Is Our Medical System Broken??
Wednesday, May 20th, 2009
I’m getting hundreds of emails from energetic, intelligent, and motivated people who have tried and failed multiple treatments from multiple reputable doctors.
Specifically, I keep hearing about failures of antibiotics, accutane, benzoyl peroxide, facials, retin-a, and lasers.
With all the failure going on in so many reputable doctor’s offices, one has to think, ”Is our medical system broken when it comes to Acne??”
It’s not that primary care doctors and dermatologists aren’t having some success, it’s the rate of failure that has always concerned me. I define success with acne as the personal feeling of control of one’s skin, the lack of fear of future acne, and an inactivation of all significant inflammation of the skin. Based in that definition, If I were to make a random guess based in my clinical, personal, and social experience with acne, my guess is that chronic acne has a global failure rate of over 60% in every type of doctor’s office.
–One of reasons this failure rate is not being reported properly is because a patient will simply not follow up if they are doing poorly. I believe many doctors have a false sense of the actual success rate based on the lack of follow up of the failed patients.
This high failure rate begs the question whether our medical system is broken in respect to the treatment of chronic acne. Why is the failure rate so high??
The reason the failure rate is so high is because the typical protocol for acne is simply weak and needs dramatic improvement.
It’s usually not the caring and energetic doctor’s themselves…, it’s the system.
Here’s the typical protocol again:
-3 minute consultation
-quick diagnosis in about 2 seconds (this part of the medical system is not completely broken as acne is much easier to diagnose than to treat)
-quick treatment with Rx pad. Usually something with topical antibiotics and benzoyl peroxide or retin-A, differin, etc…
-reschedule for 2 months (As acne takes a long time to heal??? or does it??) —see videos.
-schedule to come back 2 months later for follow up….
–the acne is still active so you get to take oral antibiotics. (moving up the predicted algorithm)
-3 months later, you still hate your skin and you are finally offered accutane as predicted by the set algorithm)
-you don’t like the idea of accutane, so you ask for alternatives and are faced with resistance and a flurry of other topicals and pills that may or may not help.
-For those still battling, the satisfaction rate never rises above mediocre and 9 months later you are left wondering…., “Is this Medical System Broken??”
It doesn’t matter how compliant or perfectly you use the medication. The failure rate will still be over 60%. How can that be???!!
This is typical thought pattern of a frustrated patient….. “If I have done everything perfectly as instructed, how come I’m not better??”
The reason is because the set medical algorithm for acne has a very weak relative success rate. If blood pressure pills only worked 40% of the time, there would be a massive outcry for better treatment and research. For some reason, doctors and patients have gotten stuck in a complacent wait and see pattern with acne hoping that the condition will get better without having to take accutane. When accutane fails, another hope and wait process continues with alternate or repeat treatments. There is never any confidence in a single treatment both from the perspective of the patients or the doctors. When the doctors and patients both lack confidence in a treatment plan, it’s a recipe for further failure.
You may wonder…., Why don’t doctors guarantee their work with expensive laser treatments for acne?? the reason is because they know that although it may help some people temporarily, the overall longterm satisfaction is very low.
I see the traditional acne algorithm as an overall medical failure relative to other medical conditions.
It failed me as a patient, it failed all my patients prior to them coming in, and it will fail millions of others all over the world before it is finally put to rest one day.
** I am writing this post for those who have failed everything and are left baffled by the outcome. I want you to know that it’s not baffling at all that you have failed. It happens all the time in the traditional system and should be viewed as a typical failure. My hope is that this post will make you feel better knowing that your skin, like all those in the videos here, is not different or “special”. it’s just stubborn and tricky. Give yourself a break, there are now better ways than what you have tried previously.
For those having success in the traditional treatment algorithm, we celebrate any and all success with this challenging condition.
be well,
-Dr. Neal
©2009 “Is Our Medical System Broken??” by Dr. Neal Schwartz
