There is a famous story, perhaps apocryphal, concerning what happened in the cigar-filled back rooms of the 1920 Republican National Convention which produced the surprise nominee Warren G. Harding. As the story goes, certain factions allegedly pushed for Harding because he “looked like a President.” However, his regal countenance notwithstanding, rumors were aswirl that Harding had potentially damning skeletons in his closet which could lead to scandal if selected. The legend then states that, when asked by party bosses if there was anything in his past of which they should be made aware, Harding responded, “Let me make a phone call.” We don’t know who the phone call was to or what the subject matter was but we do know that Harding administration would later be rocked by systemic corruption, most notably the notorious Tea Pot Dome scandal. Harding was later quoted as saying “I am not fit for this office and should never have been here.”
Unbeknownst to cancer patients around the country, a medical scandal is brewing that many doctors may not be fit to render treatment — the oncological equivalent of Harding. A new study, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,” from the Institute of Medicine of the National Academies (IOM) is out which finds that many doctors fail to to have an adequate understanding of the latest science concerning cancer treatment. One patient advocate quoted in news story on the report noted how unaware the average patient is of the problem:
“When cancer patients understand that their local doctor in their community hospital doesn’t have half the new knowledge about their particular subtype of cancer, well, ‘gobsmacked’ would pretty well describe it,” said Clifton Leaf, a cancer survivor and journalist whose new book “The Truth in Small Doses: Why We’re Losing the War on Cancer – and How to Win It” is critical of the cancer establishment.
In best case scenarios, doctors are having to pick up the phone and contact “palliative-care consultants” to help them do their job, while on the other end of the spectrum some “physicians believe their own experience trumps scientific evidence, others suspect their patients are different from the norm, and still others are simply unaware of treatment guidelines.” All of this raises issues not only about physicians’ ability to competently treat those suffering with cancer but also doctors’ ability to communicate with patients in a manner sufficient to obtain advised consent for the proposed course of treatment:
Patients can’t even assume their doctors will communicate adequately. Many are failing to explain the pros and cons of treatment options, let alone asking patients about their preferences. Nor are they spelling out the goals of treatment or even what treatment patients have received and how it might affect their future health. Some chemo, for instance, raises the risk of heart disease.
Also writing about the IOM report in the Washington Post, Harold Pollack summarized the current sad condition of cancer treatment:
The IOM makes plain that our cancer care system is particularly poorly organized to properly care for people with advanced cancers. As outlined by Thomas Smith and Bruce Hillner in a now-classic piece, too many patients are subjected to punishing and futile treatments. Too much costly imaging is performed, for too little therapeutic benefit. Too often, costly supportive therapies, such as Epogen, that raise red blood cell counts are provided when they are not needed. The lack of easily used electronic health records aggravates fragmentation of care and perpetuates miscommunication and medical errors.
The take-away is that cancer patients should not be hoodwinked by a kind beside manner and a doctor “who looks like a doctor.” Rather patients have to take an active role in their own treatment and ask sufficient questions to allay any fears about their physician’s competence. Failure to take charge of your own treatment could place you in a position — as happened to Warren G. Harding — of being a victim of medical care which is “at best, contrary to the best medical practice, and, at worst, bizarre.“