It is very common where I work where it takes several visits before a patient is "squared away", and then finally sees us, and then someone is breathing down my throat to get me start the imrt head and neck plan, while it took 6 weeks to get everything together. For example saw someone today that had weight loss of 40 lbs and jaundice in early February, CT scan showing pancreatic mass in early in February. Bx happened in mid February. Referral to medonc and surgery in late February. Pet ct in early March. Referral to local med onc, who then delayed by ordering an MRI (was already deemed unresectable by CT showing encasement of celiac). Now, I see the patient.
I will easily admit I have more time than my med onc colleagues, and would certainly see the patient asap and do the work up myself, but there is butt hurt - people feel like we are stepping on toes or trying to take over. Not the case. Most of us just complete the NCCN guided work up, and it's typically not done: There are enough lymphomas that I have to send back to med onc for a BM bx (only when indicated), or order an MRI of brain for a stage III NSCLC, because the med onc ordered a CT scan. I get a referral for a gallbladder cancer treated by simple chole, and have to be the one to refer to a surgical oncologist for radical resection/partial hepatic resection. There are enough early stage 3 lung cancer patients and even some stage 2s that see me before seeing a surgeon, and I'm pressed to start chemoRT.
I assure you it's not because the medonc is dumb or lazy. It's the sheer numbers of patients they see. But, the referral typically comes late and incomplete and then I get pressured to start treatment asap.
Gutonc- you're clearly knowledgeable and respected on the board. If you aren't sending folks to us asap, give it a try. The average radonc sees 5-10 consults a week and has a lot more time get everything going.
But, not pinning this on medonc. The surgeon or whoever diagnosed the patient can always consult us early, but they typically go thorough med onc first, and everything then can get delayed, because, honestly, I've seen med onc clinics. So many patients; so little time. These poor guys don't leave the clinic until 7p and still don't have time to get everything done.
RadOnc doc is not pinning this on a particular specialty. We see this constantly. It's a systems problem, not one doctor. I think if the world of oncology could see us as equals rather than a technician, we could really help streamline things, and take a great burden off of the med onc, who does hero's work (no sarcasm, at all)
