Thursday, May 18, 2006
Sometimes doctors give choices, sometimes they don't

By Dr. Anthony Policastro
Nanticoke Memorial Hospital,
Medical director

I recently had a visit from a patient who expressed concern about the lack of information provided by her physician. She was interested in knowing the values of her lab results. The physician responded by just saying that she didn't recall the exact numbers. Physicians have classically been a paternalistic group. They take the information. They reach a conclusion. They make a decision. They provide that decision to the patient. They then move on to the next patient and the next problem. That is what many patients desire. It is not what all patients desire. Most decisions in medicine are complicated. The actual treatment plan is driven by what statistically will work best in that situation. For example, when a child comes in with a sore throat, the need is to decide if it is a strep throat or not. That cannot be done simply by doing a physical exam. Some patients may have a terrible looking throat and not have strep. Others may have a benign looking throat and have strep. In order to decide, the physician has the option of doing a rapid strep test. If it comes back positive, then the physician can treat the patient. A positive rapid strep test means the patient definitely has strep. However, some patients with a negative rapid strep test may still have a strep throat. The test is not 100 percent when negative. However it is close to that. So most negative tests do indeed mean there is no strep throat present. Thus a patient with a sore throat and a negative rapid strep test presents a dilemma. It can be that there is indeed no strep throat there. That is the most likely thing. It can be that there is strep there, but it will only show up on a real throat culture. So the physician can do a regular throat culture. That will take 24 hours to come back. One option is to just wait for the result. A second option is to give antibiotics until the culture comes back. There are then three possible approaches. One is do nothing. A second is wait until a culture comes back. A third is treat until a culture comes back. Each of those has risks and benefits. If we do nothing and the patient really has strep, then we have an untreated condition. Since we already have a negative rapid strep this is not very likely. If we do the culture and wait, then we might have problems contacting the patient if the result comes back positive. If we treat until the culture comes back, we run the risk of side effects or allergies to the medication. What usually will happen is that the physician will decide which of the three makes the most sense and present only that option to the patient. The patient might agree with that if he/she knew all the facts. But he or she might not. The same thing is true for treating strep. We can use oral penicillin. That is the best drug. However, it tastes lousy and parents might not give it as directed. We can use amoxicillin. It tastes better but is more likely to help create resistant bacteria in the community. The parents also might not give it as directed. We can give a shot of penicillin. We are sure of the patient getting the medication. However, it hurts a lot. What usually will happen is that the physician will decide which of the three makes the most sense and present only that option to the patient. The patient might agree with that if he/she knew all the facts. But he or she might not. Patients need to be aware of the fact that there are frequently alternatives. If the physician is prescribing a treatment plan that he knows will be difficult to follow, it would make sense to ask about those alternatives. It is better to have a plan that the patient will follow than it is to have one that is a little bit better but will not be followed.

Cancer support group will meet this Thursday
The Wellness Community-Delaware is offering a support group for people affected by cancer and their loved ones at Nanticoke Memorial Hospital, Seaford. The group will meet at the Cancer Care Center, second floor conference room, on Thursday, May 18, from 4:30 until 6 p.m. Clare Wilson will be the facilitator of this group, which will continue to meet on the third Thursday on each month. All programs at the Wellness Community are free of charge. For more information or to register, call 227-1155. The Wellness Community-Delaware is part of a national nonprofit organization that provides support, education and hope to people with cancer and their loved ones. Through participation in professionally led support groups, educational workshops and mind/body classes, people affected by cancer learn vital skills that enable them to regain control, reduce isolation and restore hope regardless of the stage of disease. At the Wellness Community-Delaware, all programs are free of charge. More information about the Wellness Community is available on the Web site at

NMH plans Cancer Survivors Day
Nanticoke Memorial Hospital will celebrate National Cancer Survivors Day (NCSD) on Sunday, June 4. This local event is part of a worldwide celebration coordinated by the National Cancer Survivors Day Foundation and sponsored by "Coping" magazine and Lilly Oncology. A cancer survivor is defined by the NCSD Foundation as anyone living with a history of cancer – from the moment of diagnosis through the remainder of life. Ten million Americans are now living with and beyond a diagnosis of cancer. In the United States, half of all men and one third of all women are expected to be diagnosed with cancer at some point in their lives. Many forms of cancer can be prevented and most can be cured if detected early. This year's local National Cancer Survivors Day celebration of life will be held in at the Nanticoke Memorial Hospital Cancer Care Center on Saturday, June 4, 1 p.m. to 3 p.m. For more information contact Nanticoke's Cancer Care Center coordinator at (302) 629-6611, extension 2577.