Robert Whitfield MD discusses balancing patient wishes with surgical decisions in cancer care. In this excerpt he describes a breast cancer case where the patient requested an alternative approach; he opted to respect her preference, performed the operation in a hospital (patient required overnight monitoring), and explains his routine oncologic technique: excise the scar en bloc, send specimen to pathology for margin assessment, and take cultures of the area. The clip emphasizes surgeon judgment, patient autonomy, and operative workflow choices.
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I mean, I had done cancer surgeries with my colleagues and on our own and reconstructed. And so this was not a big thing for me to do. Yeah. And so I did it that way. But how dare you do what your patient wanted? I mean, aren't you the doctor? Well, I think. I think it was just kind of one of those things. Whereas I was like, I've always been intellectually curious, and I didn't make a big deal about her asking me that. I said, well, I take them out that way, basically, anyway. So, yeah, it's fine. There's some nuances to it, but, yeah, of course. Why didn't she want that? She didn't allude to that at the time. She did not tell me anything. And I was like, okay. So I took her to the operating room. She had to be monitored overnight for a separate medical condition. So her case was done in the hospital, which predominantly. I don't use hospitals. I use surgery centers. So I took her to the operating room. And so each oncology takedown for reconstruction proceeds for me the same way. Of course, I'm trying to do everything and take it out intact. Because if you're going to have a cancer recurrence, it's usually at the scar in a breast cancer case or the tissue associated with the scar underneath it. So you excise the scar, you take it out all together. And so when it comes out and the pathologist looks at it, they can actually make sure that everything is in order. And also, you take cultures of the area when.
