CROSS regimen on the chopping block

[communitydoc13]

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Well that took all of a week. One of our satellite providers called me for help. They have a patient with a large lower esophageal adeno in a patient they treated for a different thoracic malignancy a few years ago asking me what options they have. The surgeon wants preop CRT but they are worried about how to deal with the prior dose. Hmm

I'd go with the chemo alone here. I believe Neo-Aegis demonstrated slightly better outcomes with chemorads frankly, but any benefit has to be weighed against toxicity. Perioperative chemo reasonable in the non-irradiated patient and preferable here.

 

[ramsesthenice]

Provider? Can we just... ****ing not with that here, please, for my own sanity? One of your satellite physicians, colleagues, something, anything, just not ****ing provider, please.

Anyways, getting past that - in the previously irradiated setting, I see no reason to demand that the patient get the toxicities of reirradiation rather than consideration of perioperative chemotherapy, especially if the dose to the esohpagus in this area was significant from the previous treatment course.

This is literally the first time in my career I have heard someone have a negative connotation to the word provider. Its a pretty ubiquitous word around these parts. Our community docs are great. Meant nothing to suggest otherwise.

 

[HolySmokes]

This is literally the first time in my career I have heard someone have a negative connotation to the word provider. Its a pretty ubiquitous word around these parts. Our community docs are great. Meant nothing to suggest otherwise.

I don't think he took issue thinking you were disparaging the community docs, rather it's that the word "provider" is being used to encompass MD/DOs along with NPs, PAs, RNs, MSWs, etc... It categorizes everyone the same and "equal" and just further erodes what little authority physicians maintain with the expansion and encroachment of midlevels

 

[Neuronix]

We're not supposed to call them midlevels anymore either.

I can see why--experienced midlevels in the major academic centers get paid not far off what a new MD grad gets paid. Before long we can all be the same...

 

[ramsesthenice]

Great. One more word to add to the list of words to stop using.

I realize 1972 is getting a ways back now, but that was when George Carlin blessed us with a little diddy that started out: "There are 400,000 words in the English language and there are 7 of them you can't say on TV. What a ratio that is. 399,997 to 7. They must be really bad!"

Ratio isn't looking so good anymore 🙁

 

[Ray D. Ayshun]

I'd go with the chemo alone here. I believe Neo-Aegis demonstrated slightly better outcomes with chemorads frankly, but any benefit has to be weighed against toxicity. Perioperative chemo reasonable in the non-irradiated patient and preferable here.

Not knowing what the composite plan looks like here, but there's technically permission to do 30 gy from poet.

 

[TheWallnerus]

Provider? Can we just... ****ing not with that here, please, for my own sanity? One of your satellite physicians, colleagues, something, anything, just not ****ing provider, please.

Anyways, getting past that - in the previously irradiated setting, I see no reason to demand that the patient get the toxicities of reirradiation rather than consideration of perioperative chemotherapy, especially if the dose to the esohpagus in this area was significant from the previous treatment course.

We're not supposed to call them midlevels anymore either.

I can see why--experienced midlevels in the major academic centers get paid not far off what a new MD grad gets paid. Before long we can all be the same...

There’s an anti-provider-screed once a year at least. I identify as male. I do not identify as provider

Professional Identity Misformation and Burnout: A Call for Graduate Medical Education to Reject “Provider”

The professionalism of faculty and resident physicians has been on full display during the COVID-19 pandemic. Media stories have notably praised heroic “doctors and nurses” rather than “providers and nurses,” acknowledging the dedication and training of the people saving lives while putting...

meridian.allenpress.com

Also do not use the term physician assistant anymore. It’s physician associate.

Physician Organizations Challenge PA Name Change

The AMA and AOA release statements against the rebrand

www.medpagetoday.com

 

[Doctorer]

There’s an anti-provider-screed once a year at least. I identify as male. I do not identify as provider

Professional Identity Misformation and Burnout: A Call for Graduate Medical Education to Reject “Provider”

The professionalism of faculty and resident physicians has been on full display during the COVID-19 pandemic. Media stories have notably praised heroic “doctors and nurses” rather than “providers and nurses,” acknowledging the dedication and training of the people saving lives while putting...

meridian.allenpress.com

Also do not use the term physician assistant anymore. It’s physician associate.

Physician Organizations Challenge PA Name Change

The AMA and AOA release statements against the rebrand

www.medpagetoday.com

Can't wait for the first PA to "correct" me. Wonder if I'll be able to keep a straight face.

 

[evilbooyaa]

Also do not use the term physician assistant anymore. It’s physician associate.

Physician Organizations Challenge PA Name Change

The AMA and AOA release statements against the rebrand

www.medpagetoday.com