The Curbside Consultation

Recently a friend of my husband’s in San Diego had a mammogram which 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.

7 thoughts on “The Curbside Consultation

  1. You helped her by listening. You helped her by affirming a good doctor choice, a good surgeon. You helped her by being compassionate and kind. Help after a Cancer diagnosis comes in many forms. You did a good thing.

  2. I also think you did a good thing, tho I really get it about curbside doctor advice as I am asked questions all the time about dogs and cats I have never seen or had my hands on. But you did listen, you did give her referrals of the best kind. That alone made it a very good thing. And the best was you gave her the name of the surgeon you would let cut you. The multifocal part was caught and was at least partially addressed and she can ask better questions of her oncologist and surgeon. :)

  3. If you decline to opine, though, it makes you look like one of those snooty professionals who relishes the the air of mystery around the medical priesthood. I know I can’t resist hitting my doctor daughter up for off-the-cuff advice, which she reluctantly offers only after a lengthy preamble of caveats and cautions about the limitations of remote medicine. We call it a “phonognosis.”

  4. Attorneys will experience the same thing. We like to tell stories of cocktail parties where your new acquaintance has a friend who has this legal problem and what do you think? We’ve actually had to defend ourselves for giving out that “free” advice without disclaimers so we offer broad, non-specific advice and encourage that person to make an appointment with us during working hours. But as someone who was able to chat with you, Miranda, about my diagnosis of breast cancer, I have to agree that the best part was you just listening to me. I know from experience that I am not hoping for free advice but just someone that cares enough to talk to a stranger and set some of their fears to rest. Hopefully, I am passing on your blessing to those around me now.

    • Thank you Marie! I was probably having a moment of cynicism when I wrote this. Several people have called me out on it and said exactly what you said! I hope you are doing well. M

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