Why a second opinion might surprise you

  • Posted on: Jul 30 2015

Patients often request a second opinion about recommended vein treatment. About once a month, however, I disagree completely with the recommendations of the first physician because I cannot confirm the original ultrasound findings.  A typical story is that the patient hears an ad on native language radio (e.g. Spanish, Farsi, Korean) and responds to an offer for a free consultation and a promise to eliminate leg veins, leg pain or swelling. An ultrasound is performed which reports reflux in two or more veins. I’ve seen as many as seven!  The physician advises the patient to undergo multiple laser procedures at no cost because “insurance covers it” and the physician generously offers to waive the deductibles and co-pays.

In contrast to the patient’s first ultrasound findings, I identify no reflux in any vein whatsoever, much less in four to seven. Without reflux, there is no need for interventional treatment of any sort, especially laser closure of a saphenous vein (EVLT).  Sometimes, the patient has already received treatment and the symptoms that led to the patient to the original doctor remain unchanged or even worse. More brazen physicians obtain approval for multiple ablation procedures and bill for procedures they never perform.

Any physician can occasionally misidentify a refluxing vein, but I recognize the same doctors repeatedly recommending unneeded laser closure of multiple normal veins.

Folks – that’s fraud. It’s a rip-off of the insurance company to be sure, but worse it’s an assault on the patient, who consents to undergo totally unnecessary procedures with unwarranted risk and destruction of veins that (albeit less frequently these days) could be used later in life as substitute arteries in vascular bypass procedures.

This immoral behavior is a total perversion of the most important medical principal of all – First Do No Harm. If you believe physicians would never deliberately perform such immoral acts, then I suggest you look at these two recent articles (Cancer doctor fraud, Overtreatment of arterial disease) for starters.

Here are some red flags and suggestions to help you avoid these unscrupulous fraudsters:

  • Beware physicians who advertise heavily on radio, TV, or on billboards. Here in Los Angeles, such advertising is very expensive, which may tilt the physician in favor of his pocketbook rather than your best interests. Furthermore, a direct referral from an advertisement to treating physician conveniently sidesteps your own trusted personal physician, who could serve as a common sense brake to outlandish proposals for treatment. Also, note that advertising on ethnic radio attracts older non-English speaking patients who have Medicare insurance. Unlike private insurance companies, Medicare doesn’t ask fussy questions about whether treatment is indicated. But beware, the doctor probably also knows how to persuade private insurance companies to approve even unneeded procedures.
  • The more laser closure procedures the doctor recommends, the less likely any of them is needed. Most patients need only one and about a third need two. Three is extremely rare. Four is once in a lifetime for me. More than four, well, I’ve got a bridge in Brooklyn I’d like to sell you.
  • Patients who are seeking treatment for spider and/or blue veins that do not bulge rarely need laser closure of a saphenous vein. Some do… but tread carefully.
  • The ultrasound technician is the doctor’s wife (or fiancé, nephew, etc.) After all, it’s a family business.
  • Here’s a reference to get you started evaluating a doctor’s qualifications for treating veins.If you’re still not sure, you improve your chances of getting the right advice with a second opinion from a physician who is a member of the American College of Phlebology or the American Venous Forum. University vein programs (UCLA, USC) will also give you an unbiased opinion.

So if you are a victim of a vein scam, what can you do about it? A lot, but it depends on whether the second consulting physician is willing to join you to prevent others from mistreatment by unscrupulous doctors. I recently asked the Ethics editor of the highly respected Journal of Vascular Surgery what a responsible physician should do when he identifies irresponsible scammers. In his published response, he recommends reporting the offending physician to the State Medical Board. To do that, however, the patient must co-operate by signing the required complaint forms, which, regrettably, many are reluctant to do. Another option is for the public and responsible physicians to keep exposing these vermin to the light of day, and with time and persistence perhaps we can eliminate their stench from our noble profession.

The noble man does what is right;

The lesser man does what is profitable.

—  Confucius (about 500 BCE)

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