After beating cancer, survivors need a medical home

Breast cancer survivors often drift away from their primary care provider—sometimes for years. A shared care model could help these women head off the other diseases that may also affect them, such as hypertension or diabetes.

With the good news that many more women are surviving breast cancer due to improved detection and treatment comes some unsettling findings about follow-up care. As writer Bonnie Darves reports, breast cancer survivors often drift away from their primary care physician for years after their diagnosis. Without ties to a “medical home,” patients rely on specialists for non-cancer-related care that their internist is most qualified to provide.

When the internist is out of the loop, ongoing health issues such as diabetes, hypertension or depression can be overlooked. And the situation can persist for years as patients undergo increasingly complex treatment regimens. Experts weighing in on the issue endorse a shared care model, which sounds a lot like how things are supposed to work in a patient-centered medical home, with the primary care physician coordinating care and maintaining open lines of communication with specialists and others involved in their patient's health.

For now, widespread implementation of the medical home style of care is still a distant possibility. The unfortunate reality is that many internists remain frustrated by continued low reimbursements and increasingly burdensome paperwork, leading many to reconsider their options. The current primary care shortage has boosted demand for locum tenens, according to recent survey results reported in Stacey Butterfield's cover story. Locum tenens work attracts doctors for many reasons, including the opportunity to travel, to practice in a variety of settings and to try out jobs that may become permanent. But some are just escaping the daily grind. As one doctor put it, “Now I do medicine—period.”

Also in this issue, don't miss the latest commentary by Jerome Groopman, FACP, and Pamela Hartzband, FACP, on a reader-submitted case about an 87-year-old woman referred for hospice placement after sudden decline. Our commentators discuss how falling back on stereotypes instead of spending time investigating symptoms can lead to attribution errors. Once again, cognition plays a much larger role than tests or procedures in getting to the right diagnosis.

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Janet Colwell