Shopping for doctors

Seeking second, third, or fourth opinions when it comes to diseases, especially cancer, is not uncommon.

THE next time you hear a group of doctors utter the word “shopping” disdainfully, you can bet it is not Harrods, Saks Fifth Avenue, or the Galeries Lafayette they are talking about.

To these shopping havens, doctors and their partners give of their time and money approvingly and willingly.

The shopping doctors describe, with a sneer, refers to patients asking around for opinions on their disease and how to treat it.

A patient who needs to undergo surgery to remove a brain tumour trudges around, a bag of x-rays and scans tightly tucked under her arm, from neurosurgeon to neurosurgeon. Sometimes it is two surgeons she sees. Often, it is more.

Patients have been known to see as many as six surgeons before deciding on the One.

The patient with breast cancer shops twice. She must shop around for the breast surgeon for the surgical part of the treatment, which involves removing part or whole of her breast.

Following the operation, she shops again for the oncologist, who will administer the follow-up treatment, which is usually chemotherapy, radiotherapy, and endocrine therapy.

What accounts for shopping?

The first reason is cost. Prices for a surgical procedure or a course of radiotherapy or chemotherapy are compared. To some patients, the lower the price tag, the better.

The second reason is bedside manner. The doctor who chews pumpkin seeds whilst consulting or who constantly checks the TV monitor for the latest share prices may lose the potential customer. Conversely, the charmer who speaks confidently, looks the patient in the eye, and has a firm handshake, is all set.

The third reason why patients compare and contrast doctors is that they want to hear what they want to hear. A patient having undergone surgery for colon cancer, sees four oncologists. Three of them recommend a six-month course of chemotherapy. The fourth one says no, and the patient happily goes along with this naysayer.

The fourth reason for shopping is that some patients need to slake their intellectual thirst. They want the doctor to make sense and to clearly articulate the treatment algorithm. The most eloquent doctor is chosen.

It is often a combination of reasons, but I think the upshot of it all is trust.

As I have always said, the relationship between a doctor and a patient is a special one. You must trust someone who will provide comfort, hope, and healing in times of adversity and illness, someone whose decisions may make the difference between life and death.

Many of us doctors see the same patient not once, not twice, but 50 to 100 times in all. The heart patient trusts his cardiologist and sees the same cardiologist for two, three, four decades. The endocrinologist who looks after diabetics similarly examines the same patient five to 10 times a year.

Rheumatoid arthritis is a crippling and chronic disease, but it usually does not kill. Again, if you trust your rheumatologist, why change?

And yet patients do change doctors whom they may have been seeing for a long time.

For oncologists, change is not uncommon. A patient, whose cancer is getting larger and spreading to more organs, abandons his oncologist and seeks another. He thinks the second (or third or fourth) oncologist may have a new trick up her sleeve. He may think the treatment given by the first oncologist may not have been optimal.

Any long term relationship can sour for any number of reasons. Friends and relatives try to do good by recommending other oncologists, and often, a cancer patient tries his best to please all around him.

They acquiesce to the suggestion to change doctors. The patient can have a religious epiphany and seek an oncologist of the new same faith.

Strangely though, I have not heard of a cancer patient who abandons all religion and seeks an oncologist who is an atheist.

Change the pilots midway through a long haul flight by all means, but provide the second set of pilots with the history of the flight. Where did the flight take off from? What were the weather conditions? How much fuel did the aircraft start with? Were there any anomalous readings on the dials during the first part of the flight?

Patients who change doctors midway through a long term treatment regime or surveillance programme should request of the doctor a long and detailed medical report. Everything should be in the report. From the diagnosis to any revised diagnosis. All the results of blood assays and imaging scans. The surgical procedures done and the drugs (and dosages) given must be clearly spelt out.

The question of offending the doctor should not ever arise. In the same heartbeat, the doctor should not hesitate in giving that detailed report. It is for the good of all the doctors concerned, and more importantly, for the well being of the patient.

Shopping can be therapeutic. Flying can be smooth. Seeing doctors should be both.

Sumber