Real-Life Decision Making
You have finished your training and have found a job as a cancer registrar
at a local hospital. The hospital employs only one cancer registrar. Therefore,
like many cancer registrars, you work alone.
Your supervisor is in charge of all medical records, but she is not trained
in the work that you do. When you started the job, Mary, the cancer registrar
that you replaced, spent a few days showing you around. She answered your
questions about the job.
Before she left, Mary told you that sometimes you must send a form letter
to certain physicians. The letter asks them to verify which treatment methods
they used for a particular patient. Mary said you must have an in-depth knowledge
of the treatment options available to patients. The treatment options vary,
depending upon the type of cancer and the stage of the disease.
For example, she showed you the records of a breast cancer patient with
a stage one tumor. The pathology report showed that the tumor was estrogen
and progesterone receptive.
Estrogen and progesterone are hormones found in the body. The physician's
discharge note says that the patient had a lumpectomy. A lumpectomy is an
operation where the tumor is removed. The note also says that the patient
will have radiation therapy for six weeks.
Because the tumor was receptive to the two hormones, Mary knows that the
patient would typically receive hormone therapy after the radiation is finished.
The physician's note did not mention whether he plans to give hormonal therapy
afterwards.
Sometimes physicians forget to mention that in their discharge notes. Other
times, they decide not to give the hormone therapy for medical reasons. Sometimes
there is a reason why a particular patient should not have hormone therapy.
Mary says that in cases like this, you must send the physician the form
letter to verify that your information is correct and to ask if he plans to
give hormonal therapy. If he does, you need to include that information in
the medical records. The form letter you send is also helpful to the physician.
It reminds him that it is time to contact the patient again.
Mary told you that you must study every record and decide whether or not
to send a form letter to the physician asking him to verify that you have
the right information about the treatment plan. Mary told you not to send
these letters routinely. Send only the record alerts when you think that one
is needed. This is why you must understand the types of treatments usually
given to cancer patients.
You wonder if it would not be best to send the letters routinely. "If these
letters help remind the physician that it's time to contact his patient,"
you think to yourself, "then why shouldn't every case get the letter"?
You also think, "And what if I made a mistake and didn't send a form letter
when it was needed?" You know you are new to this work and have much to learn
about cancer treatments. It would be easy to make a mistake. In that case,
your completed record would be incomplete.
You know it is very important to have complete records. You
can't remember whether Mary told you the reasons for sending the letter to
selected cases only. You think she said it took too much time. You think that
will not be a problem for you. What do you do?