Thursday, December 11, 2014

Getting a Second Opinion for Cancer Surgery

Second opinions for medical advice is nothing new and an accepted part of modern day medical practice. Practically all doctors are happy to provide second opinions for patients who seek them.  It goes without saying. My own surgical practice has a significant proportion of patients who come through such channels.  I usually ask them how they came to see me and in the vast majority of circumstances it was due to a recommendation from a friend or acquaintance who had been treated by me for the same condition.

Procedural specialties have particularly taken to having an on line presence for marketing of their services.  It makes a great deal of sense.  The more patients you can attract so as to be able to perform procedures, the more income that is generated.  Increasingly we are seeing offers of seeing patients for second opinions appearing on the websites of surgeons. Often there will be a form to complete where you type in your basic demographics and some basic information about one's condition which in turn invites the surgeon or designated staff member to make contact and subsequently encourage the patient to make an appointment.

What concerns me is that the second opinion marketing is mainly directed to newly diagnosed cancer sufferers.  These patients are vulnerable and on the steep learning curve with the acquisition of knowledge about their condition whilst trying to cope with the unknowns that lie before them. The second opinion websites often boast the achievements of the cancer surgeon being promoted but with very little possibility of the reader being able to verify the statements.  

We see statements such as 

“I was the first…” 
“I have done the most…..” 
“I pioneered the introduction of ……..”

Not uncommonly these statements bear zero relationship to the consultative or clinical or technical skills of the surgeon.

Rather than allow these websites seed one's mind about that the current care being received is inadequate, readers should instead consider why is it that such great efforts are being made to promote the availability of a second opinion service.  It is nothing more than a mechanism to goad patients into switching doctors when at their most vulnerable time. There should not be a need to promote that second opinion services are available as this goes without saying. If a surgeon had such a good reputation, why would they need to market for those second opinion cases. Do they have a deficiency of work that necessitates such action?  

There is nothing wrong with seeking out information on suitable surgeons to see for a second opinion but perhaps one could do better than a cold call to a website.  Consider other sources for recommendations. Start with the family doctor and additionally, staff who work at the hospital you would like to attend, if you know any.  Look the overall digital footprint of the provider and in particular independent sources of information.  When searching provider websites, be wary when there is over the top self promotion and whether you feel that a second opinion form is being thrust into your face. If it was from anything other than a medical provider website, you would probably consider it differently.  Remember that marketing is marketing and I'm afraid to say that even doctors partake in provision of information under the guise of marketing.

As a junior specialist, I recall being advised by a senior colleague that my patients would be my best ‘advertisement’.  All I had to do was to treat them with respect and compassion and to do what I would wish to have done for myself or my close relative. This was sound advice and I continue to uphold this principle.  I am grateful that my practice is sufficiently busy to never feel a need to market for second opinions - but why should I need to market for them when it is after all, a normal part of medical service provision.

Note- this piece is written in the context of Australian medical practice

Tuesday, December 2, 2014

Do You Know Who I Am.

It also happens in the hospital system but maybe not in the celebrity sense.

I never forget the moment when I was a junior doctor working in a major teaching hospital.  I was in a staff lift and the only other person in the lift and as far away as he could be from me was this cardiac surgeon.  There was no eye contact and I did not dare say a word or even a nod in acknowledgement.  Back then, these cardiac surgeons were the gods of hospital and quite frankly, I was scared of them. The lift opened on the next floor and wardsman trips over the slight step between the floor and the lift and bumped into him - yes, he dared to touch him (even though by accident).  Apart from a bit of a fright, definitely no physical harm done.  I remember clearly to this day how the cardiac surgeon then commenced a barrage of abuse of how dare he push him and does he know who he is.  The wardsman apologised multiple times to no avail with it only coming to an end when the surgeon had to get off at the next floor.  This would not likely happen in an Australian hospital these days - apart from being unacceptable behaviour, cardiac surgeons can no longer have the reputation of being a total jerk given that their livelihood is now so dependent upon the good will of cardiologists - what a contrast to my days as a junior doctor where I observed cardiologists literally begging surgeons to take on their cases for coronary bypass surgery. Stents have changed the dynamics of the cardiologist/cardiac surgeon relationship completely as well the behaviour of cardiothoracic surgeons.

I thought of the above story as a "Do You Know Who I Am incident".  It came to mind because of a more recent event involving myself.  I was coming in to operate after-hours and I was entering the theatre complex at the same time as another staff member. She was wearing her hospital ID card with her name fully visible and the picture on it clearly matching her face. I wasn’t wearing my ID card because I was wearing a T shirt and jeans and there was nowhere to clip it to.  I had it in my pocket.  The staff member asked me politely if I knew where I was and if I needed assistance or in other words, she was asking if I had a purpose to being in this restricted area.  I have been a surgeon at this hospital for almost 20 years and could have thought that the majority of people would know me.  I was initially surprised to be asked but instinctively, I took out my ID badge and showed it to her and explained that I was coming in to do a operative case. Given that she worked after hours shifts, she would not see me on a regular basis and sporting a scruffy Mo for the month of Movember probably did not help.  She did the right thing.

These thoughts lead to another thought about DYKWIM in hospital systems and the answer is often “No”.  Staff members are increasingly hiding their names on their ID badges - easily done under the guise of the badge having to attached to other essential badges or being turned the wrong way around. When you call a ward, how often does the staff member indicate who is on the phone. So much for Garling Report recommendations on staff identification.

(Typical hiding of the name on a ID badge of a hospital worker.  I took this sneak picture in a hospital lift)