Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Stop with the curbside consultations. They don’t help anyone.

Miranda Fielding, MD
Conditions
January 29, 2015
399 Shares
Share
Tweet
Share

Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast.  She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer.  This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast cancer, so at the very least excision of the abnormal area is indicated, and in some cases radiation and/or mastectomy are necessary.  My husband asked if I would speak to her regarding her breast cancer, and somewhat reluctantly I said yes.

Why reluctantly, you might ask.  Isn’t that the nice thing to do?  I said to my husband, “I think it’s a mistake to do consultations over the phone.  I have no access to the mammograms or pathology report, and I cannot examine her.  These things are important to have and do to give someone an informed opinion about her case.”  He said, “But can’t you just talk to her a little bit and recommend a surgeon, and maybe give her a bit of information about radiation therapy?”  I agreed to do it.  A few days later we connected by phone.

Having practiced in San Diego for twenty-one years, and having a major interest in breast cancer, I know every surgeon in San Diego and Riverside counties who specializes in breast cancer.  Likewise, every radiation oncologist and medical oncologist.  I am a virtual referral encyclopedia — tell me where you live, and I will tell you where to go.   In this case, I recommended the surgeon whom I would choose to operate on me, if I had breast cancer.  Same thing for radiation oncology.  I did this for my husband’s friend, and we discussed her case at length.  Because of her relatively young age, excision alone was a bad choice, so we discussed the pros and cons of excision plus radiation versus simple mastectomy with or without reconstruction.  At the end of the conversation, she thanked me, and then mentioned that there were actually two areas in the breast that were biopsied and were positive, and they were not particularly close together.

That little fact, which I would have known if I had had her pathology report and her mammograms in front of me, changes everything.  If a woman has multifocal disease, there is a good probability that she may be better off removing the breast.   I backtracked and covered that point, but I worried that I had made an anxiety provoking situation much worse by confusing a new breast cancer patient.

In the end, she sought the care of an excellent breast cancer surgeon, and I know she will be fine.  But I have the lingering feeling that in trying to do the nice thing, I did the wrong thing.

Think of this when you stop your doctor friend on the street to ask about a friend or relative who has recently been diagnosed with cancer.  Curbside consultations do no one any favors.  If you or a friend or relative need an opinion, get an informed opinion — present to the consulting physician with your history, your radiology, your lab work, your pathology and your body to be examined.  Then, and only then, you will be assured that the recommendations that you receive are the ones you should truly follow.  It could save your life.

Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries.

Prev

Let's be judicious in our use of surfactant

January 29, 2015 Kevin 1
…
Next

We forget to ask patients what their goals are

January 29, 2015 Kevin 5
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Let's be judicious in our use of surfactant
Next Post >
We forget to ask patients what their goals are

More by Miranda Fielding, MD

  • I began to love medicine again

    Miranda Fielding, MD
  • What is the recipe for a great cancer doctor?

    Miranda Fielding, MD
  • Plastic surgery is more than Botox. Hopefully doctors can remember that.

    Miranda Fielding, MD

More in Conditions

  • Breaking down barriers: How technology is improving diabetes management in underserved communities

    Anonymous
  • Yoga and self-care won’t cure my Crohn’s disease

    Kristen L. Cole
  • What causes fainting and how to prevent it during needle procedures

    Jean Paul Brutus, MD
  • Healing through love and spirituality

    John T. James, PhD
  • Lifestyle change: the forgotten solution in health care

    Tyler Petersen
  • Breaking the cycle of childhood obesity

    Martin C. Young, MD
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • An unspoken truth about non-compete clauses in medicine

      Harry Severance, MD | Policy
    • Fostering the next (diverse) generation of clinicians

      Imamu Tomlinson, MD, MBA | Physician
    • Healing through love and spirituality

      John T. James, PhD | Conditions
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Rescuing primary care: the role of health administrators [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breaking down barriers: How technology is improving diabetes management in underserved communities

      Anonymous | Conditions
    • From penicillin to digital health: the impact of social media on medicine

      Homer Moutran, MD, MBA, Caline El-Khoury, PhD, and Danielle Wilson | Social media
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • How to overcome telemedicine’s biggest obstacles

      Harvey Castro, MD, MBA | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 15 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Investigational ALS Drug May Have Clinical Benefit, FDA Staff Says
  • Cases of Deadly Fungus Tripled in Past Few Years, CDC Says
  • Small Gains in Cardiorespiratory Fitness Track With Improved Longevity
  • Improved OS With Hyperfractionated RT in Recurrent Nasopharyngeal Carcinoma
  • GPT-4 Is Here. How Can Doctors Use Generative AI Now?

Meeting Coverage

  • Rapid Improvement in Atopic Dermatitis With Topical PDE4 Inhibitor
  • New Approaches in the Bladder-Sparing Paradigm
  • Response Rates in Hidradenitis Suppurativa Continue to Climb With New Therapies
  • Another Win for a JAK Inhibitor in Alopecia Areata
  • Biologic Switch Revs Up Response in Plaque Psoriasis
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • An unspoken truth about non-compete clauses in medicine

      Harry Severance, MD | Policy
    • Fostering the next (diverse) generation of clinicians

      Imamu Tomlinson, MD, MBA | Physician
    • Healing through love and spirituality

      John T. James, PhD | Conditions
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Rescuing primary care: the role of health administrators [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breaking down barriers: How technology is improving diabetes management in underserved communities

      Anonymous | Conditions
    • From penicillin to digital health: the impact of social media on medicine

      Homer Moutran, MD, MBA, Caline El-Khoury, PhD, and Danielle Wilson | Social media
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • How to overcome telemedicine’s biggest obstacles

      Harvey Castro, MD, MBA | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Stop with the curbside consultations. They don’t help anyone.
15 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...