Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Cross-coverage has made me aware of the art in medicine

Don S. Dizon, MD
Physician
May 28, 2018
Share
Tweet
Share

asco-logo Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have lives outside of our hospitals and clinics. What’s hard about it, for me, is not the hours covered, but assuming care for patients I do not know. In such circumstances, I rely on my partner’s sign-out, their documentation covering the last outpatient visits, or when necessary, their guidance provided on a phone call. Cross-coverage has made me aware of the art in medicine, and in oncology. Nowhere is this art more significant than when it comes to patients living with advanced cancer.

Years ago I was on call over a long weekend — in addition to covering calls, I also rounded on our very busy inpatient service. One such patient still stays with me. She was in her fifties, and she had metastatic lung cancer — it had spread to her bones, liver, and her brain. She had been on chemotherapy as an outpatient and had been admitted a couple of days prior to manage treatment-related toxicities. I remember walking into her room. She struggled to turn her head, but she smiled as I came in.

I remember asking how she was. “Fine,” she said. “I just need to get stronger so I can go back on treatment.” I looked at her — she was cachectic except for her protuberant abdomen. Her labs showed anemia and LFT abnormalities, reflecting the tumor that was taking over her liver. She looked like she was dying.

But I didn’t know her. I reviewed the notes by my colleague­ — about the discussion over progressive disease despite her last trial of therapy. I searched for evidence that they had talked about prognosis in those notes, that he had talked about “incurability,” “terminal disease,” “death,” or any other loaded word, but I didn’t find it. Instead, he had recorded options for next steps, and that they had chosen one path.

Now she was in the hospital, with complications due to treatment. Although I do not treat lung cancer, I sensed she did not have long. But I wasn’t her doctor. Back then I believed it was not my place to initiate a discussion best left to my partner. Theirs was the doctor-patient relationship I cherished so much in my own practice, and end-of-life discussions are not something to be left to the covering doc … In the end, I said nothing. I examined her, told her I agreed with what our treatment team was doing, and then left her room. She had no questions for me, but then again, I didn’t ask her if she did.

Monday came around and I was no longer on call, but I followed this patient’s course in the hospital. Unfortunately, she did not recover and ended up passing away in that hospital bed. Even today I wonder why I didn’t say anything, and whether I should have. Was I concerned that my colleague would be mad, or that I would be undermining their relationship? Was I concerned about following the right protocol — how one is supposed to care for a colleague’s patient? Mostly I asked myself if it was to protect myself, so I wouldn’t be the bad guy giving bad news to a woman who was holding on to hope. Some would say I contributed to this “collusion of silence,” that I purposely hid my fear that she was dying from her, as others did as well. After all, hadn’t she had a right to know what I thought?

These experiences (sadly, it repeats itself often) have taught me that assuming the care of patients for our partners is not synonymous with babysitting them. We have to be clinicians, and we need to meet their needs and address their questions as professionals in our own right. This means answering their questions with our best-informed opinions, particularly when asked about prognosis. Cancer is serious and scary, and for some, it will prove terminal. When I meet patients at that point, I’ve learned to be honest, at least as honest as I can be. I’ve learned to be as comfortable saying “I think you’re dying,” as I am saying “I don’t know,” depending on what I believe to be true. Mostly, I’ve learned to walk alongside a patient, even if it’s just for a day, because, although it might be a short period, for however long it is, I am their doctor.

Don S. Dizon is an oncologist who blogs at ASCO Connection.  This article originally appeared in the Oncologist.

Image credit: Shutterstock.com

Prev

No more excuses for mental health: Technology offers new hope for intervening early

May 28, 2018 Kevin 3
…
Next

Medical TV shows give insight into the lives of physicians

May 28, 2018 Kevin 0
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
No more excuses for mental health: Technology offers new hope for intervening early
Next Post >
Medical TV shows give insight into the lives of physicians

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Don S. Dizon, MD

  • As an oncologist, this is the hardest role I play

    Don S. Dizon, MD
  • Why physicians should acknowledge the validity of second opinions

    Don S. Dizon, MD
  • A patient who taught an important lesson in doctoring

    Don S. Dizon, MD

Related Posts

  • The art of medicine: a patient’s perspective

    Michele Luckenbaugh
  • Can technology and the art of medicine coexist?

    Lianne Marks, MD
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • The art of medicine is slowly being pushed out. Is that a good thing?

    Steven Zhang, MD
  • Asian-Americans for cross-racial solidarity in medicine

    Angela Y. Zhang, Paul Park, Russyan Mark Mabeza, Rohan Khazanchi, and Ryan Huerto, MD, MPH
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD

More in Physician

  • Physician patriots: the forgotten founders who lit the torch of liberty

    Muhamad Aly Rifai, MD
  • The child within: a grown woman’s quiet grief

    Dr. Damane Zehra
  • Why the physician shortage may be our last line of defense

    Yuri Aronov, MD
  • 5 years later: Doctors reveal the untold truths of COVID-19

    Arthur Lazarus, MD, MBA
  • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

    Nivedita U. Jerath, MD
  • Why this doctor hid her story for a decade

    Diane W. Shannon, MD, MPH
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why physicians deserve more than an oxygen mask

      Jessie Mahoney, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The child within: a grown woman’s quiet grief

      Dr. Damane Zehra | Physician
    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the physician shortage may be our last line of defense

      Yuri Aronov, MD | Physician
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
    • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

      Nivedita U. Jerath, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why physicians deserve more than an oxygen mask

      Jessie Mahoney, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The child within: a grown woman’s quiet grief

      Dr. Damane Zehra | Physician
    • Avarie’s story: Confronting the deadly gaps in food allergy education and emergency response [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the physician shortage may be our last line of defense

      Yuri Aronov, MD | Physician
    • 5 years later: Doctors reveal the untold truths of COVID-19

      Arthur Lazarus, MD, MBA | Physician
    • The hidden cost of health care: burnout, disillusionment, and systemic betrayal

      Nivedita U. Jerath, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...