Wednesday, July 13, 2005

Dr. Know-It-All

I live in the state of Texas. Believe it or not, I love it here. Recent developments concerning the care of a child with cancer more than alarmed me, though.

It seems that a family here chose to disagree with their physician about having their daughter irradiated after her chemotherapy after looking at the research and long-term outcomes. Her enraged doctor reported the parents to CPS. The child was taken and the treatment given while she was in the care of a foster parent.

Did everyone lose their minds? First, the doctor should know, if he isn't a complete moron, that "standards of care" differ wildly and are at best opinions and at worst experimentation as there is no way to know how a body will react to the treatment (Will radiation put the cancer in remission? Maybe, maybe not. Will it cause an accumulation of radiation? Definitely. Will cause a future cancer? The odds are REALLY good.)

Second, the doctor should also have some perspective. Even if he could prove beyond a shadow of a doubt that this child would definitely live FOREVER with any treatment and the parents resisted, perhaps he could talk to the parents before calling in the troops? Perhaps he could imagine that he isn't the ruler of the world? Perhaps he isn't used to having a discussion with a well-informed patient. He should get used to it. Did this guy not consider the stress this situation would cause the child? Has he not read the research regarding immunosuppression and stress? Did it not occur to him that the stress could outweigh any potential benefits of radiation? And, by the way, had he not read the research that nearly 80% of oncologists would NOT have radiation if they had cancer.

Third, what judge doesn't do a hard pause before yanking a child with cancer from a family? Even if the doctor argues passionately for his desired treatment protocol, could the judge not wait one day while he received a second opinion?

My husband had testicular cancer and decided to forgo radiation. His survival chance without it was 90%. His survival chance with radiation was 97%. Waiting to do radiation and having to have chemo gave him a 95% survival rate if he waited. Some people feel better with that extra 7%. Good for them. He felt better not being lit up and being sick. And, by the way, knowing that should he have a more serious form of cancer down the road, he would never be able to fall back on radiation because he had already received it.

Many people make these choices every day. Parents make these choices every day. The doctor will not have to make funeral arrangements should any treatment plan fails. The doctor doesn't know the outcome. When entering the gray zone of medicine (and it is almost all a gray zone), side with the people who have to live with the consequences not the arrogant boob who resents being questioned. Link
More blogs about the woodlands rita.