The recent story of unethical practices by a medical oncologist raises significant concerns and offers an opportunity to discuss red flags that patients, families, and even healthcare providers should be aware of when navigating cancer care. While most oncologists are guided by ethical principles and bound by professional accountability, recognizing warning signs can empower patients to advocate for their best care and foster a partnership built on trust and transparency.
Red Flags to Watch for in Oncology Practices
1. Lack of Peer Oversight or Collaboration
Solo oncology practices, while not inherently unethical, lack the built-in safeguards provided by peer oversight. In group practices or hospital settings, oncologists regularly review and discuss one another’s cases, providing a critical layer of accountability. If a physician is the sole practitioner with no formal peer reviews, multidisciplinary tumor boards, or collaborative consultations, the opportunity to identify and correct questionable practices may be lost.
- Why this matters: In collaborative practices, physicians who notice deviations from the standard of care can raise concerns early. Oncologists working with medical students, residents, or fellows are often more transparent, as the process of teaching inherently invites scrutiny and questioning. Solo practices should prioritize building strong ties to networks or institutions to avoid ethical isolation. I completely understand the necessity for solo practices in more rural areas and again most oncologist are very good and ethically bound.
2. Resistance to Second Opinions or Questions
A physician who reacts negatively to second opinions or patient questions may signal a red flag. The patient-physician relationship is fundamentally a partnership, and effective communication is key to empowering patients in their care. Physicians who welcome inquiries foster understanding and build trust, while those who become defensive or dismissive may be creating barriers to collaboration.
- What to look for: If a physician discourages second opinions or becomes upset when their decisions are questioned, it undermines the patient’s autonomy and ability to make informed choices. A truly patient-centered oncologist sees questions as an opportunity to educate and ensure understanding.
3. Poor Documentation and Lack of Transparency
Medical records are essential not only for continuity of care but also for demonstrating the rationale behind clinical decisions. Physicians who fail to document the “why” behind their treatments, especially for non-standard approaches, create confusion and risk mismanagement of care. In this case, the oncologist’s lack of documentation obscured the reasoning for transitioning patients to palliative care, prescribing aggressive treatments, or deciding against curative approaches.
- Why this matters: Accurate documentation allows other healthcare providers, whether in the same practice or consulted later, to understand and potentially challenge treatment decisions. Poor documentation can also complicate legal accountability, leaving patients vulnerable to harm without recourse.
4. A Focus on Volume Over Value
Red flags may emerge when a physician’s practice seems disproportionately focused on the number of patients seen or treatments billed, as opposed to the quality of care provided. While productivity is important in medicine, outliers in patient volume or billing without sufficient explanation should be critically examined.
- What to look for: If a physician consistently spends minimal time explaining treatment plans, neglects adequate follow-up, or prioritizes volume over thoroughness, it may reflect a concerning approach to care. Patients deserve to feel their concerns are heard and thoughtfully addressed, rather than rushed or dismissed. I’ll admit that even in my own clinic, delays can occasionally occur. A few complex or challenging visits can disrupt the schedule. However, I always strive to dedicate the necessary time and attention to each patient, ensuring their needs are met with care and understanding.
5. Overreliance on Authority and Intimidation
The relationship between a patient and physician should be collaborative, with the patient’s autonomy and values at the center. Physicians who rely on their authority to dictate care rather than engaging patients in shared decision-making may not be acting in the patient’s best interest. In the reported case, the oncologist’s demeanor reportedly discouraged questions from patients, families, and even colleagues, creating an unhealthy dynamic of dependence and fear.
- Why this matters: A healthy physician-patient relationship empowers patients to take an active role in their care. Physicians who discourage open dialogue may be prioritizing their own agenda over the patient’s needs.
Building Trust in Oncology Care
Patients and families can take proactive steps to ensure they receive ethical, evidence-based care:
- Ask for Second Opinions: Seeking a second opinion is not a sign of distrust but a way to confirm diagnoses and treatment plans. A good oncologist will encourage this and nowadays these opinions can be done remotely via virtual meetings.
- Look for Collaborative Practices: Physicians who regularly consult with colleagues, participate in tumor boards, and are part of group practices often have greater checks and balances in their decision-making.
- Review Medical Records: Many modern electronic medical records (EMRs) allow patients to access their physician’s notes. Reading these notes can provide insight into the physician’s rationale and allow for better-informed discussions.
- Ask Questions: A strong oncologist-patient partnership includes the patient feeling comfortable asking about treatment options, risks, and alternatives. If a physician avoids such discussions, it may be time to seek another opinion.
Empowering Patients Through Education
The best oncologists view patient education as integral to their practice. Encouraging patients to understand their disease, treatment options, and prognosis not only fosters trust but also minimizes the risk of miscommunication. Transparency and respect for patient autonomy are the hallmarks of ethical oncology care.
The recent case underscores the importance of recognizing red flags in oncology care. While most oncologists are deeply committed to their patients, systemic and individual safeguards are essential to ensuring that care remains ethical and patient-centered. Patients and families should feel empowered to advocate for themselves, ask questions, and seek second opinions—steps that not only protect their health but also strengthen the overall quality of care.
By fostering open communication, prioritizing transparency, and supporting collaborative practices, the medical community can ensure that trust in oncology care remains steadfast.
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.