Battle for breast cancer
One of the most disturbing trends that I have witnessed in the last few years is the development of hospital-based comprehensive breast cancer clinics. These so called comprehensive breast cancer clinics are designed primarily by hospitals in order to keep breast cancer patients tied to a hospital setting and so that the hospital themselves can refer patients within a selected or a favored group of physicians. This is not always what I would consider best for the patient.
Here’s how it works:
Many mammograms are done at hospital-based mammography unit. In the past, a mammogram would have been ordered by a primary care physician. The primary care physician would then get the report of the abnormal mammogram. Then in consultation with the patient, the primary care physician would have referred that patient to a surgeon of his choice for the biopsy, or would have set up a needle biopsy under his direction at the hospital. Today in these comprehensive breast cancer clinics, any women that has an abnormal mammogram is being immediately informed of her results and referred to a surgeon of the hospital’s choice without any input from the ordering physician. This is justified by the idea that the faster the diagnosis is ruled in or out the better for the patient. This directs these women to hospital-based services and, in many cases, is cutting out their primary care physician’s input on surgeon choice, on oncologists choice and of radiation therapist. This is more based on money than what is best for the patient.
A situation arose recently in one of my patients who I have followed a long time for colon cancer. I had seen her for her routine follow up appointment for her colon cancer six months ago, talked to her about routine health maintenance scheduled a mammogram which was recently done. The patient’s mammogram was abnormal and she was referred to a hospital-based surgeon and biopsied before I received the initial report of the mammogram. Unfortunately her biopsy turned out to be positive. I believe that she would have been better served by having me discuss with her what an abnormal mammogram might have meant. I believe this patient would also have been better served if I as the ordering physician had an opportunity to speak to her about the competency of the surgeon that she was referred to.
These “breast clinics” that hospitals now are using are completely economically driven. It is an attempt to keep control of patients and their diagnoses and refer to physicians who utilize hospital-based services more than other physicians who may use different surgeons or different outpatient facilities. Is the care the patients receive in these clinics inappropriate? In most cases I would say no. Patients receive their biopsies quickly, and most biopsies are benign, but I feel that by cutting out the primary care physician, or the primary care oncologist they are depriving a patient a valuable opportunity. Discussion and consultation with physicians who may know them better than any other physicians can not be underestimated. These clinics are preying on women’s emotions, and their fear of cancer. The idea that a patient has an abnormal mammogram and needs a biopsy as soon as possible is appealing to women. This may, in some cases, not be absolutely necessary and/or may be better handled by physicians that know the patient better. Whenever I talk to women about mammograms I encourage them to understand that the majority of abnormal mammograms when biopsied are benign. Getting input from whatever physician knows them the best in terms of what surgeon to use to do the biopsy or consideration of a needle biopsy is very important. This is something that they should discuss with their primary care doctor or a physician that they have a strong relationship with. Patients need to realize that the rush to biopsy and the rush to get them involved within a “comprehensive breast cancer clinic” is very much economically driven.
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