HEALTH MATTERS: Finding the right doctorQ. I am new to Grand Forks and need a doctor. What is the best method for selecting the right doctor for my family? Should I use one of the services on the Web that rates doctors?
By: Dr. Joshua Wynne, Grand Forks Herald
Q. I am new to Grand Forks and need a doctor. What is the best method for selecting the right doctor for my family? Should I use one of the services on the Web that rates doctors?
A. I’m not sure how useful the various Web-based options are. My experience with looking at physician ratings is similar to when I use the Web to check out a hotel or a restaurant — there often is a lot of variability in the recommendations.
More important, in my experience, are the recommendations of neighbors and friends who have had direct contact with various physicians in the community. I have found that they often are the most reliable sources of information about health care providers.
In my clinical practice over the years, I have seen a significant number of new patients who have been referred by a current or former patient, so referrals through other patients are an important mechanism for meeting new patients for most physicians’ offices. And while a good recommendation is no guarantee you’ll like the doctor, I surely would avoid any provider who gets a bad recommendation from a friend or neighbor!
Q. I’ve had some flank pain, and my doctor discovered that I have a kidney stone. She referred me to a urologist who agreed with her diagnosis, and ordered shock-wave treatment. Should I go ahead with the therapy?
A. Kidney stones are common, occurring in about one out of 10 people in the course of their lives. They usually are composed of calcium deposits, the mineral that makes up bones.
Many kidney stones cause no problem and are asymptomatic, but some can irritate the urinary tract and cause pain, bleeding into the urine, infection, or damage to the kidney.
Asymptomatic stones are often left alone, but those causing symptoms need to be removed. Although surgery used to be the usual method of removal, it is used only rarely today.
Rather, the stone is removed directly by using a tool inserted through the skin into the kidney, or by passing a tube back up the urinary tract from below. The alternative treatment, as was suggested for you, is to use an external machine that generates waves of energy that form shock waves within the body.
When the shock waves hit the firm material in the stone, the energy fragments the stone into pieces that then can be urinated out of the body. The treatment is generally well-tolerated, but bleeding, infection and urinary obstruction may occur.
Unfortunately, there have been relatively few good clinical trials comparing the various treatment options available, so you will need to rely on the clinical judgment of your urologist for guidance.
In general, shock-wave treatment is best suited for smaller kidney stones that are found in certain locations within the kidney. The important thing in your case is to get the stone removed, one way or the other, before it causes any serious damage. Since you are having pain, your stone needs to be removed.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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