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    Wednesday, April 13, 2005

    If the Cancer's Gone, Why is Death Knocking at the Door?: Practicing medicine within easy reach of a renowned tertiary care center has its advantages. Patients can get highly specialized care, such as bone marrow transplants or epilepsy surgery, without completely uprooting the lives of their loved ones. It also has its disadvantages.

    Aggressive public relations campaigns often leave people with the impression that the specialty center can work miracles, even for run of the mill diseases. And so, once in a while, you'll find someone who has landed in the hospital with a routine illness, such as pneumonia or emphysema, who asks to be transferred to miracle-worker hospital with the expectation that they'll get better faster there - even though there's nothing different to be done. The antibiotics don't work faster at a tertiary care center, and they can't transform old, smoke-damaged lungs into pristine healthy ones.

    But even worse, is the tendency of the tertiary care centers to leave their failures on the doorsteps of others. They've done such a good job of selling themselves to the public that people do really expect miracles. Go to them with cancer, and you'll be cured, just like the guy in the newspaper or on the television special. I don't know what kind of conversations take place in the privacy of the consultant's office. Maybe they do honestly lay out the odds for patients, and the patient (and their family), blinded by hope, doesn't hear the bad mixed with the good. But, I do know that all too often, when the treatment has been exhausted and the patient ends up in the closer hospital in extremis, the miracle-working specialists are nowhere to be found.

    As one of the oncology nurses told me yesterday, when neither my patient's miracle working oncologist nor his miracle working gastroenterologist would accept a patient transfer because there was nothing else they could do - "Don't you get the feeling they want us to take the blame for anything that goes wrong?" Then she added, bitterly, "They do this all the time, you know." Well, I didn't know that, but I certainly did get the impression they were reluctant to take responsibility for the complications of their treatment, or to admit to the patient that all was not as well as he had been led to believe. Meanwhile, my patient can't understand why he isn't feeling better. He's been told by better doctors than me that his cancer is "gone," his treatments "successful." And as far as the tertiary care center's records and statistics go - he is one of their success stories. But not because they cured him, only because they won't let him be anything but a success.

    UPDATE: Dr. Andy wonders if it isn't a comfort for patients to come home to die rather than go to the big specialty driven hospital in a far off city. Undoubtedly it is, but only if they already understand that death is the only alternative. My beef is the lack of communication that often fosters false expectations in patients, who then blame the local doctors when things turn out worse than they hoped.
     

    posted by sydney on 4/13/2005 09:02:00 AM 0 comments

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