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181575 tn?1250202386
How to docs regard HepB and each other?


By cajim:
My family doctor never bothered to test my liver readings until we mentioned during a visit that we heard on the radio that 10% of Chinese are HepB carriers.  He then ordered the test.  Sure enough I had HepB but my wife has HepB antibody.  He then referred me to a hepatologist who commented that not all doctors knew enough about liver diseases.  She on the other hand has an MD and a PhD and is a frequent attender of conferences.  She recommended Hepsera (end of 2006) rather than Baraclude.  For second opinion I consulted an GI doctor who recommended no treatment given my HEP B PCR QUANT = 107000 IU/ML but all else were within normal range.  He further commented that most HepB carriers got HepB as a child, never knew or felt so, and would grow old like everyone else.  My current doctor, also an GI doctor, also recommended no treatment (early 2007) but put me on monitoring and when other readings showed abnormalities and HEP B PCR QUANT showed increase, he recommended treatment.  Still he commented that HEP B PCR QUANT and other readings fluctuate and increases do not necessarily mean worsening and decreases do not necessarily mean improving.  As for genotyping and biopsy, he could order them if the patient wants them, but they do not change the course of treatment now.  They just provide numbers for hepatologists who love them.

How do you feel?  Do you have the feeling that GI docs tend to look HepB down and hepatologists tend to look HepB up?

Zelly's Response:
That is really interesting, cajim.  I have only see a PCP who was an infectious disease specialist who, in hindsight, did not seem well informed about Hep B and more recently a GI who seems more up-to-date but appears to have the wait-and-see attitude of your GI.    
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181575 tn?1250202386
As HR's post would indicate, tests and numbers could be very important diagnostic tools in the right hands.

It's just that many doctors follow the general guidelines, which is easily dated in the medical field.  Different doctors have different expereicen and expertise.  I don't think it's fair to expect pefection form any one doctor.  This is the reason that patients seek additional opinions.

I think a good doctor would welcome the chance to discuss new information, especially if you done you part in learning.

My doctor still disagree with my combo treatment but it's something that I feel comfortable with.  And even he said I've have done my homework and understand my own request.  I don't think he would have given me my current combo prescription, if I said to him, "look I heard from this guy this the the best thing for me so I want to be on it too."  I brought names, recent research abstracts, reviewed my labs, and discussed with him the exact reason why I want to do it.  I think I said to him, "what you are telling me is very assuring but if this combo even gives me a half percent chace of a better outcome, I want to do it.  Because as you said, we don't know if I could stop the meds."
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On this you are 100% right!  The more we know about our conditions and the research and updates behind them the more our doctors see we are serious about our conditions.  After all, there is no one who cares more about your health than yourself.  I am learning and hopefully someday will understand all that you and others post here.  Thanks.
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