older (78) at the time I consulted with him - I figured that out from a birthday photo book he had on the table in his waiting room. He looked kind of frail and I was concerned he might decide to retire when we were in the middle of some sort of treatment or therapy.

So I didn't schedule any further appointments. Roughly three months later I received a letter from his practice that he had developed a health problem and decided to retire.

Anyway, I did appreciate his candor. I'm kind of on the fence about the physicians who receive "consideration" payments. Clearly it would not be wise to take a hard line on your urologist selection by excluding all that take influence payments. Too many good Doctors are doing it and our selection is already small. But it still concerns me to a degree.

[Stepone]

Impartial, interesting question, but my chief concern is, how many surgeries has the urologist done and what were the outcomes?
When i had my nesbit surgery for my penis in 2015, I had been to a total of 4 urologists that did the surgery. One had a great bed side manner and discussed it very openly, but he only performed about 4 surgeries in a year. The next urologist was not very friendly, very mechanical, and was at a teaching hospital, and performed about 9 Peyronies Disease surgeries a year. The 3rd urologist knew all the other doctors, had performed about 20 Peyronies Disease surgeries, and also was very friendly and caring. The 4th urologist told me to come back in another year, hmm.
My penis is straight with a nice slightly upward curve and it's shorter, but ok.
Recently the Viagra and erectile injections have been working less. I can get an erection, but I cannot maintain it long enough for climax, if I don't do the injection and the Viagra. I never have a problem with an erect penis staying longer than 60 minutes, it easily goes down, but will surprise several times over the night with erections.
That being said, my penis is shrinking from the Peyronies Disease and I am set to visit a different urologist in April. My former urologist retired last year. I am so thankful for all the messages from Hawk and others to make this journey a less than frightening one.
I also appreciate all the sharing everyone has done on their particular surgeries, as I believe this will be helpful for me, once I decided to get the implant.
Thanks to all and I will stay in touch too.

[Alibaba]

When I saw Levine about my first implant disaster, he told me Milam was a friend of his and they go to conferences together. Fairly shut it down he was not going to comment other than it looked fine to him and no more discussion.  I just read a lawsuit against a drug manufacturer. The highest prescribers of the medicine are also the highest kickback from the manufacturer doctors. The drug company says there is no relationship between them prescribing the most and paying them the most. They claim all 20 some doctors are "paid consultants".  I prefer doctors that are beholding to the patient and their well being than those who are paid by their parts supplier. Read kickback.  

[Stepone]

In two weeks, I will be meeting with two different urologists about implants. I will give updates after my meetings as tp which one I choose. One is 8 hours away and I know him. The other is 2 hours away and this will be my first meeting.
I have read to go with the doctor that has done the most surgeries, I will ask that question of course, but I also must recognize that the doctor that I really wanted will not take my medicate advantage plan, which is Dr. Kramer in Baltimore, Md.
I am trying to come up with a list of questions to ask each surgeon, so if you have any, please share them with me.
I am also using Hawks descriptions of the "surgical approach" and "post surgical recovery" times to give me some basis to use a comparison, when I talk with the surgeons.
I am at the point now, that I believe an implant is the best thing for me.
I have no problem getting an erection when aroused, but I just can't seem to maintain it. I use Cialis, Viagra, and a bimix for injection into my penis, but still I have to keep pulling out and concentrate on getting the erection again and again. I can go from rock hard to soft in just a few minutes, so I am getting more and more frustrated which causes even more problems. My spouse is great about all this, even though sometimes it takes forever for me to ejaculate. It's just so damn frustrating and depressing.
I have also noticed my penis is shrinking more in length and width due to the Peyronies Disease, so I am hoping this surgery will prevent any more shrinkage.

[TonySa]

Are you able to switch back to regular Medicare mid year f he accepts that?  

[Stepone]

I cant change my plan, as my spouse is connected to it, its complicated. Its a holdover from my previous employer and is actually a pretty good plan. This is the first time, I had a urologist say they would not take my plan. I think I will call the doctors office again, as I would think they would take United Healthcare PPO. I am not sure that the person I talked with really understood which plan I had.  

[Pfract]

Are you going to use a ved prior to surgery to help on stretching the tissue a bit?  

[Stepone]

I have been doing some.
I have a pump and a stretcher.
I have not been too religious about it, as I am trying not to damage the penis.
I don't want more scar tissue which can cause more shrinkage with the Peyronies Disease.

I called and Kramer does not take United Healthcare Advantage PPO. UGH!

I called Perito Urology in Florida, he does a lot of implants, so that could still be a choice, but for now I am still planning my visits for Raleigh and GBMC in Baltimore. HOw are you doing?

[Pfract]

Hey man. A lot of guys regret not going to a top doctor first and end up having to have a revision later on. Are you sure you are not willing to pay out of pocket for your implant? You can finance as well..  It's around 25 grand. Super expensive but....  

[Stepone]

Actually, I am sure, I have had various surgeries in my life and have found that there are a lot of good doctors and bad doctors. But I have always managed to make it through. The one surgeon I know does over a 100 each year. His last patient last Friday was 92. He said he would give me names to talk to and some actually will come to the hospital to "show and tell", so I will be fine.
And no, I do not want to shell out $25K when I don't have to. LOL.

[TonySa]

100/yr, def hi volume.  Who is it, if I may ask?

[Stepone]

Dr. Segal

[TonySa]

Great, where is he?

[Stepone]

GBMC Campus, Baltimore, MD

[tomas1]

Just a warning about surgical assistants and others your surgeon may utilize:
I was hit with the bill for a surgical assistant who wasn't covered under Medicare.
They had a report on our local TV where a woman was hit with a bill for thousands of dollars about her insurance.
They recommend getting a firm list of everyone who will be involved in your surgery and show it to Medicare or insurance company.
My surgeons office got very snippy and said "you signed a paper saying we could bring in anyone"
I guess I was lucky to only have to pay $500 for it, but I pay a small fortune for Medicare supplement insurance.

[Alibaba]

Look up Dr. Perito in propublica and see where the loyalty lies. Nearly a million a year in product manufacturer payments for training seminars and such.  

[Hawk]

Look up Dr. Perito in propublica and see where the loyalty lies. Nearly a million a year in product manufacturer payments for training seminars and such.

And that is not even the biggest reason that I would avoid him.  He has been charged with disturbing illegal criminal activity and had significant civil legal actions against him.

[Larry]

And that is not even the biggest reason that I would avoid him.  He has been charged with disturbing illegal criminal activity and had significant civil legal actions against him.

WOW...  OK, so he's a slime-ball BUT from everything I have read and heard about him, he is an exceptional gifted surgeon... maybe he should be doing surgery in prison..

Larry

[Pfract]

Larry: not only that stated above, he couldn't care less about proper sizing nor erection quality.  

[Larry]

I wonder to what degree the Doctor's judgment is influenced by these "arrangements." Is their judgment impartial when they recommend a treatment or medical device to us?


I am certain you are 100% correct... there is no other reason for a good surgeon to stick with only one brand when both brands serve different types of men and their dicks.

Larry

[Frank55]

Here is a Propublica update. It does not appear that the increased exposure of these "arrangements" has resulted in a decrease in drug and medical device company influence spending.

Apparently the Dollars for Docs database has been updated to include information through 2018.

Interesting quotation:

"There is a perception among many physicians, including some in academia, that drug company payments are fairly benign — a moonlighting gig that educates other doctors about important medications. But since ProPublica began looking at physician payments, one drugmaker after another has paid tens, or even hundreds, of millions of dollars to resolve allegations of improper, or illegal, marketing tactics."

https://www.propublica.org/article/we-found-over-700-doctors-who-were-paid-more-than-a-million-dollars-by-drug-and-medical-device-companies

[tomas1]

This conversation got me wondering why some hospitals only will implant devices from 1 source?

My doctor pushed (mildly) for me to get an implant when I first suggested injections.
I did end up 5 years later getting one. I also wonder why he seems biased toward the CX when I've heard hundreds of guys getting LGX.

He claimed any implant over 18cm would be floppy but I know that's BS. I had no curvature or other issues,

[TonySa]

It seems most docs have at least prefer AMS or Coloplast.  Therefore, I think it's crucial we go our research and finds a doc compatible with our needs/preferences....of course easier said than done...

[Stepone]

I am in line with TonySa. My thoughts are that of course doctors have preferences. From their experience they may favor a certain device because it is slightly easier to install, perhaps the pump seems to fit better, or the tubing is more flexible, or the cylinders are easier to handle, or patient feedback is better, or less patient confusion with deflating, etc.
I can tell you that my doctor asked me if I had done any research prior to me visiting him and I said I preferred the Titan, based on my what I thought I needed. He went over the obvious differences with the manufacturers and said he liked my choice and that is one that he installs a lot of.
In summary I was comfortable with my decision.
I do wish however that the first urologist that did my Nesbit and the other 3 urologists that I interviewed for the Nesbit would have discussed implants and I would not have lost length from the Nesbit.
I believe I share responsibility for not researching more. I was so focused on my penis bend and hinge at the time, I wished I had been more educated to all the possibilities of correcting the issue. I believe sometimes it is easy to be so emotionally tuned in, we may not be open to asking about all the possibilities.
It's a tough call and it is easier to blame others, but I for one am happy that this site exists as it has  given me resources but also kindness and compassion that has helped me through this emotional roller coaster.