By Robert Knutzen
It strikes us as absurd that we even feel compelled to write this piece of personal opinion. Sadly, it is even more absurd that the hospital/university/medical center administrators and chiefs of internal medicine across the world has such little understanding of the value of the pituitary endocrinologists on their staffs that they continuously undercut the operating budgets and the staffs of these departments and divisions because they are not "profit-centers".
Allow us please to strongly disagree and share with you the basis for this opinion. Even in major university hospitals (and we know where they are) the pituitary endocrine staffs are kept at a minimum and in some it is only considered part time work to be shared with diabetes care.
Allow us, since we know first hand, to recite but some of the associated disorders and medical needs faced by an average pituitary patient and managed by a GOOD pituitary endocrinologist. (Yes, some of us DO find our way to good endocrine care, no thanks to the Deans of Medical Schools who clearly, in many cases, do a very substandard job of teaching the basics of physiology and endocrinology to their medical students and nurses; we do not know where they teach it well enough to do their students, society and the patients much good).
The scenario is pretty much as outlined-give or take a few fiasco's here and there: First the patients spend an inordinate amount of time looking for a diagnosis in all the wrong places. To the insurance companies and HMO's this ignorance is apparently acceptable, mostly we suppose, because it is cheaper NOT to find anything wrong and therefore not having to treat life-altering and often life-shortening disease(s). Any GOOD pituitary endocrinologist, over a cold beer, will tell you that it is NOT that difficult to diagnose most pituitary disorders, IF you have a reasonable level of suspicion. Since we (the pituitary patients) constitute between 20 and 30 % of the world's population, therefore the same percentage of the average physicians patients, it is impossible to hide behind "rare". That excuse died an ignominious death many years ago.
Secondly, the patient has asked for help at OB/GYN's, family practitioners, urologists, rheumatologists, orthopedists, dermatologists, psychologists, psychiatrists, optometrists, opthalmologists, herbalists, acupuncturists, chiropractors and virtually anyone else who promises help and healing (It is interesting that they may be referred, again, to many of the same specialists AFTER diagnosis, and the same doctor now says, Ah Ha, Now we know what to treat you for). Finally, one of the above, or a family member, a hairdresser or a dentist or shoe-salesman will finally direct the patient to an endocrinologist. The patient (not often enough) will start asking questions, and, not getting satisfactory answers, will find his or her way to a pituitary center.
Thirdly, and here is the rub, most experts are booked months or at least weeks in advance. He or she, the expert, is overworked, overwhelmed and under-appreciated. Now, the core: A) The endocrinologist starts with a series of tests; the financial beneficiary - the laboratory (in house or outside). B) An MRI scan; the financial beneficiary - the scanning lab or radiology department. (In house or outside). C) An opthalmological scan; the financial beneficiary - the dept. of opthalmology. D) A bone density scan; the financial beneficiary - the orthopedic division or a separate laboratory or scanning center. E) A colonoscopy; the financial beneficiary - the dept. of gastroenterology.
Now we start treatment:
A) Prescriptions for medications and/or hormone replacement; the financial beneficiary - the pharmacy and the pharmaceutical industry. B) Neurosurgery; the beneficiary - the department of neurosurgery. In many cases this is followed by radiosurgery or other radiation treatment; the beneficiary - departments of neurosurgery/skull based surgery and or the department of nuclear medicine/radiation. And, lest we forget, the hospital STAY; financial beneficiary - the hospital/medical center directly. As we all know, this may be accompanied by other tests or surgeries or treatment, all usually directed to other departments or divisions by none other than the overworked and under-appreciated endocrinologist who "puts food" on everyone's table but is considered a COST center in his/her own university or medical center.
The absurdity of the situation must be appreciated by anyone who can read, add and multiply: The pituitary endocrinologist is potentially a MAJOR PROFIT CENTER for everyone associated or affiliated with the department of endocrinology in all major hospitals/medical centers. In a law practice he/she would be called a "rainmaker". To the patients and families they are considered a God-send.
Can we please start an economics course for hospital administrators? We, the patients, need it to insure a ready supply of eager, willing and capable pituitary endocrinologists to care for us! And our numbers grow, every day.