One Oncologist's View of Supportive Care

I had forgotten how much I learn during the week here in San Antonio from doctors while waiting for the shuttle that will take us from hotel to convention center. This morning I was waiting and stuck up a conversation with an oncologist from Kentucky. I told her my story about being a 28-year survivor and my mom dying of breast cancer, and she talked about the studies she was eager to hear about. Then I said.

“What do you provide for your patients in terms of supportive care?”

She replied that she thinks they have a couple support groups, but that “her patients don’t want to go” because it’s too negative.

I always want to stop at that point in this oft-repeated conversation and ask how many of her patients wanted to do chemotherapy when she told them that was their treatment. But I didn’t.

I went on to ask her if she didn’t think they should go, and she told me that she had tried to implement a number of supportive care programs including yoga, but she would have to find the funding and then try to find a location and publicize it -- it was too much.

I said, “Why doesn’t the hospital pay for it?”

She looked at me like I just don’t keep up.

“They are about the bottom line and they don’t want to spend the money.”

Then she said something interesting about having more time to create programs like this if she was still in the 10-doctor practice she was in five years ago. I asked her why she wasn’t.

“Because it got to the point we couldn’t afford it," she said. That was when we all went with the hospital. They charge a lot more but we could not keep it going on our own.”

This was where I remembered that oncologists are not business people. I asked her how it was going being with a hospital, and she said that she hated it because everything she did was overseen and judged and “having to ask for half day off or vacation” is ridiculous. In addition, her treatment choices were judged. And, she said, the care is much more expensive, but the insurance companies will pay for it more easily when the hospital is in charge. She said she had tried to delve into the agenda of the hospital but couldn’t make sense out of any of it.

We have a real problem in this country when insurance companies decide our care. We have all known this for a long time, but it is coming home now in a real way that we have no control over our care — and our doctors don’t either.