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

 

Beware the Jabberwock

There basic rationale behind "high-tech" cancer treatments should never be too esoteric for the end-user.

Sadly, a time comes when there’s little more than symptomatic management in your arsenal to fight stage IV cancer. These days, a surprising number of such heavily pretreated patients opt to try touted “high-tech” treatments. If there’s no ongoing mainstream protocol to conflict with, after stating that no personal judgement is possible in the absence of sufficient data, I do little to stop them.

If US$ 100,000 + is just a drop in their bucket, who am I to say that the cost of this hope is too high?

Upon their return, those patients who’d left in fair overall condition can even have a new gleam in their eye. I’m truly happy for them but, when they try to get me to concede that the treatments had worked, I resort to grunts & wordless Gioconda smiles. If pressured to speak: “Well, if you feel good, then it was useful”.  If pressured further, then one bites one’s lip to answer truthfully… in one’s head:

www.buckcash.com

Patient: “The treatments are genuine breakthroughs– its the only explanation. If it walks like duck, and squawks like a duck, it IS a duck.” (Me: I used to think so, till Danny DeVito’s duck suit turn in “Batman”...)

Patient: “They’ve been published in journals. Its very scientific.” (Me: Both the NEJM & the JCO Editorial missed out on this paradigm shift?)

Patient: ”They use your language.  They did scans, cryotherapy, chemotherapy, and a gene thing. We don’t even have those therapies here or in the USA Centers yet.”

(Me: O frabjous day! To use "My Language", yet wax poetic in paraphrase: It really is brillig, the way these slithy toves do gyre and gimble in the wabe… Because all mimsy are the borogroves, and the mome raths outgrabe!)