The question
My enlarged thyroid was detected by a breast cancer screening program specialist. Three weeks prior, I had a physical by my general practitioner, who missed it. Since then, I have undergone two operations and have not heard one word from my GP, despite a generally optimistic diagnosis of thyroid cancer. Trying to assume the best, I e-mailed, asking if she had received any reports; she wrote back that indeed she had and then asked if I had any questions. I was so shocked by her response I have not written back. Having never reached out over the course of the past two years, she has left me with the distinct impression she cares not a bit for my circumstance. Do I sound needy? Or is this the nature of most patient-GP relationships?
The answer
I think most patient-doctor relationships, particularly in medium to large urban cities, are exactly what you describe. Once you are in the care of a specialist, the general practitioner is no longer involved in that part of the treatment. I'm not saying it's ideal but that's the reality.
Logistically, a doctor would not be able to follow up with all of her patients who had a diagnosis of cancer or one that required surgery. In small towns, with one hospital, it's do-able, but not in bigger cities with many hospitals. Consequently, I would not read anything into this lack of contact. In fact, I'm impressed she e-mailed a response to you.
What I'm wondering is whether the underlying issue is that you feel let down because, as you mention, she missed your thyroid cancer diagnosis.
But I'm not sure she missed anything. Most doctors would not consider a thyroid examination on most healthy women of a normal age during a physical exam, especially if there was no issue, according to Cathy MacLean, head of the department of family medicine at University of Calgary.
"A patient can have an enlargement and it's not overly obvious," Dr. MacLean said in a telephone interview. "A family doctor would be pleased for the patient that it [cancer]was picked up" by a specialist.
I think the relationship with your GP has gone off-track. And I think you should call her to say you want to make an appointment about your diagnosis.
There are two ways to play it: Tell her that you had a physical and a few weeks later, someone else found the enlarged thyroid and you feel it was missed. Or you could simply say you want to reconnect after having been with other medical specialists for so long.
Just because you have been with specialists, doesn't mean you should not still regularly see your GP; she can be a translator and help with the stress of dealing with a very frightening disease. That's part of her role, too.
In answer to your question, I don't think you are needy. But as Dr. MacLean points out: "The relationship is a partnership. And if you need us, sometimes you have to let us know."
I think, in this case, you should call her.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com .