The Doctor/Patient Relationship
Operator: Maryann from Virginia’s online. Please go ahead.
Maryann: Hi. Thank you very much for taking my question. Being the topic of the doctor/patient relationship, I was wondering if you could comment about the fact that although patients are told to keep informed and find out as much as they can and so on and so forth, a lot of times the reaction from doctors when you’re sitting in the exam room and you say, “I’ve heard such and such,” or “I was talking to so and so,” or “I saw it on the Internet,” you get this kind of blank stare of like, “How dare you think you know more than I do.” So can you respond to that, and I think that’s probably not just with breast cancer but with a lot of different diseases.
Dr. Jacob Bitran: Well, I don’t give people blank stares. I just send a smile when they tell me that they’ve been on the Net. Look, from my standpoint, I think the best patient is the one who’s most informed. The only problem with some of the stuff that you pick up on the Internet is that you have to go to reliable websites.
Maryann: Exactly.
Dr. Jacob Bitran: Because some stuff is junk. Some stuff is good.
Maryann: Right.
Dr. Jacob Bitran: There is a lot of garbage that’s out there so you sort of have to filter through some of the garbage to get to the good stuff; but again, I think right now we’re living in the information age. Access to information is readily available. It’s not like 30, 40 years ago, 50 years ago where I could, a doctor could sit behind a desk and say, “Look, I know everything and that’s that.” We are living in that kind of age. You see, oftentimes we’ll hear reports in the media before I even see it in a journal, okay. So again, I think…
Maryann: So do you push it; as a patient, do you push it? For example, in my case, I was ER-positive but only one percent and so when my oncologist was talking about putting me on Arimidex, I’m like, “Well, wait a minute. Am I going to be having a lot of side effects that potentially in the future have some problems where they find out, ‘Hey, you shouldn’t have been taken this?’ And so and she looked at me and she said, “Positive is positive.” So I’m like, “Do I keep pushing this?” or do I say, “Okay, I’m going to shut up now because it was reliable information that I was depending on as well.”
Dr. Jacob Bitran: Okay, but if, listen, if one percent of your breast cancer’s ER-positive, that’s not positive. That’s considered...
Maryann: Negative.
Dr. Jacob Bitran: That’s considered ER-negative.
Maryann: That’s what I thought.
Dr. Jacob Bitran: Okay and you know I would push it, and if you get a push back, then that’s the time to get another opinion.
Maryann: Okay, thank you.
Operator: Elizabeth from New York is online. Please go ahead.
Elizabeth: Hi. I had an HER2? breast cancer that was invasive but it wasn’t in the lymph nodes. I had a grade III cancer and a nodule behind the breast in the wall. Actually, my mammography showed a suspicion and my sonogram was negative and showed nothing, and I was told to wait six months but I decided to go with a biopsy and I had chemo. I had four treatments of chemo. I was put on Arimidex and I couldn’t take the side effects. So after 24 days, my oncologist changed it to Fermara. I’m having the same side effects. I’m almost afraid to call my doctor because I was so scared for the two weeks that I wasn’t on medicine because he told me I was at such a high risk for it to come back and I’ve had three. My first cousin’s younger than me, who all died of breast cancer and five of them have had mastectomies; three of them, the lumptectomies died. So now I’m scared. I had the mastectomy. I had the chemo but to me, the side effects of the Femara and Arimidex was much worse than the chemotherapy that I had.
Dr. Jacob Bitran: Now the… Well, first of all, I would definitely talk to your doctor and inform him or her about the side effects that you’re experiencing. There is one more drug in this category which are called “the Aromatase inhibitors” that can be tried. Maybe the side effects won’t be as bad; maybe they will be equally bad. If you can’t take Aromatase inhibitors because of the side effects, there’s always Tamoxifen.
Elizabeth: He first wanted to put me on Tamoxifen but I also have a heart condition. I have an enlarged heart and three leaky valves, the slight trace leaks but that’s why he didn’t put me on Tamoxifen and put me on this instead.
Dr. Jacob Bitran: I’d definitely get back to him and tell him about the side effects you’re experiencing. There is one more drug in this category that can be tried, and sometimes with these drugs, you react poorly to the two but the third time is the winner.
Elizabeth: I just have one more question, not to take too much of your time. If you’re in a high risk for cancer coming back, and there is this lapse in between the medications that I’m speaking of or…
Dr. Jacob Bitran: Two weeks isn’t going to hurt you.
Elizabeth: Oh, okay, that’s what I was afraid of. Thank you for your time.
Elizabeth: Okay, thank you.
Dr. Jacob Bitran: So you’ve got nothing to worry about being off of medication for two weeks.
Elizabeth: Okay, I was worried about that and because I had my mammo in July and my mastectomy in September and I said, “Oh, my God, what if this thing’s spreading already.” I was scared. I was really scared because the difference in discrepancy in test, and I just insisted that I wanted the biopsy. But as soon as I went to the breast surgeon himself, the one who specializes in breasts, he immediately wanted to do the biopsy. I mean he didn’t hesitate, just that the reports my medical doctor did and said, “You could wait,” and I didn’t want to. I’m glad I didn’t.
Dr. Jacob Bitran: I’m glad you didn’t.
Elizabeth: I had no lumps, nothing. I was so sure I was flying until I had that mammography, and it was all calcification that was cancer. So, okay, that’s all I was just fearful about that. You did put me at ease. Thank you.
Operator: Marilyn from Arizona’s online. Please go ahead.
Marilyn: Okay, thank you for the information you gave. It was really nice. I fell into the category of having a doctor/patient problem, and my doctor because he didn’t like me asking questions, asked me to leave. So I needed to switch doctors in the middle of my treatment. I have Stage I, Grade 3, HER2/neu positive, node-negative cancer, and I had a mastectomy. I did four treatments of chemo and then had just one treatment of Taxotere with Herceptin and then left that doctor. Went to a new doctor and he said that he felt Taxotere was overkill and so now for two-and-a-half months, I’ve only been doing Herceptin.
