Choosing an Oncologist in the Philippines - Part 2

Part 1--> here.

Which type/s of oncologist/s do you need?  Now, you may be a Mensa member but this area is a matter of information, not IQ.  Further, if you’re a take-charge CEO with a bundle of money, take care not to drown in it.

• A trained surgical oncologist?  Exceedingly rare.  Its not the same as “cancer surgeon”, you know.
• A gynecologic oncologist?  Yes, they do exist as a superspecialty to treat malignancies of the female reproductive tract.
• A marrow transplant specialist?  Oh my.  Count them on the fingers of one hand.
• A sarcoma pathologist?  Ditto.
• Many other instances apply, I’m afraid.

Best thing to do– go to a big cancer center.  Ask for a multidisciplinary meeting.  Don’t see a single specialist alone– lay your case before The Team.

• Seek a second opinion.
• Can parts of the treatment plan be executed at another hospital?  Many of the docs cover smaller/cheaper institutions.  Major cancer centers can also refer you to a gamut of networked specialists, from provincial areas to large first world institutions.  Your options would be greatly expanded.
• “…but this is my budget.”  The Team will discuss current standards of care, ie, “best”/ideal treatment.  Frequently, there are alternatives that would not sacrifice outcome significantly.
• “Do you have ongoing clinical trials for me?”  You don’t pay to go on a trial.  The investigational medication is usually provided by the pharmaceutical companies.  

Pitfalls next.

Choosing an Oncologist in the Philippines - Part 1

Okay, so a cancer has been diagnosed.  Just when you need your wits about you 100%, you're in a daze.  You're told to see a "cancer expert”. Not feeling ready?  Doubting the diagnosis?  Do it anyway, but make sure that the "expert" is a bona fide oncologist.

When to see the specialist/s?  ASAP.  Before anything else, know what it is that must be done.  Many times, you’ve got just one chance to do it right.

But which specialist/s?  If you have insurance, your choices may be limited to specific physicians.  A few professional societies are working on this one (on the premise that patients should have the right to choose from its accredited membership).  Great idea to have corporate considerations out of the way–

If the hospital is specified by your health coverage, that’s another issue.  Does the hospital have the necessary expertise and facilities available?  Sub-specialty physicians tend to stay close or within institutions that can enable them.  Some illustrative examples:

• Would your general surgeon be familiar with sentinel lymph node mapping? 
• What would a laparoscopic surgeon do without a laparoscope? 
• Even if the newer IMRT (intensity modulated radiation therapy) is ideal for head & neck cancer applications, its available only in a handful of centers. 
• Continuous infusion chemotherapy would be given on an in-patient basis if there are no ambulatory pumps.

Next:  Which type/s of oncologist/s do you need?  

Its a Business (too)

Had a discussion with The Kid on the appropriateness of business courses in a medical school curriculum.

Does it make sense?  In a word, “YES!”  You’ve gotta learn to talk the talk, especially by mid-career.  Part of The Job is dealing with administration and, even if you aren’t any smarter 15 years into your practice, you will be called upon to give your “sage advice”. 

On a more personal level, if only I’d had similar exposure before my mind was caught up in a highly technical specialty, then I wouldn’t be at the mercy of account managers, insurance brokers, & real estate pros.  As someone trained to consider & research each case management decision, who is frequently cast in the role of a take-control resource person & “expert”, I suspect that I delegate too much to the Money People. 

A disaster waiting to happen?  Maybe.  After all, to “Death and taxes’, add the inevitability of “Decline”.

Previous Comments

Really nice post. I LOVE IT.
Posted by Noah Berkowitz at December 6, 2011, 9:32 am