Remember the good actors in medicine

Many of us find ourselves responding recently to a shocking news story about a Michigan oncologist who may have violated the primary charge to clinicians: First, do no harm.

The federal government is charging Farid Fata, MD, with multiple counts of fraud for intentionally misdiagnosing patients with cancer to justify billing Medicare for unnecessary scans and chemotherapy.

The case will be sorted out in federal court over the coming months and years, but how do these charges impact patient encounters for each of us going forward?

There is the possibility that these allegations could lead to erosion of patients’ trust in us. On the flip side, this can serve as an opportunity to remind ourselves of strategies that we can employ to maintain and build that trust.

Keep in mind that telling a patient that he or she has cancer is likely the worst conversation that any of us will have with a patient. In my experience, it may be telling an apparently healthy 30-year-old woman who has had nothing but headaches that she now appears to have a glioblastoma.

Of course, we are never cavalier in such discussions, but just as importantly we can never appear rushed. Even on the busiest day, you can’t rush.

Second, you must immediately discuss strategies for moving forward. You must not only not dismiss the idea of a second opinion, you must responsibly encourage it. And part of that encouragement means that you must make sure that all of the patient’s records — including scan results and your notes — are easily made available for that second opinion.

My mom had cancer and I know from our experience how difficult it was for her to be comfortable that she was doing the right thing in seeking a second opinion. That is a burden we cannot place on our patients.

Finally, for every headline like the ones being generated by the Michigan case, there are hundreds of headlines about the “good actors” in medicine. We need to remind our patients, and ourselves, of that good news.

Sanjay Gupta is editor, The Gupta Guide at MedPage Today, where this article originally appeared, and chief medical correspondent, CNN.

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