The Prostate Monologues by Jack McCallum

Author:Jack McCallum [McCallum, Jack]
Language: eng
Format: epub
ISBN: 9781609615581
Publisher: Potter/Ten Speed/Harmony/Rodale
Published: 2013-04-15T04:00:00+00:00

James Manley, DO

My Primary Care Physician

“We have to look at patients on an individual basis.”

I have been going to Dr. Manley for almost 20 years. We’ve grown older together. I feel like I know him even though we don’t socialize outside of the office. He probably feels like he knows me, too. Oh, the anatomical secrets that a PCP takes to the grave.

When I interview him, he gives me his thoughts on primary care philosophy and the USPSTF recommendations against testing.

“No matter what the panel says, it is putting a much greater emphasis on cost than we ever had before,” says Dr. Manley. “It is about numbers. How many people do I have to put on a statin to prevent one heart attack? How many people do I have to order a PSA test for to prevent one death from prostate cancer? And all the statistics in the world can’t hide this fact: If you happen to be the one in a hundred or the one in a thousand who dies from something because you were not screened, the numbers don’t mean anything to you.

“The controversy is only going to get worse, and I think primary care doctors are really going to have to look at the reasoning behind these recommendations against screenings. Let’s say a man comes to me at age 50 and I don’t recommend PSA screening, and at 55 he comes back with lower-back pain and it turns out to be prostate cancer. And he wants to sue me because I did not order a PSA test. I can say, ‘Well, they told me not to screen.’ Okay, we’ll see if lawyers really care about that.”

Dr. Manley pulls up the USPSTF recommendations on his smartphone and begins reading.

“Okay, 55-year-old, doesn’t smoke, sexually active. The ‘A’ recommendations include aspirin to prevent cardiovascular disease. Colon cancer screening gets an A. High blood pressure screening, an A. That makes sense.

“But then how ridiculous is this? HIV screening and syphilis screening are also A recommendations. Really? Where are they getting the numbers from? I have been in practice for 25 years and I have never—never—had a newly diagnosed HIV patient.”

“That’s because you serve, basically, a white, suburban, middle-class population,” I say.

“That’s exactly my point,” says Dr. Manley. “Individual doctors should decide what screens are necessary and what are not. And I am still waiting for one of these higher-up, ivory-tower docs to convince me that we will do worse in the long run by testing somebody as opposed to [seeing] someone to whom we do nothing and his cancer eventually metastasizes. They try to tell me that the average man is going to die of something else. Well, not somebody who gets prostate cancer at 40. That guy is going to die of prostate cancer if he’s not treated.”

Dr. Manley believes that the USPSTF guidelines are more about future cost considerations than about the tests themselves. That may be obvious. According to the Web site Healthcare Blue Book, a PSA test costs between $23 and $45.

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