In most cases patients benefit from, right from the get go, having a multidisciplinary tumor board and resulting treatment team and plan. I sat in on mine and was allowed to ask questions and comment. There were 13 doctors in mine at MDACC. There were some additional residents in attendance to learn. Some were actual treatment people out of surgery, radiation, chemo etc. but there was also a nutritionist, a psycho oncologist, and allied people even insurance and financial people included. (Being able to pay for any given treatment idea in a profit system like in this country is part of the equation) Everyone with different training and experience got to weigh in on what should be done with me to obtain optimum end results. The scans and test results were all on a couple giant screens.

They clearly had very different approaches to the plan, no surprise the surgeon favored surgery, the radiologist his profession. But until they all agreed 100% on the final idea, the arguments went on. There is little question that education and training bias exist in deciding what to do. In no big CCC does any single doctor get to determine what treatment a patient will get. It’s not what is best for the patient, and there is a lot of liability associated with getting a plan wrong. Unfortunately in the US medical system, doctors outside of bigger institutions, in private practice, are legally free to treat people they feel competent to treat, even with complex and multifaceted ideas like cancer.

The argument has often been made by many, that allowing say for instance an ENT head and neck surgeon to do procedures in the cancer realm as a stand alone provider should be limited to minor surgeries, and while most have privileges at some general hospital to have access to a surgical operatory, and they can choose the difficulty and type of operations they do there, that is not best practice medicine. Note the underlying, never said point here is, there are financial incentives to keeping a patient in your own practice. But this is how American medicine is structured.

To any ENT professional reading this, I used your profession as one example. I would say the same thing about a dental oral surgeon and many other professionals. It’s not an attack on otolaryngology.