Thursday, June 28, 2012

"Doctor's Duty Of Care" Practice and Malpractice In Melanoma

This is going to be awkward, let me admit to that right upfront. This is one I wish I didn't feel compelled to write, but do. Let me begin by stating that I'm from a "medical" family. My Daddy is a retired dentist. My husband and daughter are both pharmacists as is a brother-in-law, as was my father-in-law and his uncle before him. I have a great medical team. I've always had great medical/dental care. From the moment I first presented my mole to a PA at a Duke Urgent Care for removal, I've been in the Duke system and under the care of melanoma specialists: dermatologist, surgical oncologist, and if ever needed an oncologist (whom I've met a couple of times but, as yet, have not needed the services of. But she's there and has my file if I ever need her).

I've been aware, all my life (well, since I was old enough to actually be aware of this), that not everyone has great medical care, even adequate care. I wish that wasn't the case, but we all know it is. In the world of melanoma I find myself constantly asking people if they are in the care of melanoma specialists as that is crucial. Even then not all specialists are created equal. Some are better than others. Aim At Melanoma has a great tool for finding an oncologist that specializes in melanoma. This list is just for oncologists, but generally, where you find them you'll also find melanoma specialist dermatologists and surgical oncologists.

I am also aware that before we ever get to a specialist, we are diagnosed, usually, by either a dermatologist or primary care physician. Again, some are better than others and all are not created equal. The minute they say the word "melanoma" the next words out of their mouth should be, "Let's get you into the hands of Dr. So-and-So, the best melanoma specialist in our area." In an ideal world that is always said! That ideal world does exist in some places, as I, myself, live there. When I received my diagnosis, in a voice-mail from the doctor at the Urgent Care, after he said my mole had melanoma in it, he said, "I've made you an appointment with a Duke oncologist to see what we're dealing with." That Duke oncologist turned out to be the top melanoma specialist at Duke.

People, there are standards of care when it comes to melanoma. Particularly read this page and the page after it. You'll see what to expect overall and by stage. This is what to expect. Period. If this isn't happening to you then you've got the wrong doctor. Get referred to another one, even if you are seeing a "melanoma specialist." Remember, not all are created equal.

Now for the awkward part. I'm becoming increasingly aware of sheer ignorance on the part of some in the medical profession when it comes to melanoma. Maybe it's arrogance on the part of some as they may not like to admit they don't know what to do. Maybe it's sheer negligence. Whatever it is, if you have been diagnosed with melanoma, at any stage, and your care does NOT line up with the standards as found at the National Cancer Institute (the two links in the above paragraph) then your life depends on you getting out from under the care of your present doctor that is treating you for melanoma. That simple.

And document what your "care" has been as you may have grounds for a medical malpractice claim. I'm learning of some very alarming practices when it comes to the treatment of melanoma, and not from already questionable clinics and programs. I'm talking about doctors whom their patients trust. When we are given that diagnosis we're stunned to say the least and it's a natural reaction to trust, automatically, the doctor who gives that diagnosis. We already believe our best interests are at heart and we'll do whatever we're told. Often without stopping to think or question.

Thinking and questioning are vital activities! If something doesn't make sense, it may be stupid or even fatal to follow blindly and do as told. You are your own best advocate, maybe even your only advocate, and it's up to you to open your mouth and ask questions. It's up to you to insist on seeing a specialist and it's up to you to demand that second, or third, opinion if you want to.

It's up to you to know the "Doctor's Duty Of Care." This is what to expect from your doctor, any doctor, about any reason to have a doctor. This must be coupled with the melanoma standards of care. If you become aware that your doctor may not have lived up to the standards then this will help you know if you're possibly the victim of negligence. This is two separate documents from the same site and there are links you can follow in the articles for more information.

Melanoma is something of a "take charge" disease. Take charge of it or it will surely take charge of you. If it has already spread to at least one lymph node then it is already somewhere in the stage 3 spectrum. If it has spread to at least one vital organ then it is already somewhere in the stage 4 spectrum. It is beneath the body surface and requires being treated as such. If it has not spread to lymph nodes or organs then it is somewhere in the 0-2 spectrum. All must be staged accurately and all must be treated stage appropriately. Not all doctors are able to do that, unfortunately. God bless those that can and do and they're in the majority. Most of us have nothing to worry about when it comes to our standard of care.

Some of us do though and I hope this has proved helpful and provided food for thought and information to set you on the right path.

Word to the wise: if, after reading this and the links within, you have a sick gut feeling that you're not being treated as you should be, take action immediately. ASAP means ASAP. With melanoma you don't have time to sit and worry or cry. Use the Aim At Melanoma Find A Doctor link and do just that. Find a doctor. Call the office, explain your situation and make an appointment for as absolutely soon as possible. Be your own advocate and don't be put off for even a month if at all possible. If you can't be worked in within a week, ask to speak to the next person higher on the ladder and keep climbing that ladder as long as you have to until you talk with someone who will get you in ASAP to see what's going on with you and get you on the right course. Melanoma, if it's in your body, isn't going to wait nicely. It's active and growing.

And that's damn scary. I know. But it's also the truth. It's not going to play around and neither will I.

Somebody's got to be honest with you and give you a fighting chance. And if that person is me, well, then...

I'm grateful for the opportunity. Let whosoever has ears to hear, listen.