An Open Letter to My Current and Future Thyroid Patients,
For years I have rather scornfully accused those who institute protocols and algorithms for clinical care in the office and hospital of trying shortcut real care, of putting together sets of mindless rules that can actually hamper clinical judgment and ultimately undermine proper care.
“Algorithms and protocols,” I have frequently said, “are written by people who know what they are doing for people who don’t know what they are doing.” You see, the doctors who write algorithms know the “end game” already, and when they approach the diagnosis and treatment of patients, they most often “think backwards”, looking at every step and “side-step” in the process all at the same time. They don’t go down a list of numbered “check-boxes” from steps one-to-ten.
And as I have said to many of you, my patients, everybody is different, and every BODY is different. I don’t follow a strict “protocol” on much of anything when I diagnose and treat patients. I try to spend as much time as is needed, treating each patient as an individual (and therefore I am never on schedule). And here lies the problem and the very reason why a “Protocol” has become necessary.
The problem I have just mentioned is the overwhelming demand, and my time-consuming, individualistic approach. Being, I think, one of the few practices around within the Managed Care world that thinks and works with thyroid issues “outside the box”, and since news of this (after sixteen years and over 4000 patients treated) seems to have taken off exponentially through internet discussion groups, there just isn’t enough of me to go around. I’m not bragging. In fact, I’m a little embarrassed and overwhelmed by it all. Thyroid things have become second nature to me now and, frankly, I don’t understand why the rest of the medical world won’t see it. In the meantime, I’m finding it difficult to keep up.
Wait times for appointments with me for thyroid issues are over two months, and follow-ups are getting harder to find slots for. Furthermore, it is high time that all this data that I have been gathering (rather un-systematically, I might add) for the last sixteen years, begins to take shape in a more organized and research-able fashion.
And, finally, the fact is, the majority of patients who need thyroid therapy do fit into patterns that can be managed through a protocol run by my staff, who themselves are being taught by me to understand the complexities of thyroid therapy “outside the box”. In this way, I will be free to see those patients who have even more complex issues, who don’t respond to simple thyroid therapy alone, or who may need adjustment of other hormonal issues in order for thyroid to work correctly.
This is called “integrative medicine”, and it’s a much broader and complex topic that is almost exclusively addressed by doctors outside the mainstream of medicine. These doctors are, for the most part, concierge doctors, do not take insurance, and are very expensive to see. I want thyroid therapy to be as accessible and affordable as possible.
A protocol will be a bit more expensive, but not too much. We will be requiring our thyroid patients to undergo a few more steps and a few more tests but we do submit our charges to insurance and do participate in the majority of plans and Medicare. Furthermore, we discount our fees for cash-pay patients, and will work as best we can to give a break to patients with high deductible plans or budgetary constraints.
For those of you who have benefited from “non-standard” thyroid therapy, and wish more doctors and patients knew what you know, this new protocol-driven approach will allow the systematic gathering of publishable information that, I hope, may someday benefit the hundreds of thousands (perhaps millions) of patients who need this approach.
Thanks for being patient patients.