It seems more and more often I have patients who come in and insist on getting some special scan ordered for them. Their rationale invariably consists of either, “I have a friend whose uncle is getting lots of scans for his cancer,” or “How do we know if my cancer is really gone if we don’t get another scan…?”
Believe me, I am very sympathetic to the sentiment behind each of these concerns. But what’s most important is to address the root causes of these concerns with education and mentoring — a far better approach than needlessly spending thousands of healthcare dollars of no medical value.
Indeed, it is far easier to just write an order for a PET scan or a CT scan than it is to do the hard work required to talk a patient down from their anxiety, which is often driven by family members’ insistence that “everything” is being done to fight the cancer.
Being a good doctor is not a matter of “doing everything.” In fact, burying patients with the kitchen sink does much more harm than good. A good doctor is a teacher more than she/he is a technician ordering tests. Wanting some kind of test or scan just because someone else got one is not unlike wanting a new set of golf clubs even though you don’t play golf.
What unwarranted requests for the PET and CT often reflect is a need on the patient’s part to be reassured about their status. But the best way to reassure them is to explain the overall picture, and when and where scanning and other tests will be appropriate tools to implement during the long course of their cancer journey. By explaining to patients that their type of cancer doesn’t grow fast enough to justify monthly scans, they will usually feel much better than they would by ordering a scan every month.
In the end, of course, it all comes down to trust…a trust in the doctor’s plan, which must be earned and maintained throughout the doctor-patient relationship. There’s no better way to develop this than to dialogue regularly about testing strategy and any other concerns that surface along the way. When you listen, explain and reassure, then you build trust.
And that’s the only way to be a good cancer doctor.