Monday, October 20, 2008

Second Opinions


I just finished listening to White Coat Black Art, a CBC show by an emergency room doctor.
A few topics near and dear to me were touched upon: in Central and Northern Ontario second opinions are not always possible. In addition, the show focused on surgeries, such a small part of health care and one which can be elective surgery. Also, if your Family Physician will not refer you to a physician for a second opinion, you may not be able to find a physician who will do so. For those ill and ailing, long trips in to see specialists in the big city; involving Canadian Cancer Society drivers or other volunteers, these visits may be difficult.

The more research you can do, the better. In my experience family members need to be involved and elderly patients, especially, should be accompanied by a family member. That is the best prevention tool. Patients are not always able intellectually or emotionally, to ask the right questions, nor are ADMs, either. FP and specialists do not always view the situation as subjectively as it needs to be.

Especially, there is little information on what to expect of an oncologist. And which questions should we ask? Should we take notes? Should we take a family member or friend? The patient is entitled to a treatment plan to establish treatment goals and to understand the ramifications of treatment based on age and comorbidities. In addition, with these goals of care in place, the patient needs to be monitored for medications. We need to ask if particular medications are effective; the dosage; the correct directions, if there are clinically significant drug-drug interactions; what the duration of the therapy will be; and if there are other alternatives (Holmes, et al., 2006).

Oncologists, especially, must be accountable to their patients to identify a treatment plan. Patients, or their caregivers, must ask the hard questions to determine whether the treatment plan will interfere with quality of life. Essentially, with seniors there are statistics that can predict the quality of the treatment, its impact on the patient and caregivers, and the probability of its success. A patient and family must assess the impact on the quality of life during and after treatment and determine the outside resources available if, for example, the patient is incapacitated by radiation treatment or chemotherapy. The impact of radiation can vary widely with patients, but one result of this treatment is the destruction of infection-fighting antibodies.
  • My father was taken to emergency the day of my mother’s funeral, and no one recognized that he had a prostate infection due to the radiation treatment.
  • I have spoken to women visiting my CHAP blood pressure clinics with high blood pressure (BP) being sent home with dangerously high levels of BP and being told to see their doctors.
  • A patient misdiagnosed with cancer many years ago, is treated for another disease. His FP finds, 23 years later, that it was cancer but very slow growing. Would he have had surgery for no reason?
If you are unhappy with your physician you must contact the College of Physicians and Surgeons. I did so and felt much better for it. We need preventative medicine, as well as preventive surgery. We need to prevent physicians from flaunting the rules, and going against the College of Physicians conclusions designed to protect all of us.

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