The Assertive Cancer Patient

Paperless Prescriptions Mean Fewer Mistakes

Also less waiting time at the drugstore, according to a story from the Associated Press. 

The benefits--especially reducing the odds of a serious mixup because the doctor's handwriting is illegible--seem pretty clear. So what's not clear to me is why doctors are so against it. Only 10 percent are using the computerized system, according to the AP.

Medicare is paying a small (2 percent extra in reimbursements) incentive to doctors who switch to paperless prescriptions, but that's probably not enough to make it worthwhile. 

Read the story: Pushing doctors to ditch the prescription pad

See also:

 Fatal Rx Drug Errors Soar

Prescription Drug Errors 

(This post lists most of the things I do to make sure I'm not the victim of a prescription drug error. With six or eight different drugs in my medicine cabinet at any given time I take this issue seriously.) 

@ Jeanne Sather 2008.

Breast Cancer Second Opinions

When you have a biopsy to diagnose breast cancer (or another cancer), the slides are read by a pathologist who determines whether or not the sample is cancer, and then what type of cancer it is.

But regardless of the doctor you see--you may have already chosen an oncologist and surgeon who specialize in treating breast cancer, for example, rather than a general surgeon and general oncologist--your slides will be read by a general pathologist.

"Whatever pathologist is on that day will read the pathology," says Dr. Lawton. "No one hunts for a pathology specialist."

Well, maybe not. But Dr. Lawton is betting that women who have been told they have breast cancer will want a second opinion, if they know that the service is available. 

He recently opened Seattle Breast Pathology Consultants to offer second opinions to women diagnosed with breast cancer. 

For $350, Dr. Lawton, who has specialized in breast cancer pathology for a number of years, will give a second opinion. You don't have to make an appointment to see him, just have your slides sent to his office. 

Most insurance plans will cover the cost, but Dr. Lawton doesn't bill insurance directly, so you will have to pay for the second opinion directly and then ask for reimbursement from your insurance company. 

Dr. Lawton can give second opinions to women in any state in the U.S., as well as women who are in foreign countries. His Web site has information about How to get a second opinion 

Why get a second opinion? To avoid mistakes.

Your doctors will make decisions about your treatment based on the pathology report. If that report is wrong, you may not receive the right treatment for the type of breast cancer you have. 

And mistakes do happen. See Dr. Lawton's Web site for data on errors in diagnosis: Why Get a Second Opinion?

See also:

Get a Second Opinion at Diagnosis?

Who Is YOUR Pathologist?

Medical Mistakes--They WILL Happen

@ Jeanne Sather 2008. 

Who Is YOUR Pathologist?

If you're like me, you know the names of your surgeon, medical oncologist, and radiation oncologist. You may have memorized their phone numbers. 

But your pathologist?--- 

   * Do you know his/her name? 

   * Did you shop around and ask for recommendations for a good breast cancer pathologist at the time you were diagnosed? 

I didn't. But maybe I should have.

To me, the pathologist was one of those unknown names that popped up on a medical bill--I had no idea who it was. Or the name scrawled at the bottom of a very scary report ... one I could hardly read with my eyes crossing because of stress, and one I certainly didn't remember.

The other day, I learned something new about breast cancer diagnoses and pathology reports: 

Most reports, no matter what cancer center you go to, are read by GENERAL PATHOLOGISTS, not by pathologists who specialize in diagnosing breast cancer (or whatever kind of cancer you have).

As a result, mistakes are made. A realistic guess is that 10 percent of cancer diagnoses are wrong, but cancer centers and hospitals don't publish these statistics, so there is no way to know how often they make mistakes.

But doesn't it make sense to find out who will be reading your pathology slides and to confirm his or her credentials? To me, it makes perfect sense to choose a pathologist who specializes in your cancer. 

"There are always errors in medicine," says Dr. Thomas Lawton. "But you reduce the chances of an error who you have someone who specializes." 

Dr. Lawton and I met for coffee last week to talk about his work. Dr. Lawton is a pathologist who specializes in breast cancer, and until recently he was at the Seattle Cancer Care Alliance, where I received my treatment until two years ago when my medical oncologist left for Tucson. 

Dr. Lawton recently opened a new business, Seattle Breast Pathologist Consultants, to offer second opinions to women who have been told they have breast cancer. I think it's a good idea. 

Here's his contact information:

Dr. Thomas J. Lawton
Seattle Breast Pathology Consultants
(206) 860-1074
http://www.breastpathologyconsults.com  

@ Jeanne Sather 2008.   

Get a Second Opinion at Diagnosis?

I have to admit that this is something I haven't thought about until recently--getting a second opinion when you are told that you have cancer.

We routinely get second opinions from surgeons to ask which procedure is best for us.

Ditto for medical oncologists: which chemo routine would be best?

I wrote an entire section for this blog on preventing medical mistakes, without writing about avoiding errors at diagnosis. Oops.

I wondered a bit about getting second opinions when I read about the 62-year-old British man who--diagnosed with pancreatic cancer and told he would probably only live for a year--quit his job and went on a wild spending spree only to be told a year later that the diagnosis was wrong.

Ouch.

A second opinion by a pathologist, especially if you choose a pathologist who specializes in your kind of cancer, would help prevent errors in diagnosis. That seems like a good reason to take this extra step. 

See also: 

End-of-Life Spending Spree Has a Surprise Ending

Medical Mistakes--They WILL Happen

@ Jeanne Sather 2008. 

Fatal Rx Drug Errors Soar

"Fatal Rx Drug Errors Soar"--That's the headline in the latest online edition of the AARP Bulletin Today, a publication that I started reading since one of its editors interviewed me for a story that is coming out soon. 

It's also a pub that I need to be reading since I am, at 53, in AARP's demographic. I've decided not to fight it--the organization cares about issues that I care about, such as health insurance, and the ONLY person who gave me accurate answers to my questions about Medicare and Tykerb (including the people I talked to during calls directly to Medicare) was a woman who works for the AARP. She's their Medicare specialist and knows her way around Medicare Part D like nobody's business. 

Anyway, back to the story about drug errors: 

According to research done at the Unversity of California at San Diego, accidental deaths caused by people improperly taking meds rose by more than 700 percent between 1983 and 2004.

Ouch. A relative of mine recently was rushed to the emergency room when she took too much of one of her meds, so this hits close to home. 

It also hits close to home because of all the powerful drugs I take to combat my cancer. 

Read the story: Fatal Drug Errors

Read more about preventing medical mistakes: 

Prescription Drug Errors

Medical Mistakes--They Will Happen

@ Jeanne Sather 2008.

A Doctor Who Wouldn't Listen: Sandy Adds a Few Comments

After I posted Sandy's story on July 4, she wrote to me and added a few comments and clarifications. I think they're worth adding to the story.

Sandy points out that Dr. Park did not refer her to a medical oncologist when she was diagnosed with kidney cancer in the fall of 2006.

"If he would have referred me to an oncologist," she says, "I would have immediately gone through a battery of scans to see if it had metastasized. Then, they would have done a biopsy and taken care of the tumor in my hip. They would have radiated and possibly done surgery to scrape out the tumor and filled it with a bone cement. I would still have my leg and muscles."

She also says that Dr. Park refused to order a scan when she told him she was in pain because "It was protocol" to only do scans every six months.

Later, when Sandy tried to see Dr. Park to discuss his mishandling of her care, she did so on the advice of a friend who is also a doctor. She says now, "Also, my doctor friend mentioned that 'This is the reason doctors carry malpractice'...her words, exactly. That was the reason she tried to book an appointment with Dr. Park, and go with me."

But Dr. Park had left Seattle by that time, and the clinic would not give Sandy's friend his new contact information.

See: A Doctor Who Wouldn't Listen: A 'Y' in the Road

Want to start at the beginning?

See: A Doctor Who Wouldn't Listen: Malpractice at the UW/SCCA?

@ Jeanne Sather 2008.

A Doctor Who Wouldn't Listen: Malpractice at the UW/SCCA?

Last week I met with a Seattle woman named Sandy Garvin. This is her story.

BEFORE
In October of 2006, Sandy was 57 and had just retired after 28 years as a flight attendant for American Airlines. She was traveling, sailing five days a week, and enjoying the three-story house in Seattle's Wallingford neighborhood that she had bought in 2004.

"I was having a blast," Sandy says.

AFTER
Not quite two years later, Sandy's life has changed dramatically.

Sandy can no longer sail:
"I'm afraid to get on a boat," she says.

She can't travel by herself:
"I [have to] bother people now."

She can't even take care of herself and her home:
"I have to ask friends to do my grocery shopping, because I can't carry it upstairs," she says. She can't do housework, laundry, or yard work either, and can barely make it up the three flights of stairs that at one time made her home so attractive.

"I need an elevator," she says, but she can't afford one.

See also:

A Doctor Who Wouldn't Listen: What Happened?

A Doctor Who Wouldn't Listen: A 'Y' in the Road

A Doctor Who Wouldn't Listen: The Other Fork

A Doctor Who Wouldn't Listen: Finding Dr. Park

A Doctor Who Wouldn't Listen: A Personal Footnote

@ Jeanne Sather 2008.

A Doctor Who Wouldn't Listen: A Personal Footnote

I don't use the word "malpractice" lightly.

I've been in cancer treatment for most of the past 10 years, both at SCCA and at other cancer centers in Seattle. And during that time, my doctors have made mistakes in my care.

See: Medical Mistakes—They Will Happen

I do not consider those mistakes to be malpractice, and I have never considered suing them.

But Sandy's story about a doctor who repeatedly ignored her reports of severe pain and her requests for further scans is beyond incredible. A court will decide if Dr. Park's actions did indeed constitute malpractice, which is why I've used the word with a question mark after it.

Tales like this one of doctors who refuse to listen to their patients make me cringe. In my opinion, this guy should not be practicing medicine. Because his treatment of Sandy goes beyond missing the tumor that had broken her left femur.

He also has no idea how to give a patient bad news. This is a hot button of mine, as regular readers of this blog well know, and it's something that is finally coming into the oncology mainstream, thanks to the efforts of Dr. Tony Back and others.

So, a counter-example, from Dr. Sangtae Park, as reported by Sandy Garvin.

How NOT to Give Bad News
When I was diagnosed with Renal Cell Carcinoma on October 30, 2006, Dr. Park scheduled the surgery to remove my right kidney and mass for November 6.

When I went back to have him examine the incisions, 10 days later, and asked him what the heck was that, he told me that he got it all, it was encapsulated, and not to worry for five years. "At five years, have a party, because between five and eight years, the tumors would come back with a vengeance, 15 to 20 of them." My body will not be able to handle it. I will die.

You might be wondering, WHERE did this guy go to medical school? Didn't they teach him anything?

Well, I checked, and Dr. Park went to the medical school at the University of California at San Francisco, which happens to be where Younger Son's father has his research lab. Younger Son is there right now, working in the lab for the summer.

Small world and all of that ...

A Doctor Who Wouldn't Listen: Finding Dr. Park

I wanted to know what the Seattle Cancer Care Alliance (an institution partly owned by the University of Washington Medical Center, and where cancer patients are seen on an out-patient basis) would tell me about Dr. Sangtae Park's career at the UW and SCCA, so I e-mailed Dean Forbes, the media relations person, last Monday, June 30.

I e-mailed Dean at both his work and personal e-mail addresses, but received no reply. I e-mailed him again a couple of days later, and also called him on his work number. I asked whether Dr. Park had resigned or was fired from his appointments in Seattle.

No reply.

See: One Way to Keep a Story Out of Print (Or Try To)

Chicago
I had slightly better luck with Chicago, where the media relations person returned my e-mail promptly.

This is what he said:

I am told we do not have a full bio for him. He is a Clinical Assistant Professor (5% effort) in Surgery. He joined us 2/1/08 and is not technically "faculty." Dr. Park is based primarily at Mount Sinai Hospital [the one in Chicago, not New York City] and some of our residents work with him there. You might check with Mt Sinai.
http://www.sinai.org/

John Easton
Director of Communications
University of Chicago Medical Center
John.Easton@uchospitals.edu

I e-mailed John back, asking for an e-mail address for Dr. Park. Once I get that, I will e-mail the doctor directly. None of the bios of Dr. Park that are on the Web mention his time working at the UW and SCCA, which is one thing that I was curious about.

@ Jeanne Sather 2008.

A Doctor Who Wouldn't Listen: The Other Fork

The other fork in Sandy Garvin's road is her treatment since she found out that her cancer had indeed metastasized. She says she decided she no longer trusted doctors at the UW, and she switched to the Swedish cancer center.

Her surgeon at Swedish did the hip replacement she needed by that time, because the tumor had grown to more than 4 centimeters in size. She also has been treated with radiation and chemotherapy at Swedish, including the drugs zometa and Avastin.

She has had to take breaks from treatment and take a lower-than-usual dose of Avastin in order to keep her one remaining kidney from failing. Sandy also does regular physical therapy to try to regain some mobility.

Her cancer cannot be cured.

@ Jeanne Sather 2008.