Tumor Board - When You Have No Clue

[napoleondynamite]

Today in tumor board a case was presented of a malignant myoepithelioma of the breast. I found myself fast-forwarding 18 months to when I will be an attending, thinking about what I would say about a tumor I knew close to nothing about.

I imagine this happens to attendings from time to time. Most stuff in tumor board is bread and butter, or you at least have a working knowledge enough to make an intelligent comment. Also, most times you are given some warning about the cases, so can read ahead of time.

But in that rare circumstance where you are hit by surprise - how do you handle it? What do you say so you don't look like you did 4 years of residency and didn't learn a single thing..? "I'll have to do some reading on that and get back to you?" Just doesn't sound right, even though that's what everyone has to do.

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[deleted4401]

You get a list beforehand (at least where I am at). Look it up the night before, and you will look like the hero.

If you don't know, you can say exactly what you said. Nobody looks down on you, at least in the community.

S

 

[Palex80]

You cannot know EVERYTHING.

Whenever I am hit with some case like that and this does happen from time to time, I usually ask for some time to do a literature review and then get back with more info the next day or so.

We are not walking libraries.

Last time I was hit with a case like that was last spring, asked if I would treat an amyloidosis of the main bronchus, causing obstruction...
I had no clue if you can do that, but I thought AL amyloid=antibody garbage, antibodies come from plasma cells, plasma cells can be killed by radiation, so why not?

We ended up treating the patient and he benefited from it.

 

[OTN]

An iPhone/smartphone LOADED with papers/powerpoint presentations doesn't hurt, either. Fortunately for us, we're usually near the end of opinions given on a case, so I've been able to find an answer in the nick of time this way before.

 

[deleted4401]

OTN is exactly right,, haha ... Have definitely furiously flipped through wikibooks hoping they don't ask for RT opinion until I find that reference for lymphomyoepithiliocarcinosarcoma of the anus.

-S