The Doctor/Patient Relationship
Arline Kallick: Hello everyone. We’re very happy to have you with us this evening. Our call will begin with our speaker followed by a question and answer session and then end with small support groups. During the question and answer portion, please consider that many callers have a question for our speaker and our time is limited. It cannot be a private consultation. If we go into the group before your question is answered, you can bring it up there or call the 24-hour YourShoes support center at (800)221-2141. Registration for ShareRing calls can be done by calling our hotline or going online to the Network of Strength website, which is: www.networkofstrength.org and transcripts of each call will be available online approximately five to seven days following the call.
Our topic tonight is the “Doctor/Patient Relationship”, and our speaker is Dr. Jacob Bitran. Dr. Bitran is the Chief of the Division of Hematology/Oncology at Lutheran General Hospital and member of the Division of Hematology/Oncology at Rush North Shore Medical Center, both in the Chicago Suburban area. He has published over 100 articles, authored chapters in numerous clinical and professional textbooks and written nearly 200 monographs, letters and abstracts on cancer and related clinical matters. He is an acknowledged expert in the areas of breast cancer, lung cancer and bone marrow transplantation. We’re very happy to have Dr. Bitran with us this evening.
Dr. Jacob Bitran: Welcome everybody. I’ve been asked to cover lots of different topics in terms of the doctor/patient relationship, but let me say at the onset, that the relationship is based on obviously mutual trust. From the patient’s standpoint, you have to trust, obviously you’re entrusting your care, sometimes your life, in your physician’s hands. So there has to be the trust factor that’s there. If it isn’t there, it doesn’t matter how skilled a physician is, how knowledgeable he is, what institution he’s with. If the trust factor isn’t there, then the relationship winds up going nowhere. So questions that may come up in terms of the doctor/patient relationship are first. How do you select an oncologist and is it important to even see an oncologist? From my standpoint, I think the answer is yes. It’s important to see one, even if one doesn’t require chemotherapy at all, even if one doesn’t require any adjuvant hormone therapy. It’s important to get the input in terms of appropriate monitoring, frequency of tests, frequency of visits. What is it that we’re looking for? Now many times, surgeons will refer a patient that they’ve either done a mastectomy on or a lumpectomy and node biopsy, what have you, to an oncologist. That’s fine and well because most of the time there’s a very good working relationship between the two of them.
On the other hand, it never hurts to get a second opinion. That should be done before once you embark on a course of treatment, even if it’s just a reaffirmation of what you’ve already heard. The second opinion process, at least in my mind, is important because again, it helps gain confidence in the recommendations that you’ve been advised. Most oncologists that I know of never get miffed, never get irritated about second opinions. In fact, many of them will encourage the process because once again, it’s an important reaffirmation of what you’ve been told, what you’ve heard. From the standpoint of once the, once again you’ve had the initial consultation, what tends to happen is at the end of the consultation process, a treatment plan is laid out. The way we do things in our practice is it’s a written treatment plan. So that’s the guidebook that the nurses are going to be using in terms of what’s the follow-up? When do we want to see a patient? What’s the laboratory testing that we’re going to do at the follow-up visit? What’s the frequency of mammograms and/or MRIs? Obviously from the standpoint of adjuvant chemotherapy, what’s the chemotherapy regime? What’s the schedule? What’s the dosing going to be like? Are there going to be growth factors that are used? Aren’t there going to be any growth factors that are used? All those steps become important in terms of making sure that one completes the treatment.
Now from the standpoint of clinical trials, there are lots of them that are out there. Many of the hospitals throughout the country belong to a group called the National Surgical Adjuvant Bowel and Breast Cancer Project, and they have some very good trials. Now the issue with trials is that many of the trials that were, that are in place right now were written three and four years ago. So in a field that sometimes changes on a year-to-year basis, trials may be highly relevant and sometimes what happens is they lose their relevance. So as an example, one of the studies that we’re participating in which is an NSABP study looking at the adjuvant treatment of women with node positive breast cancer is looking at a three drug program called “TAC: Taxotere, Adriamycin or doxorubicin, Cytoxan,” given on an every three-week dosing schedule with growth factor versus a program called “AC followed by T”, so its: cyclophosphamide, Adriamycin followed by paclitaxel, given in a dose-dense fashion versus AC followed by T with the use of a drug called “gemcitabine”. Now from the standpoint of women who are triple negative, ERPR negative, Her2/neu negative, this is obviously a very good study. Where it doesn’t fit obviously is in women who are Her2 over-expressive because there was data that came out a year ago about the use of adjuvant Herceptin so the study addresses an important aspect in one patient population; but because of the, because the study doesn’t allow the use of adjuvant Herceptin, it really doesn’t address the needs of another population, which are node-positive women that are Her2/neu over-expressive. So again, these trials are going to get presented by your physician. Trials, the way every investigator looks at it, participation in trials is voluntary. You’re not doing it to win the lottery. You’re not doing it to wind up on the best treatment program because we really don’t know what the best treatment program is, but you are doing it because this is the way we advance the state of the art. This is how we advance the scientific knowledge. The beneficiaries are women who in successive years will develop node-positive breast cancer, although fortunately I think we’re seeing less and less of it on a year-to-year basis. So you’re doing it for altruistic reasons, not necessarily for your own benefit.