Over the past few months, my cancer patient and I have spent much time together. At the first visit, we discussed her new, frightening diagnosis. Subsequent visits involved reviewing tests and scheduling surgery. I saw her daily during her time in the hospital and a couple of times during her difficult weeks of radiation therapy. Her life has been turned upside-down, but she is a survivor. She is starting to look, once again, toward the future.
“I will keep sending copies of my progress notes to your primary doctor,” I say, checking the computer screen and reminding myself who she sees for her general medical needs. “Dr. Johnson has been getting reports since we first met.”
“Oh, I haven’t seen Dr. Johnson in months!” she tells me. “I have been so busy with my cancer doctors that I just haven’t had time. By the way, would you be able to refill my hypertension medications?”
Now, I am getting uncomfortable. My knowledge of hypertension medications is outdated and I am convinced that the loss of regular contact with the family physician or internist is a frequent and unfortunate side effect of cancer treatment.
This impression was recently confirmed for me at the Wisconsin Cancer Survivorship Forum. The survivors shared their reasons for this:
First, cancer patients are busy. Active treatment involves frequent hospital visits and people’s lives are busy. One more trip to the hospital or clinic is often out-of-the-question.
Second, cancer patients are focused. Who has time (or money) to worry about cholesterol or health maintenance when she is battling cancer? The other problems can wait!
Third, we tend to separate PRIMARY care from CANCER care. Elaborate buildings are designed to be self-contained and specialized cancer center spaces. Marketing efforts attract new patients. Referring physicians are educated to send patients with worrisome symptoms or new findings for evaluation — and “the cancer center” will take care of the rest.
Fourth, primary physicians no longer feel comfortable caring for cancer as they might have done decades ago. While we do not expect our personal doctor to refer “routine” diabetic or hypertensive patients to specialists, we would never expect our family doctor to oversee a course of breast or prostate cancer treatment.
I worry about the separation of primary care from cancer care. Primary physicians really do take better total care of patients.
The ultimate goal of successful cancer care should be to transition survivors back to their primary doctors — a process that requires education of both the patients and their doctors. These are responsibilities that not every primary physician will want to assume and not every patient will want to assign.
Cancer survivors are best served when they continue to see doctors dedicated to caring for every aspect of their health, whether that happens during treatment or later. To me, it just makes sense.
The following is feedback received for this blog:
Your post is right on the mark! I have been bringing my lifelong friend to her treatments and other appointments for lung cancer. Everything else does fall by the wayside.
And pcp's do get to know their patients and are familiar with so many aspects of their medical needs vs specializing.
As a uro patient who has been on a roller coaster ride of ups and downs because of how it all turned my life upside down, etc ..I have sometimes thought to myself that I don't even think of the rest of my body. You forget you have other organs and things that should followed with a pcp. I am good about it, but just don't have the same focus as the *hangnail that hurts at the time*.
I wonder if she *possibly* has grown attached to you (since I know from your writing how compassionate you are) and because she looked to you for so much during this life threatening time ...it may be a way to stay connected to you? or not. :)
Sadly, my dear pcp had to close his practice (still in his prime), because he couldn't keep it going as a solo practice with expensive overhead and reduced ins premiums. :( I do have a new one and believe he will be excellent for us, but no one can replace my first one.
Sorry so long - your post touched me on many levels.
- SeaSpray
http://seaspray-itsawonderfullife.blogspot.com/
I really enjoyed this entry as I do all of them, although as someone with a lot of health problems my primary doctor told me she would actually rather have my specialists take care of everything. It seems like she's afraid to touch me with a 10 foot pole. It's a good thing I have such great specialists at Froedtert!
- youngwisconsingirl
Hi Bruce! I just came across your blog, courtesy of KevinMD. You are right, of course, about cancer care sucking patients into an orbit that excludes the PCP. And, you're right that it impairs the overall quality of the healthcare the patient receives. If consultants in cancer centers worked to prevent such happening it likely wouldn't. But, it would require sharing simple cancer care regimens with PCP's who might not want to do it. Solutions are always harder than identifying problems, aren't they?
- Bob Condon
