If you let your fingers do the walking through the Yellow Pages when you're looking for a medical specialist, a new study concludes that you may chance being treated by a doctor not qualified in the advertised specialty--and perhaps with virtually no training in it.
In fact, 12% of the doctors who held themselves up as specialists in one city telephone directory did not have certification in the specialties they claimed, even though they apparently had "ample opportunity" to gain the minimum credentials.
The Yellow Pages evaluation, published in the New England Journal of Medicine, was confined to Hartford, Conn., where close scrutiny of the backgrounds of 1,179 listings by 946 doctors who advertised themselves as specialists uncovered the disparity. Such listings are plentiful in virtually every city and what the study called "yellow professionalism" may be common across the country.
The study, from the University of Connecticut School of Medicine and Harvard Medical School, assumed that a doctor who has been certified by one of several dozen boards of examiners that evaluate specialist competency could legitimately be called a specialist. Doctors can legally practice any form of medicine they wish, regardless of their training.
But while so-called board certification is widely accepted as the minimum legitimate qualification for a specialist, significant numbers of the advertising doctors didn't meet this basic criteria. Thirteen of 30 who called themselves plastic surgeons didn't have board certification, for instance, along with 10 of 30 family practitioners and 28 of 152 specialists in internal medicine.
While physicians have advertised widely for more than a decade, the researchers concluded, telephone book listings should not be presumed an accurate portrayal of the qualification and certification of any doctor. The researchers conceded there is a lively debate within medicine over what constitutes competency in a specialty. But until the issue is resolved, they concluded, a caveat emptor approach may be the most effective from the patient's point of view.
Though transplants of kidneys from living donors have become significantly more common since 1980--and are usually successful for the recipient whose kidneys have failed--two Ohio experts suggest that too little medical follow-up is being offered to the donors.
While doctors William Bay and Lee Hebert of Ohio State University stopped short of calling kidney donors the forgotten figures in this now routine therapy, they did urge that donors receive annual checkups in case of long-term complications. The report was published in the journal, Annals of Internal Medicine.
Recent government figures indicate living kidney donations totaled nearly 1,900 in 1985--up by 600 a year since 1980. Most donors are relatives of the kidney recipients. But while there is no evidence the donors face any major risk of complications after they give up their kidneys, the Ohio State researchers suggested donors should receive long-term follow-up care, just like recipients.
For donors, an annual physical examination should be performed by a kidney specialist, and the checkup should include a urine test looking for evidence of abnormally high levels of protein in the urine, a development suggested in animal studies as a possible long-range donor problem. Donors, Bay said, should avoid high levels of protein in their diets. A slightly increased risk of hypertension may also be present.
Bay said many kidney transplant centers already offer good follow-up care but others apparently don't and some donors may receive little or no medical attention after they give up their kidneys.