THE DIAGNOSTIC WORKUP

A Specialty Medical Service — The Basis Of All Medical Treatment

• Do your medicines fail to give you relief?
• Do you have symptoms that can’t be explained?
• Have you been told “There’s nothing else we can do for you?”
• Have you been told “You’ll just have to live with it?”

If so — there is a good chance that your diagnosis is wrong.

The real problem with modern medicine is something called “norming.”

If you are lucky enough to have a common disease that is not too hard to diagnose, and not too hard to treat, you may be treated adequately. If you feel good and this is enough for you and you have no symptoms; if you can work, play, and enjoy relationships, then you are happy with your life and what I have to say may not interest you.

But if you are doing everything your doctor, and all of his or her “team” tell you to do and you still feel rotten — really rotten — too weak or too aching to work, play, and enjoy relationships — then I have something important to say to you.

Hello — I’m Estelle Toby Goldstein, MD. Some people call me “The Renegade Doctor” because my methods are not always what the medical establishment considers “standard.”

I’ve been a medical doctor for over 30 years, and I’ve got more degrees than a thermometer.

• I did my internship in general and orthopedic surgery
• I did a residency in neurologic surgery (Yes, I was a brain surgeon)
• I did a fellowship in neurology
• I did a residency in psychiatry
• I did another fellowship in psychopharmacology (the actions and interactions of drugs).

I’ve been a professor at two different state university medical schools
I’ve been a clinical research scientist, working on drugs that later achieved FDA approval and are now commonly prescribed — drugs like Prozac, Zoloft and Zyprexa.
I also served in uniform with the U.S. Army Medical Corps; as Capt. Goldstein, US Army Medical Corps with the 82nd Airborne Division, Ft. Bragg, NC.

Since then, I’ve worked in several Veteran’s Affairs hospitals and ambulatory clinics and served as chief of their day treatment centers.

As a physician board-certified by the American Board of Psychiatry and Neurology, I have also been honored to be an examiner for this prestigious board.

So I’ve been around, learned a lot about the human brain and body, and I’ve taken care of a lot of patients in a lot of practice situations

• The Army
• State prisons
• HMOs like Kaiser Permanente
• County mental health clinics
• Veterans Affairs Medical System
• Specialty organ transplant centers (liver, heart and kidney)
• Privately funded clinics

And of course, my own private practice

I’ve seen a lot of people with a lot of problems –

Unfortunately in many, many cases, the biggest problem was

THE WRONG DIAGNOSIS

HOW COULD THIS HAPPEN?

Most people get their care from some kind of organized system — Medicare, HMO, Medicaid/Medi-Cal or an institution like the VA or even while serving time in jail.

All of these situations have one thing in common –

Doctors just don’t get much time to spend with patients. Sometimes patients don’t see a doctor at all — just support staff like nurses, physician’s assistants, EMTs, or technicians of various types (such as X-ray, anesthetists, etc).

So what happens? Here is a common scenario:

A patient comes to a clinic or hospital ER or an urgent care clinic, complaining that they feel depressed.

The patient LOOKS depressed and SAYS she/he is depressed. So what is the answer?

Usually, a prescription for anti-depressants.

WHAT’S WRONG WITH THAT?

There are so many reasons a person can appear depressed that must be ruled out before prescribing what could be the wrong medicine, and possibly a dangerous medicine to somebody with an incorrect diagnosis.

• Bad Thyroid
• Side effects of other medicines (such as heart, blood pressure or birth control)
• Undiagnosed diabetes or hypoglycemia — high blood sugar or low blood sugar
• Undiagnosed infection/immune problems
• Head trauma related problem
• Sleep apnea
• Cancer
• Allergies
• Digestive disorders
• Vitamin and nutritional deficiencies

All of the antidepressants on Earth won’t help any of these conditions. And depresbsion is not the only complaint where a wrong diagnosis is applied. Other common conditions – such as anxiety — may have even more medical causes that causes a doctor to wrongly diagnose them – simply because the physician cannot spend enough time, ask enough questions, or order enough tests.

WHY DIDN’T MY OTHER DOCTORS CHECK THOSE THINGS?

I’m often asked to account for the actions — or inaction — of other doctors.

Frankly, I don’t know why people do the things they do. However, having been in several positions where pressure was put on me to crank out the prescriptions and process patients quickly, I would guess that most doctors don’t have the time to go in-depth, they are burned out and not thinking real clearly, or they are constrained by today’s “cost containment” systems from ordering tests which should be mandatory to provide a certain standard of quality care.

Besides “The Renegade Doctor” I’m often called “The Doctor Of Last Resort”

Many people are in the system for years without getting relief for their problems — or their problems are getting worse. In fact, you would be surprised how many people are treated for years and years WITH NO DIAGNOSIS AT ALL.

The system treats symptoms without trying to find the underlying cause. In the case I mentioned above, antidepressant medicines are relatively cheap and can be prescribed by any doctor. In fact, 80% of all antidepressant medicines are prescribed by general practitioners — not psychiatrists. These doctors have a basic knowledge of prescription drugs, but often don’t know much more than what is printed on the package insert or what the drug sales rep tells them.

In my extensive experience, the label directions, package inserts — and the sales reps — often suggest dosages that are much higher than necessary. In fact, although many of my patients are doing fine and are happy, I often get calls from pharmacists who tell me that I made a mistake — I’ve given a pediatric dose to a grown man or woman!

One medicine actually comes as “sprinkles” you can put on ice cream to make it palatable for your toddler. My adult patients get a chuckle out of taking medicine this way, and the dosage is just right.

NOT EVERYBODY IS THE SAME — ONE DOSAGE SIZE DOES NOT FIT ALL!

In my specialty training, I learned to adjust dosage according to age, size, weight and various factors.

• Smoking
• Drinking alcohol or caffeine
• Recreational drug use
• Natural treatments self-administered
• Activity level
• Liver or kidney status (tattoos can be a signal to test for hepatitis)
• Hormonal status — irregular periods, post-menopausal, taking hormone supplements or birth control

Medication interactions are always a concern, but the doctor may not factor these into his treatment at all. After all, medicine practices are divided into specialties and your family practice doctor may not know what your cardiologist, urologist, gynecologist, or other providers have given you.

Most people in or past middle age are on several medicines — blood pressure, cholesterol, diet pills, anxiety meds. You’d be surprised — unless you are one of those people on a dozen prescription medicines.

SHOCKING FACT ABOUT INTERACTIONS

If you are on three medications you have a 50% chance of having a significant interaction among these medications.
If you are on five medications you have a 100% chance of having a significant interaction among these medications.

Some of the side effects might be benign, but you could be suffering from:

• Constipation or diarrhea
• Skin eruptions
• Insomnia
• Nervousness/anxiety
• Aches and pains, especially muscular aches and headaches
• Blurry vision
• Dizziness and balance problems
• Memory problems
• Impotence or anorgasmia

… and a whole lot of other things you don’t want.

If you add interactions that medications can have with food, lots can be going on. Did you know that some antidepressants can cause a hypertensive crisis – potentially a stroke – if you drink wine with a meal or eat cheese? A pizza could be potentially fatal in such cases.

So what happens when you complain to the doctor about these symptoms?

He or she will often give you ANOTHER PRESCRIPTION to take care of your complaints.

Over the past ten years, I’ve taken more people off of medicines than I have prescribed new medicines for them.

I often end up going down on doses or even switching medications to get rid of side effects.

For example, blood pressure medicine and antidepressants — alone or together — can make somebody lose their sex drive. Sexuality is an important part of somebody’s quality of life, and it is posssible to adapt medical treatments in order to help.

It isn’t necessary to lose this part of the human experience and it is often possible to avoid it and still give effective treatment.

THAT’S WHY I DEVELOPED THE DIAGNOSTIC PACKAGE

If you are one of the millions of people who are fans of the hit television program “House, MD” you know how critical an accurate diagnosis is.

Over the past several years, every one-hour episode has involved a puzzling illness and the search of a specialized medical team to fit everything into a diagnosis. Only then can the proper treatment be offered. Along the way, a false diagnosis is treated and the drama consists of rescuing the patient from life-threatening consequences of the mistreatment.

Fortunately for the television actors, the correct diagnosis is finally discovered just before the hour is over and the proper treatment is administered just in the nick of time — saving a life.

IF ONLY LIFE IMITATED ART

In real life, much too often, the misdiagnosed patient is made worse by treatment.

As the patient declines, more and more methods are attempted, and often make the patient worse. In the worst case scenario, a patient is incapacitated, institutionalized or might not survive the treatment.

Nobody is perfect. Not even doctors. There are a lot of good doctors out there, but they can’t know everything.

Unfortunately there are times when a doctor can’t help you because of the medical system you are in.

In Certain Situations:

• Only certain drugs are “on the formulary” and can be prescribed
• Specialized treatment may not be available through the system
• Doctors may only be allowed to refer to specialists within their own system
• Doctors may be told that they must treat things that rightly should be handled by a specialist
• Something necessary might be offered because it is not covered by insurance
• Something — such as pain control or surgery for anything less than life-threatening — may be considered “not medically necessary”
• The patient may have used up all benefits – surpassing a monetary amount or a fixed number of visits to a clinic or days in hospital
• The patient might be considered too old or otherwise not worth the expense, time and effort, or resources of the system.

I am a private doctor. I work for nobody except my patients.
I don’t work for the government
I don’t work for an insurance company
I don’t work for a hospital or a university
I WORK FOR MY PATIENTS AND NOBODY ELSE.

Everything I do with my patients is totally confidential. There is no employer or insurance company or government agency paying the bills and demanding copies of records and tests.

Since I provide services not available in many places, and since I have such a wealth of knowledge, with over 30 years of training and experience, my rates are higher than most other doctors.

I do not accept insurance or government payments. Those entities usually won’t cover the methods I use, and they seriously under-pay what should be considered a fair rate for such services.

I limit my client base so I can give each patient all the time and attention she/he needs.

However, I know that many people can’t afford to have me for a doctor.

That’s why I put together my diagnostic package — so I can help people get an accurate diagnosis and work out their treatment plan.

Then they can go back to their system where their insurance helps pay for their care.

HOW EXPENSIVE CAN IT GET?

My husband told me about an old car he once had that developed an oil leak.

It wasn’t too bad at first. A ring and valve job was expensive and the car was running OK otherwise. About once a month he would have to add a quart of oil. Eventually it became every week. And when it reached every day, he stopped and did a little calculation. If oil cost about a dollar a quart, he would be spending a lot of money.

Instead, he bit the bullet and sprang for the repairs. The car didn’t leak anymore and he drove it several more years.

Plus, buying and pouring oil was really inconvenient.

So if you have a chronic problem and it is seriously affecting your quality of life, maybe you need to bite the bullet and pay what it takes to get a solution — a diagnosis and treatment plan.

IT PROBABLY ISN’T AS EXPENSIVE AS YOU ARE IMAGINING

I structure my diagnostic examination around a four-hour evaluation — usually spread over two visits of two hours each.  So you get a lot of my time — unlike seeing those HMO doctors who run you out of the office after a few minutes.

To discuss the cost of my Diagnostic Workup package, please email me or phone me.  I’ll tell you my availability and the cost of your package.

SPECIAL NEWS: I am now seeing patients in Los Angeles part of the week. Contact me to discuss availability of appointment times.

Are there hidden costs? Well, there may be blood tests or other types of tests such as imaging, but they won’t be hidden. I’ll tell you what you need and if your insurance pays for them, you can go to your regular clinic to get the tests.

However, if they DON’T cover tests or other needs under your insurance, I have providers that give me a “doctor’s discount” — which most doctors or clinics just pocket as a profit margin. I give you the information to get the tests using this discount. Usually the tests run about half the price of doing it through standard medical providers if you pay out-of-pocket.

After the four hours with me, you will have a diagnosis and a treatment plan. If your case is complicated and it appears to need more time than that, I will discuss the need and give you the reasons before you pay me a single cent. Then you may continue — knowing the additional cost in advance — or decide to go elsewhere.

Afterward, you will have this accurate diagnosis and treatment plan to take to your regular doctor to continue your treatment.

Some patients decide to follow up with me or even to switch to using me as their main doctor.

Such arrangements can be discussed and pricing quoted in that eventuality.

IT’S ALL ABOUT QUALITY OF LIFE

You shouldn’t suffer. You don’t have to suffer. Even in severe and chronic cases, there are methods of treatment that can improve your quality of life.

If you or a loved one is suffering and can’t find any relief or satisfaction from your current medical treatment, I recommend you start with a complete diagnostic workup – from me or any other competent medical doctor. Only then can treatment proceed in an effective manner.

If you honor me by trusting your health to me, I promise you — I will work for your benefit, and not the benefit of an insurance company or government agency or hospital.

That is why they call me “The Renegade Doctor.”

Sincerely

Estelle Toby Goldstein, MD

PS – I am glad to review existing medical records as part of this diagnostic package, and it’s all included in the basic price.
PPS – If you have a loved one who you believe is misdiagnosed or you are unhappy with how they are treated, please think of me and I will be glad to give them the same care I would give you.

ONE LAST THING – I believe human life, its length and quality, are the most important thing on the planet. I have only one life on this planet, and have already lost too many people close to me. My parents and my brother are now only blessed memories.

I believe that the worst thing that can happen to you in life is to lose someone you really love. I have only one life on this planet and I cannot live with myself unless I practice the personal, individualized, medicine I believe in.