4 ms·

I wonder if these things are somewhat caused by systems that need referrals. Btw., you still needed someone to remove your gland, I take it, so at that point s

I wonder if these things are somewhat caused by systems that need referrals. Btw., you still needed someone to remove your gland, I take it, so at that point someone else actually did their job, no?

aantix 2y ago
The surgeon did her job regarding the adrenal removal. Agree. But even with my consultation with her, I bring up the problematic adrenal and the possibility of it being a pheochromocytoma. She says "For that, I would have to see a scan about 10 years before to see if there's any growth." To which I responded, "You mean like my PET scan from 2008 of the same region mentioned in the first paragraph of your report?" She barely read my report. Sloppiness. Parallels with the software industry - I think doctors could benefit from being paired with a complimentary doctor to act as a team and to check each other's work. I think they simultaneously have a god complex for which their assessments are rarely checked. They need social pressure to probe further.
- RandomLensman 2y ago
  Would it had mattered prior to surgery if it was a different type of tumor (and rare at that)? Otherwise, I could see why that isn't a discussion worth having anyway.
  - aantix 2y ago
    It may not have mattered. A response of "A cancerous pheochromocytoma is incredibly rare. I don't see any other signs of cancer, so I didn't think to analyze those scans." That would be a completely reasonable response. But a deer-in-headlights, "I had no idea" type of look, is sad. She is a gland expert. Probably getting paid $500/hour for the consultation. The least she could do is know the bare minimum of my history outlined in the report. That is not an unreasonable standard.
    - riahi 2y ago
      Did you have a pheochromocytoma or just a hormonal active adrenal adenoma? Pheos don’t typically make aldosterone. They tend to make epinephrine and derivatives. Different cell lineage; different endocrine responsibility.
      - aantix 2y ago
        Benign adrenal adenoma. From the pathology report: "Representative sections predominantly consist of a normal adrenal gland with intermixed adrenocortical tissue and medulla. A distinct nodular area is present with prominent foamy-type clear cytoplasm reminiscent of normal adrenocortical tissue. No significant cytologic atypia, necrosis, or increased mitotic activity is present. These findings are consistent with an adrenocortical adenoma. Note: this area appears to be limited to the adrenal gland although some adrenocortical tissue is present in the adipose tissue outside the capsule that morphologically appears dissimilar to the nodule and likely represents normal/benign tissue. Clinical correlation recommended."
        riahi 2y ago
        Tough case. Adrenal adenomas are common incidental findings. ~15% are hormonally active, which means the vast majority are not. As a radiologist, I sometimes wonder about whether I make too many recommendations to referring doctors (consider endocrine evaluation for a potentially hormonally active adrenal nodule). A FREQUENT attack on us as a specialty is that we "find too many incidentals" (see attacks on mammography, breast cancer screening, other sorts of screening, ad nauseam). Perhaps I'll keep doing the adrenal nodule recommendation, although I usually only make the recommendation if it's 1cm or larger.
        aantix 2y ago
        I could see that if you're evaluating just the imaging, that's a hard call. Are you provided these details as well? * Hypertension 20+ years * Resistant hypertension - four medications with one being a diuretic. * Early onset hypertension (high school) * Low potassium Coupled with the history, Hyperaldosteronism seems much more probable. There are a ton edge cases/conditions to keep in one's head. I'm sure that's a problem in all domains, definitely medicine. I wish it could be a multidisciplinary team decision. But then it would become an issue of reaching consensus. And probably too expensive.
- resource_waste 2y ago
  I agree, the self imposed doctor shortage have caused God Doctors that think they have every diagnosis. We need more doctors, but the cartel limits it.

I wonder if these things are somewhat caused by systems that need referrals. Btw., you still needed someone to remove your gland, I take it, so at that point someone else actually did their job, no?

aantix 2y ago

The surgeon did her job regarding the adrenal removal. Agree. But even with my consultation with her, I bring up the problematic adrenal and the possibility of it being a pheochromocytoma. She says "For that, I would have to see a scan about 10 years before to see if there's any growth." To which I responded, "You mean like my PET scan from 2008 of the same region mentioned in the first paragraph of your report?" She barely read my report. Sloppiness. Parallels with the software industry - I think doctors could benefit from being paired with a complimentary doctor to act as a team and to check each other's work. I think they simultaneously have a god complex for which their assessments are rarely checked. They need social pressure to probe further.

RandomLensman 2y ago
Would it had mattered prior to surgery if it was a different type of tumor (and rare at that)? Otherwise, I could see why that isn't a discussion worth having anyway.
- aantix 2y ago
  It may not have mattered. A response of "A cancerous pheochromocytoma is incredibly rare. I don't see any other signs of cancer, so I didn't think to analyze those scans." That would be a completely reasonable response. But a deer-in-headlights, "I had no idea" type of look, is sad. She is a gland expert. Probably getting paid $500/hour for the consultation. The least she could do is know the bare minimum of my history outlined in the report. That is not an unreasonable standard.
  - riahi 2y ago
    Did you have a pheochromocytoma or just a hormonal active adrenal adenoma? Pheos don’t typically make aldosterone. They tend to make epinephrine and derivatives. Different cell lineage; different endocrine responsibility.
    - aantix 2y ago
      Benign adrenal adenoma. From the pathology report: "Representative sections predominantly consist of a normal adrenal gland with intermixed adrenocortical tissue and medulla. A distinct nodular area is present with prominent foamy-type clear cytoplasm reminiscent of normal adrenocortical tissue. No significant cytologic atypia, necrosis, or increased mitotic activity is present. These findings are consistent with an adrenocortical adenoma. Note: this area appears to be limited to the adrenal gland although some adrenocortical tissue is present in the adipose tissue outside the capsule that morphologically appears dissimilar to the nodule and likely represents normal/benign tissue. Clinical correlation recommended."
      - riahi 2y ago
        Tough case. Adrenal adenomas are common incidental findings. ~15% are hormonally active, which means the vast majority are not. As a radiologist, I sometimes wonder about whether I make too many recommendations to referring doctors (consider endocrine evaluation for a potentially hormonally active adrenal nodule). A FREQUENT attack on us as a specialty is that we "find too many incidentals" (see attacks on mammography, breast cancer screening, other sorts of screening, ad nauseam). Perhaps I'll keep doing the adrenal nodule recommendation, although I usually only make the recommendation if it's 1cm or larger.
        aantix 2y ago
        I could see that if you're evaluating just the imaging, that's a hard call. Are you provided these details as well? * Hypertension 20+ years * Resistant hypertension - four medications with one being a diuretic. * Early onset hypertension (high school) * Low potassium Coupled with the history, Hyperaldosteronism seems much more probable. There are a ton edge cases/conditions to keep in one's head. I'm sure that's a problem in all domains, definitely medicine. I wish it could be a multidisciplinary team decision. But then it would become an issue of reaching consensus. And probably too expensive.
resource_waste 2y ago
I agree, the self imposed doctor shortage have caused God Doctors that think they have every diagnosis. We need more doctors, but the cartel limits it.