Whose Patient is it Anyway?
For some reason I've had a recent run on breast cancer patients. From abnormal mammograms to masses I've found on exam to lumps the patient has found herself -- all have ended up with positive biopsies and surgical referrals. All have proceeded to oncology and radiology evaluations and are receiving appropriate treatment.
I know it's petty, but here's my beef:
All subsequent cancer correspondence on these patients is addressed to the surgeon, while I'm reduced to a name on a cc list. I suppose I should be grateful that I'm getting any information on them at all, but I find it a little galling that although I'm the one who found the initial lesion, I am now considered peripheral to the patient's care. (I'm not even going to start in on the fact that the surgeon is choosing the oncologist without asking my preference first. As it happens, there are two excellent groups in town, though I do have a distinct preference. Unfortunately they've been sending them to the "other" one.")
Part of the problem is that when the surgeon passes the patient on to the oncologist himself, pieces of the longer-term history often get lost. I have a much more productive relationship with the oncologists when I'm the one referring to them directly. If nothing else, the letters are addressed to me. I find they get better care this way (or at least they tell me they're more satisfied with it, which is generally considered a functional proxy for quality of care.)
Perhaps it's the logical extension of the old surgical maxim, "You cut it, you own it." No wonder surgeons may be more prone to a Gd-complex than other docs: they "own" people. Well news flash! You may be the primary surgeon, but you're not the primary physician. That's me, and I'd appreciate you keeping that in mind.