When the Patient is the Expert

In response to my June 10th column, one commentor wrote: "The doctor may or may not be in expert in his or her field...."

Does a Healthy Survivor ever go to a doctor who is not an expert in his or her field?

In general, the answer is no.

But let's say you live in a rural area that has only one oncologist who may not be completely up-to-date on his/her rapidly changing field. Or let's say your local physicians are experts in their fields, but not in the particular subset of disease you have. In all these cases, patients sometimes seem to know more than their physicians about their particular disease.

Healthy Survivors in these situations often consult a super-specialist who makes recommendations to their local physicians and then follows along from a distance.

For example, a local oncologist who is not a specialist in a patient's particular type of cancer, but is an expert in the care of oncology patients, can provide the cancer therapies and day-to-day care of the patient very well. If complications arise or reassessments are needed (e.g., after completion of treatment or development of recurrent disease), the patient and local oncologist can involve the consulting super-specialist again.

Another commentor offered a superb adage on my June 14th post when she wrote, "I like Dr. Bernard Lown's approach: the doctor is the expert on the treatment and the patient is the expert on the patient." More on this in my next post.

Comments

[Jacob]

I bookmarked this site for the useful information.

[Lisa Weiser]

Love that quote! I think Dr. Lown hit the nail on the head!

Thanks!

[Lor]

I find this fascinating, as are so many of your posts, but especially now, since I've been diagnosed with lung cancer again and am overwhelmed as we try to discern the risks/benefits of treatment options. Surgeons are experts and often have a bias toward surgery, of course, but oncologists may have biases as well. And usually there's such a large gray area that...well, who knows what the best path is?

Thanks again, Wendy.
With respect and always hope,
Lori

[Wendy S. Harpham, MD]

Lori,

I hate that you need more treatment. Thanks for letting me know this blog helps in some small way.

Throughout my 20+-year survivorship, the most stressful intervals were those between learning I had a recurrence and beginning treatment for it.

So I hope you can take some comfort in knowing that the distress that accompanies weighing and choosing options should resolve once you make your decision. Remind yourself that your investing in this decision -- and tolerating the distress -- will bring a certain peace from now on, the calm that comes with knowing you've done your best.

With hope, Wendy

[Jan Hasak]

Wendy, as one of those cancer survivors who lives in a rural area, I can attest to the importance of having a super-specialist available for consultation. Fortunately for me, my oncologist came from Stanford University and consults with them regularly, using their tumor board for the harder questions.

Keep up the conversation on the delicate and ever-interesting patient-doctor relationship. It's fascinating.

Jan

Jan