The question: I'm in treatment for early-stage breast cancer. When it's done, I'll be sent to my general practitioner, whom I have little faith in. I've had excellent, patient-focused care from medical staff treating my cancer. Should I find a new doctor or stick with this one who, for better or worse, at least knows my history?
The answer: Given the background information you gave me on your GP - reluctant to order tests, not a good listener, dismissive - you are right to be concerned. I've seen how well oncologists advocate for their patients; your fondness for them is well placed.
A study published this year in the journal Current Oncology found that 87 per cent of early stage breast cancer patients surveyed in Ontario preferred to visit their cancer specialist for routine follow-up.
Like you, most cancer patients in Canada are sent back to their GPs. So long as a follow-up plan is in place, it's the best way to provide good quality, cost-effective care.
Sandy Sehdev, a medical oncologist at William Osler Health System in Brampton, Ont., said cases such as yours can result from a patient feeling that the GP did not act rapidly on a lump. Other patients don't want to go back to the GP because they fear a cancer's return may be missed.
"It doesn't always match the severity of the cancer," Dr. Sehdev said in a telephone interview. "The fear can be disproportionate; it depends on their perspective."
Dr. Sehdev, who is also a board director of the Cancer Advocacy Coalition of Canada, sends a two-page note to family doctors, detailing follow-up care for the life of his patients.
Among his recommendations for breast-cancer patients is a clinical physical exam every six months for five years as well as an annual mammogram. Investigations - bone scans, ultrasound of the abdomen or pelvis, chest X-ray and laboratory tests - are not recommended in asymptomatic patients due to their ineffectiveness and unnecessary radiation exposure.
I suggest you talk to your oncologist, then your GP, and tell them you were concerned that maybe something was missed, if indeed that is the case. Perhaps your worries will be extinguished.
You may also want to contact Willow Breast Cancer Support Canada (1-888-778-3100 or www.willow.org), which can provide a list of support groups and services in your area and connect you with other breast-cancer survivors.
Breast-cancer survivors are smart, well-organized patient advocates and - who knows? - getting connected with them may lead to names of cancer-knowledgeable GPs.
If you feel you are done with this GP, it's a good time of year to find another, as a new crop is just graduating. The College of Physicians and Surgeons in each province can put you in touch with doctors accepting new patients.
The solution requires leg work. But don't stay in a bad relationship with your GP. A lack of confidence can be corrosive.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org.