OVEC Blog May
10, 2017
WHY VEIN TREATMENTS FAIL, AND WHY VEINS
RECUR
Recently a
patient brought to our attention her negative experience with us treating her
veins several years ago. I thought I’d comment on it. The gist of her
complaints were; we didn’t get the job done, her veins are back worse than
ever, and we told her (unflatteringly per her account) that there was a time
limit to her treatments, in that we didn’t have time to do anything other than
“the essentials”, since we were operating on the limited insurance “shoestring”
budget. I’m paraphrasing a bit here, leaving out the more un-editable words,
but I don’t think it’s an unfair paraphrase.
Rather than
taking the position that much of the complaint is unjustified, I want instead
to focus on the true part of what she complained about, and explain exactly why
her treatment didn’t give her the results she might have wanted. First of all,
we all ought to be learning, even doctors. The moment any of us thinks we know
everything that is to be known or which is useful in our work, we are probably
already rehearsing for the moment we leave this planet, which in any line of
work is not a good thing, and especially in medicine! The patient, we’ll call
her “Eva”, said something true, something other patients tried to tell us over
the years, but which we weren’t yet in a position to hear very well, or
understand.
Patients want
and not unfairly expect that they will have a beneficial amount of time with
the doctor. They expect more than merely a technician, because, honestly, many
technicians COULD be trained to do many of the procedures we actually do.
Another thing patients want is thoughtful discussion, which is another thing
that takes time. If all physicians were were information providers, there might
even be better sources for that on the internet, than the information that
merely comes out of a doctor’s head. Patients want attentive care, an approach
that works, and an environment with the tools to satisfy those needs.
Honestly, insurance-based vein care a while back, maybe say, the early 2000s, while never perfect, was for many (even if not all) do-able, because the pegs we were being asked to put in the circular holes were not quite square yet. One could force, kind of, the situation to work for enough patients. But gradually a kind of noose tightened, and things got to a point gradually where so many restrictions, so many unwarranted intrusions, and frankly, so many roadblocks were encountered, that the fraction of patients for whom the experience was perfect became smaller and smaller. Eventually, it was clear something had to change.
Patients imagine sometimes, I think, that what insurance companies are underwriting is “care” and what the doctors merely do is “provide” that care. What often does not occur to them is that insurance companies too often actually orchestrate, mandate, ration, limit, and take charge of care, leaving a piddling reward at the end of the day for the “care” the physician provides, one that takes far too long and with far too many man/woman-hours to recoup, by which time it is clear to the physician who still has his eyes open that he is no longer serving the needs of the patient, but really serving an endless, enslaving treadmill, which he must run ever-faster, ever more efficiently, and ever-cheaper. Worst of all, the doctor is at risk of becoming not so much a treating physician but a cog in the insurance wheel, merely a usable instrument of their enterprise. In the end, often BOTH patient and doctor TOGETHER suffer, because when patients are not happy, doctors typically aren’t happy either, whatever certain patients may choose to believe. There are far easier ways than medicine to become rich, and most physicians actually draw a great portion of their self-esteem from how happy their patients are, rather than how well compensated they are!
Now don’t get me wrong. It wasn’t like we did not have enough experience, or know how to treat veins. I am one of the most highly experienced interventional cardiologists and vein physicians in the country. You don’t get to the point where I’ve been, having done more vein lasers than any physician in North America from 2004-2014 (15,000), and far more injections of spider veins (22,000). We had become during that time period one of the busiest, if not THE BUSIEST, vein clinic in the entire country. It’s just that we were trapped in two self-defeating ruts, the insurance rut (about which I commented above), and a second, poorly recognized one – the laser ablation rut. Both of them, not just one, led to the issues patients used often to complain about, and whereas in the old days we would have poorly understood that, now we perfectly well do.
Now though, there is a new and better way. The recurring bulges, dark spots, sore spots, and basically inflammatory lingering areas of the skin which these and other patients may experience are largely due to the unfavorable “laser tradeoff” where one robs Peter to pay Paul, so to speak, destroying veins potentially functional in the future so as to solve a problem in the present. It works, if one is fortunate, but only short-term, and even then not always. Today, we no longer destroy areas of potentially future functioning veins, but spare those, limiting ourselves to SEALING OFF THE HIGH PRESSURE LEAKS (even these are not destroyed but merely sealed), so that a physical barrier permanently protects the downstream veins from the “high pressure bully” that has been causing the downstream bulging all the while. This bad approach is actually the normal standard of care in most vein practices, but we would never do it again. It is a bit like throwing the bay out with the bathwater. No one wants the malfunctioning segments to continue to wreak havoc, but do entire lengths of potentially functioning veins have to be destroyed, and with such destructive and traumatic measures such as the more than 120 degrees Celsius of heat as with laser and radiofrequency?
Honestly, insurance-based vein care a while back, maybe say, the early 2000s, while never perfect, was for many (even if not all) do-able, because the pegs we were being asked to put in the circular holes were not quite square yet. One could force, kind of, the situation to work for enough patients. But gradually a kind of noose tightened, and things got to a point gradually where so many restrictions, so many unwarranted intrusions, and frankly, so many roadblocks were encountered, that the fraction of patients for whom the experience was perfect became smaller and smaller. Eventually, it was clear something had to change.
Patients imagine sometimes, I think, that what insurance companies are underwriting is “care” and what the doctors merely do is “provide” that care. What often does not occur to them is that insurance companies too often actually orchestrate, mandate, ration, limit, and take charge of care, leaving a piddling reward at the end of the day for the “care” the physician provides, one that takes far too long and with far too many man/woman-hours to recoup, by which time it is clear to the physician who still has his eyes open that he is no longer serving the needs of the patient, but really serving an endless, enslaving treadmill, which he must run ever-faster, ever more efficiently, and ever-cheaper. Worst of all, the doctor is at risk of becoming not so much a treating physician but a cog in the insurance wheel, merely a usable instrument of their enterprise. In the end, often BOTH patient and doctor TOGETHER suffer, because when patients are not happy, doctors typically aren’t happy either, whatever certain patients may choose to believe. There are far easier ways than medicine to become rich, and most physicians actually draw a great portion of their self-esteem from how happy their patients are, rather than how well compensated they are!
Now don’t get me wrong. It wasn’t like we did not have enough experience, or know how to treat veins. I am one of the most highly experienced interventional cardiologists and vein physicians in the country. You don’t get to the point where I’ve been, having done more vein lasers than any physician in North America from 2004-2014 (15,000), and far more injections of spider veins (22,000). We had become during that time period one of the busiest, if not THE BUSIEST, vein clinic in the entire country. It’s just that we were trapped in two self-defeating ruts, the insurance rut (about which I commented above), and a second, poorly recognized one – the laser ablation rut. Both of them, not just one, led to the issues patients used often to complain about, and whereas in the old days we would have poorly understood that, now we perfectly well do.
Now though, there is a new and better way. The recurring bulges, dark spots, sore spots, and basically inflammatory lingering areas of the skin which these and other patients may experience are largely due to the unfavorable “laser tradeoff” where one robs Peter to pay Paul, so to speak, destroying veins potentially functional in the future so as to solve a problem in the present. It works, if one is fortunate, but only short-term, and even then not always. Today, we no longer destroy areas of potentially future functioning veins, but spare those, limiting ourselves to SEALING OFF THE HIGH PRESSURE LEAKS (even these are not destroyed but merely sealed), so that a physical barrier permanently protects the downstream veins from the “high pressure bully” that has been causing the downstream bulging all the while. This bad approach is actually the normal standard of care in most vein practices, but we would never do it again. It is a bit like throwing the bay out with the bathwater. No one wants the malfunctioning segments to continue to wreak havoc, but do entire lengths of potentially functioning veins have to be destroyed, and with such destructive and traumatic measures such as the more than 120 degrees Celsius of heat as with laser and radiofrequency?
For a bit over a
year, we’ve treated veins this better way, and eliminated the negative
experiences some patients used to experience. To do this we are unable to
settle for the now-understandably-second-rate standard of care afforded by
these approaches, and we daily have seen the gratifying results.
Call us today, to find out more!
Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh
Call us today, to find out more!
Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh
President, The
Oklahoma Vein and Endovascular Center
405-947-2228
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