Principles of Medical Ethics 

Before You Donate

Think very seriously before donating to any breastcancer organization, or fundraising program until you read their Annual Report to see who their top contributors are, and if they have a product that appears frequently in the message the organization sends to the public. That would be unethical and its illegal. The same applies to a request that the public buys products, but does not receive a "donor receipt" for tax-deductible purpose. Read any and all food labels that breastcancer "non-profits" are promoting to raise money. Some organizations tell the public to help them raise money by asking you to visit their websites, but that only gives them "hits" to increase their sponsors.

Another tip, "signing" an online Petition is not acceptable, so don't fall for such antics. An ethical non-profit, or professional will not request your visit to their website, nor use "cookies" placed on your computer when you visit their site.

Purchase the Breastcancer Postage Stamp, the Post Office will always give you your charitable deduction receipt. Its a valid form of fund raising.

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For my daughters, family, friends, 'sisters,'  soul mates and the physicians who helped me accomplish these early steps—my current teammates, and the radiologist who led me to the answer! And the men who love and care about women—and themselves, including physicians.

Ask all physicians you interview the same questions in order to be able to compare. Do not let these questions be answered as the physician is on the way toward or out the door! Remember, your Team may include others than physicians, including spiritual advisors, friends, loved ones, pharmacologists, pathologists, even experts far away who will advise by Internet, and as below, repeated.

• Is the physician board certified (surgery, oncology, radiology, etc. included)? You can check this out by going to  http://www.certifieddoctor.org/index.html or calling your State Board of Medical Examiners. The State may not give you other states information.
• Each physician has a "Credentials File," kept by their superiors, and you may ask to see any letters placed in that file by patients--good or not so good.
• You may put doctors names in www.google.com, www.yahoo.com, etc. and see what comes up.
• Date of last certification update?
• Where was medical training received, and residencies, and fellowships? (Varied educational cities/regions experience is a PLUS)
• How long in practice? How many breast operations has s/he performed? Where?
• If surgeon: How many mastectomies/breast surgeries has this surgeon performed? This year? Totally? In other words, a general surgeon who's recently moved into breast surgery only, may prompt you to keep looking until you are comfortable with the individual's expertise (you'll know when you are).
• How will YOU reach the physician—especially after surgery? Get that information now at this point. Other responsibilities of the surgical team member (travel, lecturing, etc.)
• Who would replace (or "cover" for) your physician in the event he/she is away? Ask for those physicians name(s).  Write them down in your notebook with the other answers.
• Are names of women available who have used the services with each member of the team? May YOU talk to them? They have to obtain the other's permission first, unless the doctor is prepared for this question.
• Who (name) determines protocols for breast cancer that are used by the surgeon, and oncologist?
• Request an oncologist be involved on the team, before any surgery (note: This is a very personal decision. For some, this may be very difficult. If so, trusting your surgeon, and hopefully your family physician, wait until you are more accepting. Oncologists understand!)
• If surgery is needed will your lymph nodes be excised and examined for cancer cells? If not, why not? If so, will they run tests for estrogen and progesterone receptors, HER-2 on the material taken to pathology?
• Where will the pathology be done? By whom? Request a second opinion be done automatically (ask any physician if they'd accept just one opinion on a wife, sister, mother, etc.)
• Request copies of all pathology reports and radiology reports as well as all x-rays, to keep yourself! IF you trust your radiologist, who guarantees s/he will maintain them for at least 10 years, you may decide to leave them but not your mammograms. Keep them yourself!
• What specifically is the emotional support offered by the surgeon's or oncology practice, prior to and immediately after your surgery, and during recovery? To be told they have a social worker on the staff is insufficient. Most patients don't ever see or hear from that person, and professional, psychiatric initial evaluation of individual circumstances is usually needed.
• There are two very excellent national support groups to help you, as well, and most breast surgeons should be referring you to Bosom Buddies or one other national group. They will phone you after you call them and visit with you, help you recover, work your arm, and your heart.
• Hospital: Level I Trauma Center? If not, how far is it to reach one? Request to be transferred there if there is a need for you to go into Intensive Care for any reason.
• Are there oncology (cancer specialty) staff nurses on the floor you will be on after surgery (vs. temporary nurses")? This may not seem important for all breast cancer surgery, but it certainly is! The mind-body connection does not filter out disease variables. To most of us "cancer" is cancer.
• Why is the surgeon selecting the hospital she/he selects (my 2nd surgeon's answer was very complete on this)? Remember, your physician is in charge of your case always, in any hospital and will determine the care you receive.
• Would you be told if you were being placed into a neo-adjuvant TRIAL? That is a trial for a new drug, based on prior research, but before any Trial may ethically be performed, the patient must be told in the presence of a legal witness all the possible side effects, what has occurred with other patients, in the past, how long the drug has been used, and the patient must have had surgical biopsies to her breast tissue and lymph nodes.

To be certain, make sure that you have had at least four opinions from pathologists, breast surgeons, and breast oncologists. Be very careful, be wary, it is your life. Be certain that you are NOT being put on a trial without surgery, and if you have a 3 cm breast mass or smaller.

As one of the nation's top surgical oncologist's stated, its very ". . . unusual to sign patients up for a neoadjuvant trial with only a 2-3 cm tumor since 65-70% will be node negative and better than 80% survival." Thus, obviously, node examination and pathology reports are crucial.

Talk directly to all pathologists who review your surgical and biopsy tissues.

Note: The floor nurses at that hospital can tell you a lot about your physician!

You may request the plastic surgeon close the wounds, if one will be on your case, but it is rarely necessary with a highly experienced breast surgeon—they care.

Shared responsibility comes with your insistence that you have the individuals you select on your team, and you are an active member.

Possible team members may be:  Your internist or primary care physician, surgeon, oncologist, endocrinologist, ob-gyn, certified breast radiologist, psychiatrist/psychologist, anesthesiologist, plastic surgeon, spiritual advisor, family member, friends, and YOURSELF.

Sometimes groups blame each other for deficiencies and the medical model is not doing very well now-a-days. It has been "going to change" for thirty years now and it just hasn't. Now, I believe some of our younger physicians have more openness to new concepts, thus less potential for liability. Socio-economics are shifting, and values being considered (stress creates earlier deaths, etc). The increase of minorities and women is making a shift. There is interest in sharing parenthood so they don't view parenting or their profession as a trade-off.

However, if you are told that "insurance (or the government)" is causing something, or making something else happen or not happen, call your insurer and ask to speak to the Case Management supervisor and check this out. I found them very willing to help me.  And, minimally the insurers must know what YOU need, in actuality!

My insurance changed mid stream on me! That should be against federal law! In less than one calendar year, I have had to work down two sets of "deductibles."  Your local congressperson can help answer the government part of that accusation, too.

Be sure that you can be honest with your team. Let them know your fears, things they said that concern you, etc. They need to know ahead of time if you are not comfortable with their care. Write them a letter if you cannot 'face' them. 

Doctors are patients, too, and would be the same if they were in your place (worse!). There's not the hurry most of us feel when we find we have a suspicion of cancer! Sometimes, what makes us feel this 'hurry" thing is physicians who appear indifferent to your concerns.

You have a right to search until you find a team with whom you feel comfortable. No longer does one have to put up with "S/he has no bedside manner but. . . "  because we're not even allowed to stay in bed that long anymore. Patients are sent home the next day and then what do you have?

If you have specific values you would like to incorporate into your care (religion/spirituality, music, meditation, other people/advocates/family take care of this now. The time you invest in pulling this together is worth it. Most often, one of your physicians will help you to do this. Reach out your hand to them.

Your doctors will watch the 'clock' for you—and each other!

Note: The courage you'll need to do this for yourself, or a loved one, is absolutely nothing compared to the courage that may be needed without these first steps, initially.

Next: What You Must Tell Your Doctors

 
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 rev 10/13/05