mother with CA

[missmacrn]

I am a new user. I have been reading from this site for a couple of weeks since my step mother has been dx with CA and thought I might as well join and maybe I can get some feedback on some specific concerns I have. My step mother and I are very close. She and my Dad have been married for 25 years and we have grown to be very good friends over the years. Her mother and two sisters have or have had CA. Her 39 year old sister died 2 years ago from breast cancer. After her sister died she went to her GP and told him that she wanted a mammogram because of the family history. He deferred her from it stating that it may stir something up. ( I thought she had one done.) He instead performed breast exams until now. She insisted on having a mammogram during breast cancer month. Sure enough a tumour was present which when biopsied was positive for CA. They did an U/S in which the nodes looked inflammed. Bone scans and cxr all were negative. She underwent surgery last week removing the tumour and nodes. We will find out next week at follow up with surgeon about the nodes. I find myself extremely angry with her GP. She is angry but feels she needs him. (we are in a region where there is an extreme shortage of doctors and it would be very hard to replace him.) How should this be handled...should he be reported? If she didn't insist on having a mammogram who knows how far it would have gone.

[Thunderwolf, MSN, RN]

I am sorry to hear about stepmom, but glad she was assertive enough to follow thru...despite her doc. Are there any support groups around regarding women with breast CA? You might want to connect with some one in social services who may know how to find out. There she and you can find additional support, answers, and possibly a referral to a better doc. I hear you regarding your doc in question. But, if your doc doesn't serve you and your interest and prefers to minimize genuine concerns as your stepmom did, it is like having no doc at all! The best message sometimes for a doc like this is to take your business elsewhere. Despite the scarcity of docs, it is YOUR health...there are better docs! I'm sorry she had to go through all this frustration and worry. I hope things improve and you all get good news on the follow up visit. You have my prayers. Wish you all the best!

Welcome to allnurses!!!!!!!!!!!!

[Tweety, BSN, RN]

Maybe if you posted this on another board besides the intro board, you can get more answers.

I'm not sure if M.D.'s are like nurses in that they are bound by "what a prudent doctor would do". If a prudent doctor elsewhere would given your step mom a mammogram at that time, then you might have a case.

Good luck.

[NRSKarenRN, BSN, RN]

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how should this be handled...should he be reported? if she didn't insist on having a mammogram who knows how far it would have gone.

1. who is the insurance payer?

if a managed care company, send a letter to the physician utilization review department regarding your concerns. i'd also make a call to them registering a complaint and see if your mil can have "case management" to make sure her future cancer treament goes smoothly due to denial of sevices by pcp.

if medicare, can file a complaint about the quality of care with the states quality improvment organization--see medicare website link. search for info on topic, select state and check box "quality of care/complaints" to find contact info

http://www.medicare.gov/contacts/include/datasection/questions/searchcriteria.asp#astep2

2. make sure concern documented in the hospital and specialists chart so it's on record at facilities pcp is associated with. if the doctor is on staff at the local hospital, would also send concern to their medical staff board.

3. report concern to local medical society.

4. she can always ask for a copy of her chart "for specialist use"---doc has to provide a copy under hippa with her paying the copy fee. review and if you see documentation request denied or no documentation at all, can seek legal counsel. know full well if you go this route, will need be have another doctor.

if the doctor has appologized for not listening to her sooner, and has otherwise provided good care, might be more willing to continue with the current physician. otherwise, look for a new one.