A CONSULTATION WELL DONE

When I was in active clinical medical practice, some times I ran late.  Patients could find themselves in the examining room a quarter or half hour after their scheduled appointment had passed.  I would explain that when an emergency arose, I had to deal with it and interrupt my normal appointment flow.  And then I explained that I would do the same for them if the need arose - and kept my word.

So, when my Cutaneous Oncology consultant ran late today for my scheduled appointment, it was not an issue. I kept in mind the reason I was in his office, mentally highlighted his credentials and skill set - and was rewarded by an excellent consultation experience.  The remainder of this blog will deal with my definition of an excellent Oncology (Melanoma) consultation.

1. Timeliness.  My consultation was scheduled in a timely manner, neither too quickly (which would have denied the consultant the opportunity to communicate with other doctors involved in my care or review my records) nor too late (after critical time periods for care had passed).  Adequate time was reserved and the consultant extended our session to cover important subjects.

2. History. The consultant was well-prepared through his discussion of my "case" with other professionals involved in my care and his review of my electronic medical record.  But he went through many targeted questions, eliciting additional information relevant to my melanoma, my general health, and specific conditions which would need to be considered before treatment recommendations could be made.

3. Physical Examination.  A medical assistant recorded routine vital signs,  but the consultant performed a targeted thorough physical examination.  An experienced competent physician, could cover all of the relevant physical diagnosis issues in five minutes or less. He did.

4. Discussion of Findings/Formulation of  Evidence-BasedTreatment Plan.  In a careful, thorough, humane and frank manner, and without leaving out important considerations, the consultant reviewed pertinent findings in my medical records, history, and physical examination.  He then discussed relevant data from scientific studies of melanoma from his own vantage as a hands-on treating physician, as well as an academic expert on the disease.  Going further, he discussed the strengths and weaknesses of the available scientific data, current professional biases among oncologists, the economics of treatment, and his conclusions concerning the application of all of the data he collected, and evidence-backed scientific  data to formulate a prognosis and treatment plan.  Throughout this process, he distinguished his professional opinions based on personal experience from positions favored by the weight of reliable data. All of this discussion was carried-out in understandable language, though reference to some of the currently available pharmaceuticals and intricacies of acquired resistance to treatment by melanoma and the biology of the immune response of one's body to melanoma may have been difficult for my wife, who accompanied me.

5. Planning for The Next Step. I left the consultation with a clear understanding of the next steps to be taken by the consultant and his plans for further communications with my other physicians and me.  

Some of the information I gained today was serious and disturbing. But there was a sense of completeness, professionalism and competence that made the consultative experience worthwhile.  After all, adults need to discuss major health issues seriously and make serious informed decisions.  

I left the consultant's office to attend a biomedical ethics committee meeting elsewhere, reassured by the high quality of the care I had just received.