Thank you for addressing a most perplexing issue in our clinic in Dr. Wendy Harpham's "Stewards of Survivorship" column. Our patients won't go to their PCP. They trust only us. It is everything I can do to get them to go to their PCP-for UTIs, hypertension, immunizations, lipid management. I tell them, "Together we saved you from the cancer but not to die of a preventable illness....And, we cannot, just because you are here, refill your thyroid or blood pressure medications because 'you're my doctor, aren't you?'"
I give my patients a "How Will You Check Me and What Tests Will You Do?" handout on the very first visit emphasizing that I work with not insteadof their PCP for their general health. Many of the PCPs, as Dr. Harpham notes in her column, may not be up to speed on survivorship and many are simply deer in the headlights, thinking that any aches or pains are due to the cancer. There is no attempt to get a film or to do an exam-just "Call your cancer doctor." They are a conduit only. Then, when we suggest this to patients, they are angry, and feel we are not caring.
My staff knows this is our practice-suggest this to the patient and then come to me with angry patient phone calls. Sometimes we are forced to see them and end up doing exams, x-rays, labs that are generally normal and sending them back to their "virtual" PCP.
Dr. Harpham, what do you suggest for those of us who embrace your concept that we need to work in partnership with the PCP, but have such difficulty having patients embrace the idea?
FRANKIE ANN HOLMES, MD
TEXAS ONCOLOGY, PA
CODIRECTOR, BREAST CANCER RESEARCH PROGRAM
US ONCOLOGY RESEARCH
HOUSTON, TX
http://www.breastcancerdoc.md
Reply from Wendy Harpham, MD
Your dilemma highlights the difference between theory and practice. Since your patients' initial consultation, you've defined roles and boundaries by explaining clearly that their PCP will continue to manage their non-oncology medical care. Yet some patients still pressure you to tend to medical issues that have nothing to do with their history of cancer. Worse yet, in some cases the pressure originated with the PCP.
Yours is a common, complex problem involving heightened emotions on both sides of the stethoscope. Patients may be struggling with uncertainty and their sense of vulnerability, as well as the emotional, financial and time burdens of medical visits. Oncologists may be feeling annoyed or disappointed with PCPs who encourage survivors to see their oncologists for primary-care issues. PCPs may be struggling with loss of confidence in their ability to properly evaluate and treat medical problems that arise during or after cancer treatment.
Realistic answers are available. In forthcoming "View" columns, I'll explore the emotional and logistical challenges of keeping PCPs involved in their patients' care throughout treatment and recovery, as well as when transitioning patients' post-treatment "survivorship" care back to their PCPs.
With hope, WENDY