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.

EDUCATION!  Your tool to health

The general public has no idea of the role of a radiologist, much the same as how we view "the pathologist."  If we care about our health, and that of our loved ones, we had better bone up on these two specialties.  In many regards, I have noticed that a great majority of the other specialties are ignorant of these two specialties as well, and the federal laws governing their role in relation to other specialties, and the patient.  This is someone YOU need and will need for a long time to come.  Corporate Radiology has become a thorn in OUR sides - hospitals play into that game.  Find out just WHO is your radiologist, and what practice/company they belong to!  It is your right!
 

Mammograms & Other Radiological Studies
 

Radiology includes a mammogram, CAT scans, MRIs, nuclear or "contrast studies (where a nuclear substance is injected by IV into your veins,  for greater visualization),  and the new non-invasive, non-radiological scanner manufactured by OmniCorder Technology, Inc.  You have a right to question any examination you are scheduled for,  be shown how it is done, know the risks, what any side affects may be, how long it will take, who is performing the test, what you can expect by having the test, who and where is the radiologist (s/he has to be there), and that YOU will be informed immediately - at least as quickly as the radiologist knows.

This is where your role as an equal team member becomes valuable to you - OR you may select someone else to be given the report.  An advocate for you.  It is up to you.

BEFORE any radiological studies are performed, or in fact, you finalize your decision on a physician check out their credentials on the Resourcespage, and the FDA link to accredited facilities.

Mammograms do not hurt. In fact most screening, and diagnostic tests do not hurt.  If you are being hurt, mention it, and if it continues ask to see the radiologist, and tell them to "Stop"  until s/he arrives, and explains to you exactly what is going on (I was recently in a situation where it took a radiology group six hours to perform a simple bone scan - the positioning required being on one's back and the tech taped my toes together, so my heels were pointed outward - and I, ME, swallow that nonsense, and suffered.  Yes, I am fighting back!)  The Administrator investigated, found I was correct and said he'd pay for the repeat scan - the one they did still was not acceptable.  However, I've ended up paying two different  hospitals in Austin for this same test and the first which owns most of the hospitals in Austin have refused my petition their board of trustees as of 2/00.  We'll see!

Mammograms used to be very uncomfortable, and even sometimes painful, but the new equipment and technology has helped with that.  It may be uncomfortable but not like having your teeth cleaned, or an injection, and not like a headache, or anything like that.

How do we get ourselves to have one, or repeat one if we've received a call that it needs to be done?  Radiologists have told said that that they cannot understand why women won't have mammograms, won't come in for a repeat (or a sonogram), or won't come in for a biopsy when they need one.  Relating this to a group of women recently, we heard a voice from the edge of the pool say:  "They're scared."  It was a nineteen-year-old, sitting and observing.

Running away was certainly an impulse I shared with probably thousands of women but I knew from life experience I could not do that and decided to just take "this" one step at a time, and try to get my ducks in a row up to a certain point - primarily get opinions.  I did - The next step was to survive a biopsy.

TAKE THAT SECOND STEP - SETTING THE APPOINTMENT (Checking out the facilities, radiologists, etc. is #1).

Start by planning a mammogram if you are fifty or over (see what to do at Before Mammograms).  If you are afraid to take that first step, that's normal: Ask a friend or child, spouse or an RN friend or neighbor to help you make your call (it's not easy to make requests that establishments don't want to respond to).  Print out the list of questions to ask (Questions).  If you cannot ask those questions, again, get someone else to make the call for you. No one knows whether it is you or not.  Take someone with you, too, so that you have someone with whom you are comfortable.

Don't forget to get all former mammograms for the past five years before you make an appointment. Under the federal law you have the right to own your original mammograms, and are not to take copies.

Make an appointment, and go in (wear a 2-pc outfit), remove all your clothing from the waist up, including jewelry, and put on their wrap or robe.  You are asked to stand or sit so that the technologist (most always a female if you are female) can adjust each breast, one at a time, between the "photographic plates."  There is some compression, but nothing like it used to be; however, very small-breasted women do notice the compression more.  That's it.  It's fairly quickly completed.

They are interpreted (read) by a physician who is called a radiologist.  This is a doctor with special training after she/he completed medical school, and internships, just like a surgeon, obstetrician, and oncologist. They have specialized and passed their board examinations and therefore, most likely, registered with the American Board of Medical Specialties (AMBS).  You can go to their web site to check  http://www.certifieddoctor.org/index.html and their link is here on References & Resources  pages, so that you can check on these physicians reputation, and you should!

Radiologists are doctors, too!  Under FDA regulations, they are the ones who are supposed to perform biopsies, ONLY.  However, a surgeon may do one, but a radiologist must be present!  They can perform other tests to detect, locate, and treat diseases. The public does not know what a radiologist really does.  However, they may be found performing some extensive procedures, which include anesthetized patients being treated for accumulations of fluid from illness, etc.  "Radiology doctors" may specialize further and become experts in the male and female breasts. Therefore, it's not just a photographer taking a picture of your breast tissues. A radiologist who reads your mammogram is hopefully, a breast specialist. HOWEVER, they are required by the FDA to read 260 mammograms every six months.  There are a lot of weekend seminars where they pass the films around and get this regulation cleared for them, so ask them to see their continuing education if you do not know for certain that the certification is valid.  That is exactly how my mammogram was 'mis-read' in 5/98!  It was read by a neuroradiologist!

If you haven't met a breast radiologist, plan to do that. Generally, they are caring, concerned doctors, who so often are the first ones to find a woman's breast cancer. They want to help stop this disease. If you get "negative vibes" from the radiologist you meet, find another one.  Your protons are clashing for some reason!

A technologist generally does the mammogram, and gives it to the radiologist. The radiologists I know are very accommodating physicians. I know that one in my city is now in heavy demand because he diagnosed my cancer, thanks to another outstanding radiologist who referred me to him. Word travels fast and women are relentless when it comes to getting good care, if they just know what to do.  AND, now, my own radiologist is in higher demand, because his thorough approach to reading all of my mammograms, after chemotherapy, caught another mass on the opposite side.  He was thorough, communicative with our entire team (including me), hung in there, and helped to see me through the trauma - which was all anyone could do.

It is very, very important to remember that your radiologist ends of with about $5.00 for doing the mammogram, and reading it.  Therefore, if another specialty physician performs biopsies instead or without a radiologist present, the surgical fee alone is far above that.  Therefore, it is going to take time for us to find radiologists who are willing to review our former mammograms with us, then the current one. If necessary s/he performs a biopsy.  I am NOT suggesting here that you do not consult with, or find a breast surgeon to look at your mammogram, because you can encourage the two physicians to communicate - beginning your team approach!  In addition, a breast surgeon is invaluable to you.  However they cannot perform a stereotactic biopsy without a radiologist present under current FDA standards (1999 - ).  Check with the FDA.

I preferred to have my breast surgeon view my mammogram, and she did for my second mastectomy, but it wasn't necessary to go in and obtain a biopsy, I was still full of chemo!   However, a well-trained pathologist was vital to my team.

Find one, and you'll find, if you ever find yourself dealing with breast cancer, that you will be seeing a lot of him/her for a long time.  I have used one radiological group because they were subcontractors in the hospital I was in., and I was not informed of that (that should be against the law!).  They have made enough mistakes with me to be sure I don't use them again!  Find out, ask questions, check with your friends....they'll tell  you if they've had any problems. I did and I found out many people had the same problems I did and some worse!
 

TURF BATTLES IN MEDICINE - WHY?

Why does the patient have to do all of this?  Oh, dear, I wish it wasn't necessary!  However, I don't even purchase a plant for my patio without making sure its either well "crocked" for drainage in the bottom, or I know I'll have to do that myself, and take that cost into consideration.    With physicians, there is a constant turf battle going on, and it is truly dizzying!  You may have to stomp you foot and yell, "Where does 'the patient' come in here, doctor(s)?  Where is your knowledge of "....do no harm" come in?  Now grow up and let's get to work to save lives and care for others - you may be the patient one day, and very soon, indeed!"  When we all realize that illness makes us equal, it is a sobering thought!  I had no idea who the man or woman was next to me in the chemo room, or in post op!  When I went through the horrors of going to M.D. Anderson, and spending hours in their lobby, not yet a fully diagnosed metastatic cancer patient (according to consultants agreements), I met physicians who were patients, their spouses, vice versa, a corporate CEO, (who did tell me if he ran his company "like this" his stock holders would have his neck), I felt the zeal and the mission of Mother Teresa and Dr. Patch Adams....it has to stop!  We're part of this planet, and we are here together for a reason - there has to be a reason!  Also read the FAQ

My original problem arose due to 3 occurrences:

• I didn't know enough then to ask for a second reading by a separate radiologist within ten days because, at that time, I didn't know what the usual x-ray department procedures were (I did get an oral report at the time of my mammogram and told her of the ductal distention feelings I had in that side of that breast) but she reassured me there was nothing to be concerned about.   A second reading would have caught it.  It was obvious!
• The person who read my next annual mammogram was not a breast specialist (I could see the sites myself. I don't know why he couldn't) nor read sufficient mammograms it is my BET to be acceptable to FDA regulations!  The  radiologist who re-read it couldn't figure out "how he missed this," himself; however, the second radiologist told me, "we read 100-150 at a time and it’s easy to...."  Yes. Miss something!
• The facility did not have the radiologist read it that I had requested! The fault lies with the individual professionals.

Did these physicians errors change my life?  No one will ever have any idea of how much they have hurt and harmed me!  And, the Courts had better wake up as well as the state board of medical examiners and the medical specialty boards.  We're entering a new era: medical technology and the public may just not want a physician any more - or if they are confident in medical consultation, they may!

If someone asks me to do something I'm not trained to do, or incapable of doing, I don't do it. If it involves a person's life, I surely wouldn't. Bad things happen because good people don't work to stop it.

So many good people:

I caught the last error because I make quarterly goals for myself and I complete each one, or I cannot cross it off, and it drives me nuts.  Also, I have great respect for the radiologist in another city who gave considerable thought to a referral to the doctor he named - and it was that radiologist who found my cancer (and greatly admired the referring radiologist, too).  However, this second radiologist was not to receive my mammogram until I caused a ruckus. Sometime later.

I had put my request in writing at the time of the mammogram and verbally requested him specifically at the time of the mammogram!  I followed up as I've noted elsewhere on this site.  When he did receive it (weeks later!) he diagnosed it, and called me right away. You should see me now - I follow my films (and pathology slides and tissue blocks) around like a bloodhound. In one instance, being too ill, I called that radiologist I knew to come to the hospital and read them for me! I do not leave anything to chance any longer!

Physicians really do not know the anxiety they cause and the increased margin of error they permit by delayed readings of films, and reports to the patients. Not until it hits them, or one of their loved one. "Quality Control," as such, cannot exist except in auto parts, etc, not with human lives.

And, too, if there was just more personal interaction between physician and patient many errors and misunderstandings would be avoided.  Ahhh, but that's not the "model."

Repeating, with or without insurance, women may also visit or telephone the city/county hospital in their area (that is excellent care!), for examinations, mammograms, and classes. Call the YWCA, United Way, and local churches. If you are near a medical school, university, or college of nursing, call them, too. Nurses are just a good resource, period.  You may also call the American Cancer Society (ACS) at  1/800/227-2345 for the telephone number of the ACS nearest facility.   Worrying about money, or insurance is not worth the time you spend on it.  Just get that screening examination!

You Take the Lead

Everyone has the right to request her/his own acceptable standards for preliminary screening and detection but most of us have to be shown, first, and need an advocate. More consumer participation is going to be required to force a change in the current, routine breast cancer detection standard of practice. This will save lives, and saves money (which can be funneled into research and pharmacology). If we do this, there will be less misread mammograms (where there is a malignancy, and it goes unnoticed), and more carefully performed biopsies leading to more accurate pathology reports on what was found during biopsy.

It is uncomfortable to confront anyone in the medical profession just because you would prefer things done your way. But, this hierarchical structure must change, for everyone's benefit.

However, in our lawsuit conscious society, most doctors and nurses want to know what you want, and they become patients during their lives also. To be insensitive to your needs just leads to misunderstandings, and that is not something the medical profession wants to happen, or continue happening. For example, I know how hard the members of my team work for me, and I know they have many other patients. I don't want them overworked. I care about them, too. As their team member, I want to be sure the team concept works, and I have to risk being open with feelings to be honest with them about my case, and my care. It's very hard not to care for someone you respect.

Go forth with your requests, and be well!