What is the role of the inpatient oncology consult?

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unleash500

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At my hospital, all the oncology consults get turfed to outpatient. Eg. Once you get tissue patient can get discharged and seen as an outpatient, no need for us to see inpatient. What should be the role of the inpatient oncology consultant? Is this normal?

Hematology sees all the unstable liquid cancers/ benign heme / etc

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From what I’ve seen it’s “normal” in private practice to push everything to outpatient follow up.

In academic centers with fellows — obviously more robust inpatient follow up. Which I think is fair. It’s easy to forget what it’s like being a resident or hospitalist, nobody knows jack about the disease or the whacky drugs we use. Forget about other specialties.

Cancer is scary, people are ignorant, which breeds a lot of fear in non Heme onc doctors and also the patients who can sense when a doc is out of their depth.

It’s surprising how badly people manage pain from visceral crises or dismiss patients as lost causes because of the C Word.

Had a pt in full on heart failure — but a premature conclusion was drawn that the dyspnea is from lung cancer... a stage 1B Adeno... you can’t make this up.

I often find my role is: being the patient advocate against the hospital machinery, allaying fears of patients and doctors, and ensuring patients receive adequate and timely treatment — new or old diagnosis, oncologic issue or not or whatever the case may be.
 
My role is a clerk. We don't have a solid tumor care coordinator. Oh wait, there are fellows for that.
 
From what I’ve seen it’s “normal” in private practice to push everything to outpatient follow up.

In academic centers with fellows — obviously more robust inpatient follow up. Which I think is fair. It’s easy to forget what it’s like being a resident or hospitalist, nobody knows jack about the disease or the whacky drugs we use. Forget about other specialties.

Cancer is scary, people are ignorant, which breeds a lot of fear in non Heme onc doctors and also the patients who can sense when a doc is out of their depth.

It’s surprising how badly people manage pain from visceral crises or dismiss patients as lost causes because of the C Word.

Had a pt in full on heart failure — but a premature conclusion was drawn that the dyspnea is from lung cancer... a stage 1B Adeno... you can’t make this up.

I often find my role is: being the patient advocate against the hospital machinery, allaying fears of patients and doctors, and ensuring patients receive adequate and timely treatment — new or old diagnosis, oncologic issue or not or whatever the case may be.
This all day long. Oftentimes, when someone gets a new dx of cancer as an inpatient, the knee jerk reaction is to both blame every symptom they presented with on the cancer and to have palliative care see them before oncology does.

So my role seeing a new cancer diagnosis as an inpatient is to make sure the workup is complete and be there to allay fears and answer questions.

One thing I sometimes do is just go have a chat with the patient. I'll write a quick note to pass on to the primary team that I was there, but I won't bill for it.
 
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