As oncologists, we are privileged to walk alongside patients and their families during some of the most challenging times in their lives. This responsibility becomes even more pronounced when we step into a role as a covering physician, whether temporarily filling in for a partner or taking on a temporary locum tenens assignments as I am currently doing in Montana for 1-2 weeks a month. It’s in these moments that we must decide how we approach patient care: as temporary custodians or as fully invested advocates. Today, I reflect on two patient encounters that underscored the profound impact we can have when we embrace the latter approach.
Case 1: Navigating the Complexities of Glioblastoma Multiforme (GBM)
The first patient I saw was an elderly gentleman who had recently undergone treatment for glioblastoma multiforme (GBM), a challenging and aggressive brain tumor. He had completed a standard course of chemoradiation but had faced significant complications toward the end of treatment, including dehydration, profound fatigue, and a seizure. A non-contrasted MRI had been interpreted as showing progression, and the team caring for him had discussed transitioning to palliative care.
Yet, when I saw him in clinic weeks later, he appeared vibrant and full of life. He was eating well, enjoying his family, and engaging in hobbies—hardly the picture of someone with active progression.
Instead of simply signing off on his next 2nd line treatment and deferring further decisions to his primary oncologist, I took a deeper dive. Drawing on established guidelines, I recognized the potential for pseudo-progression, a known phenomenon following radiation therapy. I also noted that the prior non-contrasted MRI brain scan was not ideal for accurate assessment and emphasized the importance of obtaining contrasted imaging for clearer insights. I had a detailed conversation with the patient and his family, explaining the situation, and worked with the primary oncologist to revisit the treatment plan. Together, we agreed to proceed with the standard six cycles of temozolomide and explore additional options like Optune therapy.
This collaborative approach, coupled with the time to educate and reassure the family, transformed a moment of uncertainty into one of hope. The patient and his family were deeply appreciative, and so was his primary oncologist.
Case 2: Restoring Continuity in Multiple Myeloma Care
The second patient I saw had been recently diagnosed with multiple myeloma. Unfortunately, his care had been marked by a lack of continuity, as he had seen four different covering physicians after his primary oncologist retired from the same clinic. He and his wife expressed frustration, not about the treatments but about the constant change in providers and the resulting sense of instability.
Initially, I planned to approach the visit as a quick check-in to ensure he was ready for his next cycle of treatment. However, their candid feedback prompted me to take a step back and focus on their underlying concerns. I spent time understanding their frustrations and reassuring them that, despite the transitions, their care team including the nurses, pharmacist, nutritionist, counselors were deeply committed to providing seamless, high-quality care.
Through our conversation, I discovered that the patient’s greatest challenges weren’t directly related to his cancer but to other chronic health issues impacting his quality of life. By addressing these concerns and validating his feelings, I was able to restore a sense of trust and stability. While I didn’t initiate any new treatments that day, the patient and his wife left the clinic feeling more supported and confident in the care they were receiving.
A Choice and a Responsibility
These cases highlight a critical choice we face as covering physicians: to either provide perfunctory care or fully invest in each patient as if they were our own. It’s easy to take a quick, problem-focused approach, especially in busy clinics where time is limited. But when circumstances allow, spending that extra time can make all the difference—not only in the patient’s clinical outcomes but also in their overall experience of care.
In smaller clinics like the one I currently serve, I’m fortunate to have the time and space to delve deeper into each patient’s story. This slower pace has reminded me of the value of truly understanding each patient’s goals, fears, and hopes—a mindset I strive to bring into every encounter, no matter how brief my involvement in their care may be. It’s also a profound reminder of why I chose oncology in the first place: the privilege of caring for this remarkable and resilient population.
Collaboration and the Power of Fresh Perspectives
As a covering physician, I also see my role as an opportunity to offer a fresh set of eyes on challenging cases. This doesn’t mean overstepping boundaries or undermining established plans but rather working collaboratively with the primary oncologist to ensure the best possible outcomes for patients. In both cases I described, the primary oncologists were receptive to my input, and our teamwork ultimately benefitted the patients.
Being a covering physician is about more than simply filling in for a colleague—it’s about ensuring continuity of care, fostering trust, and taking ownership of each patient’s well-being, even if only for a short time. It’s about recognizing that every interaction is an opportunity to make a meaningful difference. Whether we are seeing our own patients or those of our partners, the time we invest in understanding, educating, and collaborating can have a lasting impact—not only on our patients but also on the healthcare teams we serve alongside.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
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