The rise of the new breed of Dr in the increasing market of BC

MaggieR

HI all,  I didn't know what to call this but my story is to raise awareness and to alert you to what is happening out there.  
I am nearly 3 yrs into my Stage 1 diagnosis and regularly see my surgeon.  I no longer see my oncologist as they consider my GP my primary care giver.  This is good as my GP is fantastic.  I don't know why i continue to see my surgeon as her specialty is cutting, right?
Well my last appt with the surgeon was supposed to talk about my increased liver enzymes possibly resulting from my meds.  I was greeted by the "Breast Physician" who I had never met before and taken into her office.  NOt a good start as I'm wondering where is the surgeon and why am I not in her office? This '"physician'" commences speaking to me like it's our appointment telling me about my tumor markers and my liver enzymes.  I'm not listening at this point as really I don't know who the heck she is and why is she talking to me like this.  Eventually, after I asked her if she was in fact a Dr and asking for my surgeon the surgeon came in for a couple of minutes.  I walked out really confused with a blood test form written by this new Dr.
SO HEADS UP LADIES - I was not consulted about having my records given to another Dr.  I was not consulted about having results given to another Dr.  This new Dr operates part time out of the same office as the surgeon.  I suspect this is a way the surgeon can keep a cashflow on clients such as me.   This 'Breast Physician" is a GP -not a specialist.  I checked her registration.  GP's have 10yrs study Physicians/specialists 12 yrs.  The notes on my appointment were copied to my GP and signed by this ""physician"".  I won't be going back to the surgeon.  My recommendation is to stay with your GP as they know you best, know all of your history and can work holistically in partnership with you.
I think with the incidence of BC we will start to see more of these Drs popping up - just like skin cancer clinics.  Cynical yes but its just outright wrong for me to tossed around like i don't have a choice.  We always have a choice!
p.s. my gp and i are working thru more blood tests and referral to a liver specialist. Oh yeah my tumor markers are always at the same level- this Dr didn't even both to check my records - freaked me right out.  I'm in SE Qld.

kmakm

Wow. Shocking.

melclarity

@MaggieR I must say I'm a little confused. I've been in the system for over 10 years with my 1st diagnosis in 2011 after treatment, I was scheduled to see my surgeon yearly, as he is the one who does the Mammos and U/sound. At my 4yr mark, I had a recurrence in the same spot, so had to have chemo in 2015. So I then had an Oncologist. Since finishing in 2015, I have seen my Oncologist or Surgeon 6 monthly either or. I've never had any other doctor attached to my Surgeon, is this in public or private? Our care does go back to the GP after treatment, but Ive always been handled by my Specialists which later this year will go to 1yr in between thankfully. I havent heard of what a Breast Physician, so not sure. Hmmm 

MaggieR

HI Mel, I''m private and in regional Qld.  Yes, my visits have been for results of mammos and u/s done at a very good clinic, but then she put in the blood tests which resulted in ongoing consults.  In reality this should've been the realm of my GP.  And I reckon that what the Surgeon thinks too - thus her new offsider. Frankly its seems to be a cash grab to me. I will be referred to a new surgeon - as my old one is no longer the 'only game in town'

melclarity

Oh that's interesting, I admit I see my GP for blood tests and they manage that side of things there. It has nothing to do with the Surgeon. So Odd! Yes Surgeons are a plenty lol. Im in Melbourne so not sure anyone has come across this. 

Afraser

Interesting - I still see my surgeon annually, for ultrasound and mammograms, although it will be mammograms only from now on unless there is any issue as my breast tissue is now very transparent (an apparent benefit of age!). My surgeon has all this done in the centre he works in. So a one stop shop. I have never been asked to see someone else. Nurses will of course run over my records, any changes in medications etc, but that's about it. If I choose to keep up checks, I want them as far as possible with the person I know and who knows my history. 

MaggieR

HI Afraser, didn't know about the 'benefit' of age - looking forward to it. lucky you have a one stop shop so to speak. Are you in a city? My GP lets me know her limitations but the surgeon wasn't interested in discussing my concerns - bad medicine as far as i'm concerned.  I'm regional and I feel like the whole 3 years have been about the $$ unless I travel for govt specialists.  I can't help but think BC seems to be a cash cow with so many of us being diagnosed.   I just feel like I'm being taken advantage of with respect to my diagnosis - the fraternity thinking that i will go olong with anything they do, not even suggest, because they are THE specialist.  Its truly condascending.  

Tennille

I only ever saw my surgeon twice before surgery and twice after. I was then transferred to medical oncology and have been there ever since. I am a public patient so i don't know if that makes things different but to be honest I would rather my surgeon do the surgery if needed and my Onc deal with the rest.

Afraser

I am in Melbourne, and I did go private, although I have been impressed by the number of people on this site who have spoke highly of the public hospital system they have experienced. Rural is another matter! I too only saw my surgeon twice before surgery but given a week from first meeting to mastectomy there really wasn't time for much more. He and my oncologist confer often. My surgeon operated a year later (my 12 month seroma was proving a hotbed for bacteria) after fully discussing the pros and cons - he made the right decision. He's also checked out a couple of things since. Not just into the cutting! 

Mira

I have had a breast gp from the start.   I was a public patient and had my normal gp, a breast gp, surgeon, oncologist, radiation oncologist.   I've barely seen my oncologist (normally see the registrar and that's quick).  I've seen the surgeon 3 times since my op, and one of those times was for a stitch that didn't dissolve, but she's said I don't need to keep seeing her.    Oh, and a wonderful breast nurse  

Sister

I'm still at the beginning of this and going a mix of private and public but as I understand it, my surgeon will continue to manage and co-ordinate.  At the moment I'm doing chemo so seeing the onc before every dose.  Then, there'll also be a radiation onc after that.  At some stage, I believe that I will be seeing the surgeon and onc each every 6 months but they'll stagger it so I see one of them every 3 months - don't know how long that'll go for.  I've never heard any talk of a breast physician - it sounds made up.  I would be sceptical about the motives behind it, too - although I do tend to look for the catch first.  It may be a perfectly legitimate way of introducing a sort of specialist-generalist into the picture - just caught up in newspeak.

jennyss

This is a very interesting discussion. For me it shows up again the variety of breast cancer treatment pathways. Seems to be affected by our different diagnoses; but specially where we live, and our public/private choices/options. Not always fair or equal.
My GP referred me straight to a surgeon after biopsy and pathology results. Lumpectomy was followed by chemotherapy and radiotherapy. I am now out in the wide world with regular monitoring appointments.
 I see the oncologist who is based at the public cancer centre where I had my chemo every six months - not sure how long this will continue. Staff here have changed quite a lot. There is also a GP based at the cancer centre who sees people with side effects or other health problems. This GP prescribed my hormone medication (anastrazole) and osteoporosis medication.
I will see the radiotherapy oncologist once more in June. I will also see my surgeon  in June armed with ultrasound and mammogram (yuk! - hurts!). After that I don't know.
 My wonderful breast care nurse has coordinated treatment for me and advised me about what was going on.
I see my GP of 14 years for all other stuff, which luckily is not very often. She also helped me with Centrelink certificates.
Surgery was at a private hospital, and all other treatment public. All a very high standard I think.

Brenda5

In the public system I hardly ever get to see my surgeon in the annual check up but his name is always on the appointment form. I see who ever is working under him instead. Don't worry, if anything odd arises in your check up he will be summoned and in the appointment for further checks. There is only so much main surgeon to go around in hospitals nowadays and they must delegate so every one is covered.

iserbrown

I found a link that may help to understand a Breast Physician

http://www.breastphysicians.org/what-is-a-breast-physician

MaggieR

Hi Iserbrown, Thanks for that link.  I checked it out and my breast clinic's director (mammogram. u/s etc) is on there and is, in fact, an examiner - YAY and Phew.  This type of GP I think is great - it makes sense if they have the proper training as the group requires.
However, the GP in my story I find is not registered with this organisation - and its been a year.  Im still cynical.
I must say its interesting reading about what types of Dr's we do see after a diagnosis. Perhaps we need more of these Physicians for consistency of treatment regardless of where you live.

Zoffiel

I haven't had any contact with my public BS after BC V2 once my  wounds healed. The last time I made the effort to go to Melbourne to see him, i got "why are you here? Come back if something goes wrong." Which sounded sensible. The hospital keeps making appointments, which I keep deferring just to keep myself in there system so i can self refer back if I need to.
It is interesting how many treatment pathways there are, and how truncated they can become when you are in the public system. I self manage most of my care as the last episode involved 4 different medical services and there was no-one I could trust to do it. I get tests or scans if i think I need them either through my GP or my oncologist.