Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, August 18, 2008

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.

8 Comments:

At Mon Aug 18, 08:06:00 PM, Anonymous Anonymous said...

Yes, you should be glad you're getting any info at all. Here they never even cc you, and they do all their imaging studies at their own center (Ka-chingggg!) so when patient comes back sick you can't access the studies. Recently one of my breast cancer patients, whom I have not seen for 2 years, fell and broke her pelvis. Onco didn't want to fool with that hospitalization and subsequent nursing home confinement. Also, on admission the patient has slow atrial fib, on no anticoagulant. Says, "oh, yeah Dr. X told me I had an irregular heart beat a few months ago." Why do the PCPs rage?

 
At Mon Aug 18, 08:19:00 PM, Blogger rlbates said...

Perhaps you could do an end-run around the surgeon in one of two ways:
1. When you make your referal to the surgeon, include your preference of Onc to them and their office staff.
2. And/Or just go ahead and tell the patient your choice and make sure they have it in writing so they can remember to ask for Dr X.

 
At Mon Aug 18, 10:27:00 PM, OpenID mwshook said...

When I was a resident (in a private community hospital, not an ivory tower), I did an elective with a surgeon. He told me to come to the twice-weekly 7am "Cancer Panel" where the oncologist, rad-onc, surgeon, and pathologists met to discuss every cancer patient.

I had been there almost 3 years, and referred several patients to their groups, and was never even aware that they did this! It was great as resident, but really, all PCP's should have been invited and taken part.

 
At Tue Aug 19, 04:34:00 AM, Blogger ArkieRN said...

After my cancer diagnosis, I didn't have a need to return to my primary care physician until a few months after I went into remission.

I was stunned to find out that none of the nine different specialists I was seeing had ever consulted with her or cc'd her on my tests, treatments, medications hospitalizations, complications or labwork! All of them were aware that she was my doctor. (It was on all of the first visit paperwork).

She had been completely out of the loop. It took 30 minutes of going over with her the course my cancer had taken before she felt up to date.

 
At Tue Aug 19, 02:05:00 PM, Anonymous Anonymous said...

Every time I see my gynecologic oncologist (or any other specialist), I ask her to send a report to my PCP. I also bring a signed, written request, since I know she needs the request in writing. Back when my PCP and all the other docs I saw were in the same hospital, I never had to do this because they could all access my record. Since my PCP switched to another hospital, I quickly learned that even though she technically referred me to the specialists, she wouldn't necessarily get a report unless I specifically requested it.

That's one of the joys of being a patient: "managed care" means managing your own care, along with all the paperwork that entails.

 
At Wed Aug 20, 01:00:00 AM, Anonymous Anonymous said...

The onco probably sent letter only to surgeon, as surgeon was the referring doc. I frankly don't care to whom the letter is addressed, as long as I get a copy and am kept in the loop.

 
At Sat Aug 23, 11:10:00 PM, Anonymous Anonymous said...

You are right dino..it's petty. You are getting a copy of the reports. Do you really need your ego stroked in such a superficial way? If you were being left out of the loop that is another story. Bates brings up a good point that you can tell the surgeon your preference for onc. As MWhook points out there is a weekly tumor board (usually several). What he/she misses is that these are open to any case involved doc including PCP's. Tumor boards agenda's are usually set up by one person and a phone call or two can usually suffice for location/hours. In all my years of tumor board attendance I have never seen a PCP. Not a complaint. Just a fact.

 
At Sat Aug 23, 11:10:00 PM, Anonymous Anonymous said...

You are right dino..it's petty. You are getting a copy of the reports. Do you really need your ego stroked in such a superficial way? If you were being left out of the loop that is another story. Bates brings up a good point that you can tell the surgeon your preference for onc. As MWhook points out there is a weekly tumor board (usually several). What he/she misses is that these are open to any case involved doc including PCP's. Tumor boards agenda's are usually set up by one person and a phone call or two can usually suffice for location/hours. In all my years of tumor board attendance I have never seen a PCP. Not a complaint. Just a fact.

 

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