More Important to Your Doctor — Patient’s Welfare or Patient’s Money?

This is a follow-up of the blog entry from the other day, What Happens When a Doctor’s Car and Mansion Payment Is More Important Than You?

First, lets get to the photos. The photo on the left was taken this week in my office. The photo on the right was taken 18 months ago, also in my office (forgive the quality — it is scanned from a Polaroid). Click the photos to enlarge.

The above photos are of a man in his mid-50s. Note that the progression of his hair loss has been very significant. Some of the medications he uses may be promoting hair loss rather than saving his hair. He tried Propecia (finasteride), but he had wiped out his sexual drive from it. He went to another doctor for a second opinion and then came to see me with that second opinion. He was a good note taker and is fastidious about medical records. His father had prostate cancer. The doctor who offered him the second opinion suggested that he have 3000 graft placed all over this head. He would then have a “full head of hair”. Even though he saw a doctor, it was the salesman inside the doctor who was talking. That has to be the worst recommendation he can get, because shock hair loss is almost a certainty and this patient would be like the fellow I showed you the other day. To make matters worse, his donor supply was low so that the probability of getting 3000 grafts would have failed.

This patient did the right thing — he got a second opinion. In this case, he checked up on me. Transplanting the corners and making a hairline is an option, but he should stay away from transplanting into the thinning area. Because of the steroids he is taking, I advised him to stop some of the medications and try to take a smaller dose of Propecia, for if he undergoes a hair transplant (or even if he does not) and would want to see his hair loss stop first. Propecia may be the only good option for him and worth a try again at half of the dose. With the family history of prostate problems, Propecia is a good medication to reduce this risk. The other doctor only talked about selling him 3000 grafts and the benefits of such a procedure for him. Why am I alarmed? Simply, this man is losing hair in ‘gangbusters’ and as he is in his mid-50s — that is not supposed to happen. He is clearly an exception to the rule that men over 50 don’t usually go through accelerated balding. With low densities, any doctor who put hair into his crown will deplete his donor supply. He is also losing frontal hair now, so what is the Master Plan when he runs out of donor supply and money?

I showed him photos of his hair, and explained how the miniaturization of the hair was throughout the top and crown and if this area was transplanted, the hair he would lose would be more than any benefits he would have if he was transplanted. I am personally appalled at the desire of a doctor to try to push him into getting thousands of grafts and to make matters worse, he was never told that he may accelerate his crown loss with a transplant. Patients have every right to know such potential side effects and the probability of that happening. Doctors are legally obliged to inform patients of such risks. My only place to vent this frustration is on this site. I don’t mean to scare you and I don’t want you to think that every doctor out there is trying to screw you. There are many good and honorable doctors that do hair transplants, but again and again, I tell patients, Let the Buyer Beware.