MARILYN HOLASEK LLOYD

THE LIFE YOU SAVE MAY BE YOUR OWN
Learning About Medical Standards Of Care
By Marilyn Holasek Lloyd

September 9, 2002

Medicine has what is called "Standards of Care." These guidelines are very important when it comes to lawsuits. If a physician does not follow a standard of care, he/she is open to attack. Each specialty in medicine has a set of standards, and they involve the diagnosis and treatment of a wide range of conditions.

These standards do not necessarily mean, for example, that the therapies are the correct ones for patients; only that the medical profession has agreed that they are the best going at any given time. One expects every physician to at least be up-to-date on the standards. This is why medical continuing education is so readily available to doctors. Lawyers specializing in medical issues are certainly likely to be very familiar with these standards. According to my husband, a physician, who was a reviewer on medical practice panels, some doctors have a peculiar sense of what standards of care are all about. In one extreme case, he remembers, an obstetrician went to a hockey game with a patient who was in active labor.

Another troubling case that I learned about involves a friend. She is now a nine-year breast cancer survivor after having been given a dire diagnosis. This year, what she thought was a bug bite turned out to be, on biopsy, a return of her lobular cancer in the skin of her neck. She was sent from a surgeon to an oncologist.

He looked at the pathology report and announced that my friend would be getting C.U.D (my term for chemo until death) This was proposed without conducting any other tests. And then he made the appointment for the small operation to put the drug-delivering shunt in her chest. The nurse in the office tried to comfort her by saying, "you can get different drugs over and over and over."

Well, I went ballistic when I heard this, because I had already looked up the standard of care for a post-menopausal breast cancer recurrence of someone who had positive estrogen receptors and was once on tamoxifen; hormone therapy was in order. And besides that, I read the pathology report. It said "cancer in the dermis" and that is the skin of her neck. That was all it said. So, I had to step in for my friend. I pleaded with her to do the following:

• Get another opinion at a major medical institution
• Meanwhile, cancel the shunt procedure until more information was gained
• Get a CAT SCAN and PET SCAN to see the extent of her disease (The scans came back negative).

After a local doctor saw the PET SCAN was negative, he suggested radiation.

My friend then sought yet another opinion at a university hospital where the diagnosis of the skin cancer on her neck was confirmed. She was then sent to a surgical oncologist who said it was inoperable, because it covered such a large area on her neck. He put her on tamoxifen. He said radiation would "cause too much damage and would be used as a last resort." She consulted another oncologist who agreed. She then consulted an expert in integrative medicine, and finally ended up taking matters into her own hands and went on a fast.

Forty days later, the tumor was almost gone. The doctors at the university hospital were pleased and said the tumor "was now so small it was operable, and it could probably go away on its own."

As you might imagine, my friend and I have been questioning why her original doctor had not followed the appropriate standard of care. He even had admitted: "I don’t know much about the hormonal treatment of breast cancer." Which I thought was absurd. Was this about money? One chemotherapy regimen could cost a patient around $35,000. A patient could live through many rounds of chemo like this. Hormone therapy is mainly a pill. Was this about power and control? My friend is not a sheep-type patient and is an advocate of alternative therapies.

And what about the local doctor and university specialist? Should they not have been applying a similar standard of care? What if she had gone through the unnecessary and potentially damaging radiation therapy?

All of which brings me to the issue of what a person should do if they suspect that a doctor is not, at the very least, following a standard of care.

• Get a copy of your pathology report--It is yours for the asking.
• Look up the standard of care--do an Internet search, or ask for help in the library
• Buy a simple Merck Manual--it lists most standard treatments
• Have a friend help you that might be knowledgeable in this area
• Don’t hesitate to get another medical opinion or a third, if necessary.

The life you save may be your own. OR

The quality of the life you save, may be your own.