1. Harpham, Wendy S. MD

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In my last column (7/25/12 issue) I discussed the dilemma of patients asking you to manage their primary care needs. Since a patient handout can be a useful tool for sharing fundamental information, here's one to help patients understand the importance of using their PCP for their primary care. Feel free to edit it to meet your needs.

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD, is an internist, cancer survivor, author, and mother of three. Her books include

I have two caveats: Handouts help only if patients read them and only if their PCPs are on board.


Meeting Your Primary Care Needs after Cancer

Dear Patient,

For you to get good care, we need to spend a few minutes discussing the important role of your primary care physician (PCP).


Why You Need Your PCP

Cancer doesn't change the fact that your PCP keeps track of all the factors affecting your health-such as infections, injuries, diabetes, hypertension, toxic exposures, immune system problems, lifestyle (diet, exercise, etc.), and medications.


After being diagnosed with cancer, patients who stop seeing their PCP for routine care may be cured of cancer only to develop a preventable illness that impairs their quality of life and/or becomes life-threatening. It happens. We don't want that to happen to you.


So you need to continue your checkups with your PCP. And you need to contact your PCP if you develop a new problem, just as you did before you developed cancer. Note: If you don't have a PCP, we'll help you find one.


Unless we tell you otherwise, continue seeing your PCP for:


* annual exams


* routine screening tests (including screening for other types of cancer)


* new symptoms, unless clearly related to your cancer situation


* vaccinations



Rest assured, I'm always available to discuss with your primary care physician any issue from my perspective as your oncologist.


Your Cancer Doctor

Some patients express surprise when I refer them back to their PCP, asking me, "Aren't you my doctor?"


The answer is, "Yes, I am your doctor-but I am your cancer doctor."


In contrast, your PCP was, is, and always will be what most people think of as "my doctor"-namely, the physician who keeps tabs on everything related to your health. The physician who works with you to prevent or delay problems. The physician you call if you develop a new problem.


Over the years I've heard dozens of logical reasons why patients want me to do some or all of their primary care. Since I'm always striving to make my patients' care smooth and easy, on occasion I do address a primary care problem. However, the circumstances have to be exceptional, because everyone pays a price when I'm not concentrating just on cancer care.


The Oncologist's Role

As a specialist in oncology, I focus on providing excellent cancer care. For me, that means staying up to date regarding the diagnosis and treatment of your cancer. It also means being available to manage any cancer that might crop up from now on.


Naturally I play a vital role in your care. But even when cancer is your greatest health threat, my efforts are secondary to a greater goal: helping you achieve the best overall health outcome so you can enjoy life as much as possible. Achieving this goal depends on the continued expertise and efforts of your PCP.


Why Oncologists Should Not Do Primary Care

Oncologists train and become certified in internal medicine before specializing in oncology. So when oncologists begin their careers, they can do primary care very well. But just because they can do primary care, it doesn't mean they should.


For one thing, my office is organized and my staff is trained to provide cancer care, not primary care. Behind-the-scenes efforts involved in primary care are not as simple as you might expect.


For another, if I were to start taking care of just a few patients' primary care needs-two minutes here, five minutes there-you'd have to wait longer for your visits with me. And you'd have less time with me during your visit.


For these and other reasons, patients who push us to refill prescriptions or check out problems that have nothing to do with their cancer unwittingly put us in a tough spot.


If Your PCP Directs You Back to Me

We can work this out.


Medicine is changing rapidly. Clinicians' roles vary from place to place, even practice to practice. I'm always happy to work with your PCP (and any other clinicians on your health care team) to help you get good care.


Where Do We Go From Here?

As mentioned earlier, my ultimate goal is one shared with all the members of your health care team: To help optimize your overall health.


I'll do my part, by focusing on your cancer care. And I'll support your PCP's efforts to take care of your primary care needs. This way, you can get good care and live as fully as possible today, tomorrow, and every day.