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

The costly decision of delaying surgery

Cullen Ruff, MD
Conditions
August 29, 2019
Share
Tweet
Share

It was a common enough reason for someone to have a CT scan. The order read, “Abdominal pain, colon cancer resected in January.” It was now March, only two months post-surgery. Yet the patient’s CT scan showed a number of large masses in the liver, consistent with metastatic cancer.

I compared the current study to the CT performed before surgery. The liver had looked perfectly normal at that time.

“That’s an amazingly aggressive tumor,” I thought to myself. The patient would have been told after the first scan that a colon tumor was confirmed, and that it would need to be removed, but that there was no sign of spread to other organs or lymph nodes. It was at an earlier stage then, with a greater chance of cure. Now it was a stage IV out of IV, having metastasized to multiple spots in the liver. There would be treatment options, some not particularly pleasant, but a much lower chance of a true cure.

Still amazed at the change between the two studies, I checked the dates on the scans and realized something: There had been a delay in undergoing surgery. The first scan, with the colon tumor and normal liver, was from mid-November. The patient did not have surgery until early January. Almost two months had passed between diagnosis and surgical excision. Two months for that cancer to have spread from the colon to the liver, making the disease incurable for this patient.

Surgery would have surely been recommended when the cancer was diagnosed; why would anyone wait that long to have a cancer removed? The reasons may vary. This patient had insurance, so the delay was likely not financial. Some cancers, like low-grade thyroid or non-melanoma skin cancers, might not require the urgency that a higher grade, more aggressive tumor might, such as many colon, lung, breast, or pancreatic cancers, as examples. Looking at the calendar dates, however, I feared that the answer was a bit simpler, confirmed after speaking with the oncologist. This patient got diagnosed in November but opted to delay treatment until January, choosing to enjoy the Christmas holidays and deal with medical reality after the turn of the New Year.

On one level, I get it. Any holiday season, religious or secular, may have its traditions and festivities that we relish. People may look forward to the personal, communal, and spiritual rituals of a season that help give our lives meaning and perspective. If it is not a holiday celebration, it might be an event that an individual or family has been anticipating, such as a wedding, a graduation, a milestone birthday, or a big vacation. There is never a good time to get sick, or to have surgery. An operation would surely interrupt and detract from a time that would normally be happier and livelier.

This case may remind us that we do not always get what we want or expect, of course — yet sometimes in those circumstances, we might do ourselves a favor to remember that we are still given opportunities that other less fortunate people may not have. Conditions are seldom perfect, and life sometimes hands us something we most definitely do not want. Yet, we do not have to like doing what is in our best interest. If we have an option that may allow for a more favorable outcome than others in the same situation might have had, in other times, places, or circumstances, it may be wise to consider accepting the offer available in a timely fashion, rather than postponing treatment and taking a chance on fate.

This particular patient chose to put this cancer surgery off until after the December holiday season. Yet by doing so, and giving the cancer more time to spread, the patient will probably enjoy fewer holiday seasons going forward. We will never know; maybe the tumor would have spread quickly regardless, or had already metastasized microscopically, and just needed time to grow and become visible by medical imaging. What we do know is that waiting two months certainly did not help.

Whether medical, financial, or of another vein: If one is unsure what action should be taken in an important situation, it makes sense to consider options and not to act in haste. On the other hand, if the decision is as clear as it may reasonably get, delaying a necessary action may be mighty costly indeed.

Cullen Ruff is a radiologist. This article was originally published in XRAYVSN.

Image credit: Shutterstock.com

Prev

It's time to seriously study gun violence

August 29, 2019 Kevin 8
…
Next

Life hacks from a 9-month-old infant

August 29, 2019 Kevin 0
…

Tagged as: Oncology/Hematology, Radiology

Post navigation

< Previous Post
It's time to seriously study gun violence
Next Post >
Life hacks from a 9-month-old infant

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Cullen Ruff, MD

  • The CT contrast shortage is a learning opportunity

    Cullen Ruff, MD
  • A critical moment that resulted in a permanent, devastating consequence

    Cullen Ruff, MD
  • Think you have an iodine allergy? You may want to reconsider.

    Cullen Ruff, MD

Related Posts

  • Hormone replacement therapy is still linked to cancer

    Martha Rosenberg
  • Please change the culture of surgery

    Anonymous
  • Cancer care costs everyone too much. What can we do about it?

    Andrew Hertler, MD
  • Why cataract surgery is more complicated than it should be

    Brian C. Joondeph, MD
  • Robotic surgery’s impact on training the next generation of surgeons

    Barry Greene, MD
  • Women in surgery: a tweet to action

    Sarah Shubeck, MD and Arielle Kanters, MD

More in Conditions

  • What if medicine had an exit interview?

    Lynn McComas, DNP, ANP-C
  • Finding healing in narrative medicine: When words replace silence

    Michele Luckenbaugh
  • Why coaching is not a substitute for psychotherapy

    Maire Daugharty, MD
  • Why doctors stay silent about preventable harm

    Jenny Shields, PhD
  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • 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
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, 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

View 1 Comments >

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

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • 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
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, 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

The costly decision of delaying surgery
1 comments

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

Loading Comments...