Whom Should I Call?
All of us have a lot of doctors and it can be confusing to decide whom to call about any particular issue. When you are in the middle of chemotherapy or radiation therapy or are having complications during recovery from breast surgery, it is clear which specialist can help you. During chemotherapy, most medical oncologists also function more or less as your PCP. Questions go first to the oncologist who may then refer you to your regular PCP or someone else. The less clear moments are usually later: Whom should you call about a fever that persists? Or back pain that lasted for several weeks? Or a rash that won't go away?
My experience is that different women make different choices. Some prefer to call a PCP because it seems less scary and normalizes the situation. Others prefer to call the oncologist because the fear is always that the symptom is cancer-related. It probably does not much matter whom you call first because s/he can always suggest that you call the other if it seems more appropriate. What is interesting about all this is the medical world is also paying attention to the issue. The bottom line, as expressed in this short article from the Journal of Clinical Oncology, is that it does not much matter. Women who receive most or all of their follow up care from PCPs do just as well as those who are followed by an oncologist.
Whom are you more likely to call when you have a worry?
Comparisons of Patient and Physician Expectations for Cancer Survivorship Care
Winson Y. Cheung, Bridget A. Neville, Danielle B. Cameron, E. Francis Cook, and Craig C. Earle*
From the Harvard School of Public Health; Center for Outcomes and Policy Research,
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and
Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.
* To whom correspondence should be addressed. E-mail: firstname.lastname@example.org
Purpose: To compare expectations for cancer survivorship care between patients and their physicians and between primary care providers (PCPs) and oncologists.
Methods: Survivors and their physicians were surveyed to evaluate for expectations regarding physician participation in primary cancer follow-up, screening for other cancers, general preventive health, and management of comorbidities.
Results: Of 992 eligible survivors and 607 physicians surveyed, 535 (54%) and 378 (62%) were assessable, respectively. Among physician respondents, 255 (67%) were PCPs and 123 (33%) were oncologists. Comparing patients with their oncologists, expectations were highly discrepant for screening for cancers other than the index one (agreement rate, 29%), with patients anticipating significantly more oncologist involvement.
Between patients and their PCPs, expectations were most incongruent for primary cancer follow-up (agreement rate, 35%), with PCPs indicating they should contribute a much greater part to this aspect of care. Expectations between patients and their PCPs were generally more concordant than between patients and their oncologists. PCPs and oncologists showed high discordances in perceptions of their own roles for primary cancer follow-up, cancer screening, and general preventive health (agreement rates of 3%, 44%, and 51%, respectively). In the case of primary cancer follow-up, both PCPs and oncologists indicated they should carry substantial responsibility for this task.
Conclusion: Patients and physicians have discordant expectations with respect to the roles of PCPs and oncologists in cancer survivorship care. Uncertainties around physician roles and responsibilities can lead to deficiencies in care, supporting the need to make survivorship care planning a standard component in cancer management.
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