I often am asked for opinions about hematology/oncology cases from colleagues around the country. Additionally, whenever a family friend or relative is diagnosed with cancer, I also often am asked for an opinion. How do you handle these unofficial second opinions?
One option is to say, “See your own doctor. I can’t comment.” I don’t have numerators and denominators, but it seems that this is an unlikely response. These are not uncommon requests, and, in many cases, we can help by reassuring or finding problems with the workup or treatment. It could be the guy at a party asking about his prostate biopsy or a relative of a friend with a metastatic cancer. You could provide general advice and stay away from specifics. Or, get “all” of the details (how?). How to intervene, especially if you are unsure of the local expertise, or you just want to really help and counsel the person?
There are many options for continuing medical education (CME) as well as for discussing general or specific (usually de-identified) clinical cases including on the forums: Best Doctors, Doximity, HealthTap, LinkedIn, QuantiMD, Sermo, and even Twitter and Facebook. Those formats all have their own platform-specific utilities, as well as potentially negative aspects. Many health systems including well-regarded cancer centers have e-opinion/tele-oncology services varying from chart reviews to formal reviews of imaging and pathology. Some are system specific and some are global opinion mechanisms. I’ve commented before on “Does Telemonitoring Have a Place in Oncology?”. I have also used the ASCO Membership Directory (for referrals) and ASH “Consult a Colleague” online tools.
However, what do you do when you want to review a case and be able to provide some input, but don’t’ necessarily want a fully public forum. Often emailing a single or small group of colleagues can work. In one case someone listed me as his physician so I was cc’d on official medical transcripts.
This also came up when someone wanted me to review a series of radiology images for his cancer. He had the digital image burned to a CD and then delivered to me by mail. I took the CD down the street to my friendly neighborhood interventional radiologist to review on his laptop. It struck me as bizarre that in this digital age we couldn’t look it up online and avoid the potential time delay and CD software incompatibilities that sometimes crop up. I remembered a beta demonstration of a patient-focused imaging upload tool (image_32 – previously known as ImagingCloud in an early beta version). At the time the image_32 patient portal wasn’t fully ready, so we couldn’t use it in a timely manner. Now that it is publicly available it likely would have helped with reviewing images. Other potential issues include tracking longitudinal patient information without an EMR.
- Have you been asked for the Thanksgiving table “curbside” consult?
- What are your thoughts on it?
- What tools have you used to facilitate care for friends and family? (e.g., online tools, Skype, FaceTime, websites, etc.)?
Dr. Thompson is a member of the above mentioned online and social media forums. Dr. Thompson is on the medical advisory boards for Doximity and image_32.