The ADVENT Standard of Care

Dr. Madan Kandula and Dr. Ethan Handler chat about ADVENT rising above the status quo to provide the highest quality of reliable healthcare.
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Published on
February 12, 2020
Updated on
April 9, 2020

Dr. Madan Kandula and Dr. Ethan Handler talk in-depth about ADVENT's vision to rise above the status quo and why they strive to provide the highest quality of healthcare.

Dr. Handler: Why should patients come here? Why should patients come to ADVENT, what separates us from any other ENT around here, because, there are other patients that see other ENTs and they've been following, like why are we different?

Dr. Kandula: Yeah I mean, why are we, we are different. I guess I'd say, I think sometimes we get called out, for being different.

Dr. Handler: Absolutely.

Dr. Kandula: True?

Dr. Handler: Very true.

Dr. Kandula: When in fact, that's, intentional.

Dr. Handler: We wanna be different.

Dr. Kandula: We wanna be different because in my opinion, the standard of care, the standard of care in medicine, is, it's not up to my standards. It's not up to what people should expect out of the care that they received.

Dr. Handler: Agreed, because the standard of care by definition is whatever the standard of care is in that community, in general, that's what that means which, doesn't mean anything, 'cause, what if it's rooted, 20 or 30 years ago, or just wrong? And so you try to do what you, we gotta do what's best for patients, and so that's why we're different.

Dr. Kandula: Yeah, which is and we're, I guess here's what I'd say, we're different not because we choose to be different, it's because we choose to do things, in the manner in which we feel like they should be done. That makes sense. I, we both came, and everybody here, everybody in ADVENT has come through the traditional medical model and we've left that in the dust, moving on, and what's the difference, I'd say the core difference between what we do and what's done elsewhere, is we, wholeheartedly believe with every ounce, of our heart, that we want to get somebody better, we will do everything in our power to make somebody better. Now, what does that mean? It means we need to understand what's going on, in order to understand what's going on we need to use the right tools to get that information. I don't feel comfortable doing things when I don't have the information that's what I know is easily accessible.

Dr. Handler: Right.

Dr. Kandula: Yet, you know, there's a price to pay, a little price to pay for some of that information. For instance, you know, our first visit, when somebody comes in the office, we'll typically do what's called an endoscopy, which is looking with a camera into the nose, the back of the throat down around the voice box, to see what's there. Why would somebody wanna do that?

Dr. Handler: Well, why are we different than a primary care doctor who can't look in the nose right? So we can take a scope, we can look in the nose, we can see the anatomy we can see inside the throat, think about how many common nasal and throat problems there are. That is the best tool out there to look inside there, with our own eyes, and see what's going on.

Dr. Kandula: And if you had that tool and didn't use it, and yet somebody has an issue that you could've seen with that tool, how is that possibly, at all, what somebody... So if somebody comes in to see treatment for us, and we don't use the tools in our arsenal, why wouldn't we? It doesn't, some of it sort of, I get confused sometimes with the premise. And the premise is that we should move forward confidently with less information.

Dr. Handler: Right.

Dr. Kandula: When in fact, you can't move. I think for us and for me and for how we do things, is once we have the information we need to understand what's going on, then our job is to educate somebody about that information, what the information is showing us. And then, if we choose to do something, we do it with confidence and with conviction because we know the information. Now the standard of care is, hey let's just, what man, we're just gonna do... We see that your septum is deviated for instance, why don't we just straighten that septum, we don't need further information. Your septum is bad.

Dr. Handler: Right.

Dr. Kandula: It's like this weirdly, it's this ignorant mindset that is the typical mindset that is inappropriate. If it were your nose that you were gonna have, if you have a deviated septum, which you do, I know this. That you need to get corrected.

Dr. Handler: Hey, everybody's septum is deviated.

Dr. Kandula: So if you had a deviated septum and I'm gonna take you to surgery, wouldn't we want to know everything else that might--

Dr. Handler: I would want you to know everything else if you were taking me to surgery because I think both of us can agree that sinus problems, a complaint from sinus issues can be obstruction or congestion, correct?

Dr. Kandula: Yeah, absolutely.

Dr. Handler: Okay, so why would I ever want to take somebody to the operating room if their main complaint is obstruction or congestion if I didn't get a CT scan to actually look and go see what's going on with their sinuses.

Dr. Kandula: Yeah, absolutely, and I think that's the question. I put the question out to the world is why would you want to move forward with less information versus more information, especially in areas that you cannot see.

Dr. Handler: Right.

Dr. Kandula: So the sinuses specifically, neither you nor I nor anybody else on this planet can, without x-rays see what's happening in somebody's sinuses.

Dr. Handler: Right.

Dr. Kandula: You cannot know, there's, it's impossible, you can't see those areas.

Dr. Handler: Right.

Dr. Kandula: So why would you think to do anything without imaging, for instance.

Dr. Handler: So an essential tool that we have is CT scanners in our offices. Now, for that reason, right. Let's get imaging, let's see what going on in sinuses. Now, patients could maybe see other providers and then drive elsewhere to get a CT scan, but that's still essential. But that also then is the reason why maybe that's not ordered at times because patients have to go to an outside center to get something done.

Dr. Kandula: Right.

Dr. Handler: And then there's time, and there's effort, and follow up, and there are phone calls. But maybe it's spun or it's in a way that a patient is like, "Oh, it wasn't necessary." But the reality is it is necessary. And so we try to make that easy, to use the tools that we have to give the patient all the information that they need.

Dr. Kandula: Yeah, because that's what you would want me to do for you.

Dr. Handler: If you were a pilot--

Dr. Kandula: And that's what I would want you to do for me.

Dr. Handler: Right.

Dr. Kandula: That's what we do for everybody and I think that's the standard. Like, that's the standard and absolutely. Because it's crucial information for us to have before we think towards... We cannot know without that information, it's just impossible. Because it's crucial, it's important that we have office-based imaging in every one of our offices. And that's crucial because we need that. Now if you don't, if you didn't have that, low and behold you would be getting less images. Low and behold you would be doing things without imaging because it's a hassle to go and get that image, let's just sort of nip and tuck here what we can see, and let's hope we don't have anything going on. And you better not be nipping and tucking me without the information.

Dr. Handler: Right.

Dr. Kandula: It's not appropriate, I wouldn't do it to my mother, my wife, my kids, I wouldn't treat them without imaging.

Dr. Handler: Which is why it's discouraging sometimes when we see patients that have had things done, whether it's septum's and maybe some turbinate work, that still have problems. Or didn't get their initial problems resolved. And so it's always just like, well, was their other issues there that maybe weren't identified. And you just don't know the answer to that question.

Dr. Kandula: Right.

Dr. Handler: Without again, getting a scan and getting, evaluating the entire thing. And it's no different then a pilot having a flight plan and being able to see and having instruments and controls. Like, think about a pilot flying without that, would you want them flying your plane? Probably not.

Dr. Kandula: Absolutely not.

Dr. Handler: And so, would you want your surgeon doing something without understanding as much information as they could before making some sort of decision with you, the patient, as informed as you can be.

Dr. Kandula: Right, yeah I don't. I mean I don't, I guess the challenge I had sometimes is I don't understand the counter-argument, 'cause there is none. There is none other than maybe you're gonna get lucky. Let's cross our fingers, let's go in, let's just take it into surgery, we're gonna straighten the septum out and boy I'm gonna hope, hope, and hope, and pray that you don't have anything going on that I can't see. And you know what, if it happens tough luck kind of a thing.

Dr. Handler: Well, what about the patient that's unlucky? That says, hey, you go in, maybe have your septum straightened, nip tuck whatever kind of thing in the nose and still have congestion on the back end. Then, if you're a doc and you're like, "Now, let's get imaging." Then, of course, the patient is gonna be like--

Dr. Kandula: "Why didn't you do that beforehand?"

Dr. Handler: Exactly.

Dr. Kandula: Why wouldn't you?

Dr. Handler: Right.

Dr. Kandula: And there's no answer.

Dr. Handler: There's not, there's not a good answer.

Dr. Kandula: There is no unless you don't have the ability to do such a thing, fine. Now, again, for the conditions that we treat, we treat nose and throat issues. We are nose and throat specialists, we have multiple tools to look in those areas to figure out what's going on. There are, most doctors, most ENT's don't have the same tools we have here, fine. Therefore, their choices are to move forward without that information or just sort of leave it alone. And so, for us, if somebody comes in and gets treated, we're gonna use the tools that we have to evaluate what's going on.

Dr. Handler: Yeah.

Dr. Kandula: And primary care docs don't need nasal stethoscopes, it's not something that they need. Now, if they had them and you could see into those areas, you want to see. Same thing with imaging, there are tools that you want to use, that you need to use, that you have to use to see.

Dr. Handler: So one of the things that separate ADVENT from everywhere else, the tools that we have in our toolbox to actually address the patient's concerns.

Dr. Kandula: Absolutely, tools are... Information is powerful, without information you're powerless. Take your choice, powerful, powerless. We choose powerful every day of the week and that's just, that's our bias. So if that's sort of a controversial biased opinion, then let the controversy and bias reign.

Dr. Handler: Yep.

Dr. Kandula: Because I don't understand, I don't understand the counter-argument to that and I never will. And I never have to, thankfully. And nor do our patients, thankfully.

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First published by ADVENT on
February 12, 2020
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The ADVENT Standard of Care