Recently, I had a cancer patient who had never had any previous health issues. Because of this, he didn’t have a primary care physician (PCP), but he did have a drug problem.
As a "drug seeker" who had a lot of legitimate cancer pain, it was important that one doctor oversee his care. Upon visiting the emergency department due to pain, the staff was concerned that his lack of a primary medical doctor would bring him back for pain management.
The social worker pursued him via phone trying to make him schedule an appointment with a primary care doctor. The patient was understandably overwhelmed with a new cancer diagnosis, and several oncology specialists. He had no needs outside of his cancer at the time. He asked why it was so urgent that he talk to a medical doctor right now. In truth, the oncologist and I agreed with him.
He didn’t require a PCP at the moment, and certainly not for the management of his cancer pain, but in time, he would. When he finished his cancer treatment, he would need routine medical follow-ups. But in the first few weeks, adding doctors who might prescribe additional medications was probably not ideal.
In time, the patient was able to successfully manage his pain and develop a cancer treatment regimen. He was then assisted in finding a PCP.
Like so many cancer patients, he had formed a bond with his oncologist. He was used to visiting the oncologist every few weeks. Despite the many conversations we had from the time of diagnosis, he still had a hard time with the idea that he needed to have a PCP. His oncologist had done so well managing his pain that he felt his oncologist could treat anything and everything. But just because the oncologist can do so, doesn’t mean he should.
Often, a cancer patient will ask why they still need their PCP, especially because many oncologists continue to follow their patients for long-term side effects of treatment, or for chronic cancer management. As patients’ healthcare conditions become more complex, however, it is important that they have the same rapport with their primary care doctors as they have with their oncologists. Goals of care discussions, end of life wishes, and care planning are conversations that should be had with primary care physicians and oncologists.
As the healthcare system becomes further overwhelmed, oncologists, too, find it difficult to keep up with their workload. Just as it is not in the best interests of the patient for a PCP to manage cancer needs, it is not in the best interests of the patient for a cancer doctor to care for routine medical needs.
Dr. Wendy Harpham wrote an article in the Oncology Times about how managing everyone’s medical problems takes time away from the cancer patient, time that is desperately needed to discuss things like goals of care and treatment options.
Harpham reminds us that the oncologist’s role is to help the patient cope with cancer as the greatest health threat, but that the greatest goal for patient and healthcare providers is helping the patient achieve the best overall health outcome. This outcome depends not just on the oncologist, but on the primary care physician and all clinicians on the healthcare team.
The goal for all of our patients is optimal health and quality of life. That requires the healthcare team to function as a cohesive whole; not independent parts. Helping our patients understand why all of those parts are necessary can be challenging. Harpham's article is not only a great explanation of why patients need their PCP, but can also be used as a handout. I hope you find it as useful as I did.
Are some of your cancer patients reluctant to seek out a primary care physician to help manage their care?