In a January New York Times article, “Should Patients Be Told of Better Care Elsewhere,” the author, Denise Grady, discusses a friend who was diagnosed with rectal cancer and needed surgery, radiation and chemotherapy.
The friend consulted a surgeon at a local community hospital who was pleasant and very direct. Because of the tumor size, it was doubtful he could save the sphincter muscles; she would most likely require the use of a colostomy bag for the rest of her life. The friend weighed her options, a doctor close to home seemed so convenient, especially because shopping around for doctors while she so ill seemed a daunting task. However, the threat of the colostomy bag outweighed the other concerns and she made the two hour hike to a cancer center where they saw people like her all the time.
He was able to save the sphincter muscles and there was no need for a bag.
This issue comes up again and again with cancer patients, including those with GIST. Will a patient receive the same level of skill and care at a community hospital as they would at a cancer center which specializes in these types of patients?
Grady sites an article published in the online journal, PLoS Medicine, which is a peer-reviewed, open-access journal published by the Public Library of Science. In this article, authors argued that doctors have an “ethical duty” to inform patients whether they are more likely to receive better treatment at another hospital that deals with a higher volume of cancer patients.
According to the Times article studies have proven the “common-sense notion that practice makes perfect.” Dr. Leonidas G. Koniaris, a cancer surgeon at the Miller School of Medicine at the University of Miami and one author of the PLoS article, feels that it is not just the doctor’s skill level that is greater, but also the level of expertise in other postsurgery areas such as nursing, intensive care and rehabilitation.
The PLoS article also pointed out a few cases in the United States and Australia, in which courts have ruled that doctors who had operated on people with poor results should have informed the patients that more experienced surgeons were available. In one Wisconsin Supreme Court case, the court decided that “information on the availability of other centers and physicians better able to perform that procedure would have facilitated the plaintiff’s awareness of ‘all of the viable alternatives’ and her ability to make an informed choice,” according to Koniaris’s article. In the same PLoS article, Dr. Robert J. Weil, a neurosurgeon at the Cleveland Clinic, argues that Koniaris’s viewpoint “faces a number of logistic hurdles”. Weil raises a number of questions and concerns such as, “Which hospitals should be chosen for comparison? “ This question is further complicated by the possibility that one surgeon may have good surgical outcomes but practice at a hospital with a poor overall outcome. Another concern of Weil’s is whether surgeons will “do less radical…operations that may have little effect on cancer outcome but improve complication rates substantially.” In this case, a surgeon may only take low-risk or “simple” surgeries in order to have a good outcome.
Kaniaris suggests that perhaps, instead of an obligation by physicians, “it should just be up to the patient.”
However, the Times article raises the issue that although patients can ask for comparative information, “Many patients would fear giving offense.”
The LRG has faced this particular hurdle many times. There are many reasons why a patient will not ask their oncologist or surgeon for a second opinion or recommendation, many of which stem from the fear that by doing so, they are in fact questioning their doctor’s competency. For many patients, doctors are seen as somehow better or smarter than the average person.
When discussing medical care with a GIST survivor, the LRG maintains that it is beneficial to consult with a GIST specialist. GIST research is a very fastpaced and quick-changing field. Each month, the LRG publishes articles about new signaling pathways found and new trials opened. When selecting a doctor, you should make sure s/he is keeping current with the latest treatments and developments. A good doctor should be more concerned with their patient’s care than their own ego.