Covering for a Colleague: My Treatment Recommendation or Theirs?

Kathy D. Miller, MD


December 14, 2022

This transcript has been edited for clarity.

It's Dr Kathy Miller from Indiana University.

I want you to think with me today about a different question. When you're covering for a colleague and a patient is at a decision point in their treatment, do you give that patient your best recommendation — what you would do if you were their primary oncologist? Or do you give them the recommendation that you know your colleague — their actual oncologist, who would be living with the consequences of this recommendation — would give?

This doesn't come up in my practice much. I have several colleagues in the breast program here at Indiana University (IU). For the most part, we practice in very similar ways. We tend to view the data and the major questions in our field in similar ways, but we do have our differences. They're friendly differences. We all know exactly where our differences lie. For the most part, they are more differences of style than substance, but there are a couple of substantive differences.

I ran into one of those with a patient last week, and I found myself struggling. Where is my obligation? Do I give this patient my best recommendation, knowing that she is not continuing in my care? Do I give her the recommendation that I know my colleague would provide because that's her oncologist, that's how they've approached the disease, and that's the person who is going to be following this patient and who's going to live with the recommendations that I give?

I suspect many of you have faced that quandary before. I'd love to know how you approach that dilemma. Where does our obligation lie? How do you handle those tricky situations?

I'll be back with you again to talk about another topic soon.

Kathy D. Miller, MD, is associate director of clinical research and co-director of the breast cancer program at the Melvin and Bren Simon Cancer Center at Indiana University. Her career has combined both laboratory and clinical research in breast cancer.

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