As a physician and health researcher, Rozalina McCoy, M.D., believes in reducing the amount of unnecessary testing and treatment associated with her patients' care. And she's spent years counseling and educating patients and providers in Mayo Clinic's Department of Primary Care and Internal Medicine about the waste of low-value tests. It's an easy thing to preach, but as Dr. McCoy has come to find out, not so easy to practice.
This new understanding came courtesy of a health scare of her own. Last year, Dr. McCoy was diagnosed with and treated for advanced Hodgkin's lymphoma. Now cancer-free, she should be reveling in her victory. But instead, as she writes in an essay recently published in the Journal of Clinical Oncology, Dr. McCoy finds herself anxious about no longer being continually monitored by her care team. She admits she had a "visceral reaction" to her oncologist's recommendation not to perform routine surveillance scans. "I was surprised, confused, fearful and even defiant," she writes. "Could I really forego these tests?"
Her oncologist "argued that routine imaging generates false-positive findings, anxiety and high costs without definitive or meaningful survival benefit." It was information Dr. McCoy knew well. She'd been making the same arguments to her own patients. But now that she'd become a patient herself, Dr. McCoy found herself feeling "anxious, afraid, and wanting more" reassurance via regular follow-up scans. "Not because I was confident that doing more would help, but because doing something — anything — gave me the illusion that I had some semblance of control over what would happen to me," she writes.
"I was scared," she says. "I also could not shake the fear that this reprieve was an illusion, that my lymphoma would come back, and that I would be blindsided by its unrelenting return."
That, Dr. McCoy writes, gave her a better understanding of the fears and worries that her patients have shared with her. "Living through these experiences led me to question and appreciate the basic tenets of shared decision making," she says. "As a physician in clinical practice, I no longer have the same naïve confidence in my ability to counsel patients about the waste of low-value tests, procedures and treatments. Instead, I can empathize in a new and real way with their worries, hopes and internal conflicts about treatment decisions."
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