Dumped because I'm Stage 4?

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I need to get this out and am prepared to be told I'm in the wrong.

For 3 years I've been seen by a Clinical Oncologist who has being practising for quite a number of years. I thought we had a good relationship  and I always had it in my mind that when the time came, I would thank him for getting me this far. You know? - be polite etc.

 But the last few times I've had a face to face appointment  I've noticed I've been seen by a Registrar. who is very nice but clearly new to it all

The first time I put down to my Oncologist possibly being ill, or on holiday.and that was why I've been seen by someone else.  But it looks as if this is now  a permanent arrangement.

The 'nice' me thinks that maybe they're just trying to share the load between them, but cynical me thinks rhat this poor registrar has had all the Stage 4, end of the line( *3rd line) hopless case  patients dumped on him.amd the Oncologist has kept the interesting patients, ie those with a potential to cure, for himself.

My husband thinks that maybe oncologists do this to protect their mental health-  as telling someone (on a regular basis) theres to be no more treatment must be harrowing, but I feel its a bit cowardly to kick someone out without even saying something..

Things are not helped by the fact I'd just about plucked up the courage to ask THE question (prognosis).  My usual Oncologist would likely have given me an answer based on Experience and Intuition which is what I wanted , whereas a newly qualified registrar is likely to give me an answer based on what they look up.in a book, which I could do myself.

So I feel as if that's been taken away from me as well.

What do others think?   Am I reading too much into it? X

  • Hiya harebell.  Just wanted to say I don't always see my oncologist. I seen him last Tuesday for the 1st time in about 6 months maybe more in fact. I usually see another team member a consultant pyhamasist who can still give me results on things like scan and things and answer any questions i have Last month I seen someone I'd never seen before and have no idea who he is   .try not to worry to much . 

  • I often see or am phoned by my consultant’s registrar. I find I see the consultant when a decision is needed but more commonly see the registrar otherwise. It’s fine by me - other than there being a new person to meet every 6 months, I find the registrars usually have more time and are more open to a 2-way discussion. When I had an immunotherapy adverse event, the registrar had more relevant experience of it than the consultant, as the immunotherapy was new to breast cancer, but the registrar had worked with the drug with other cancers. They are always fully qualified doctors with several years of experience, on their final set of speciality placements before being eligible to be appointed as consultants themselves. 

  • I really do think you are thinking about this too much   I am sure the registrar gets to see all cancer patients, at all levels of diagnoses, the same as the consultant. There would never be enough hours in the day for your consultant to personally see all of his patients, and let’s not forget, he was once a registrar himself.

    With my oncology appointments I think the totally opposite way to you. If I am seeing a registrar I know that the news will be ok. If it’s my consultant I worry that it will be bad news, and that’s why she is there. Of course, that also is not the case. In my hospital, they see whoever is next on the list, so you get the next registrar / consultant that is free. 

    I also know that if I wanted to see my consultant, I just need to phone her secretary who will arrange that for me. 


    Try to be a rainbow,in somebody else's cloud
    Maya Angelou

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  • I'm replying before I read others' posts. 

    Sorry to read about your poor experience.  You're absolutely right, if your consultant planned to delegate your meetings to a registrar for a period, then absolutely they should tell you in advance and explain their reasoning.  It could be to share the workload, for training experiences (don't take that the wrong way).  But I think it's highly unlikely to be so they can hog the interesting patients - that would be so unprofessional.  And you infer in your post that you fall into a negative category of patient - no, no, no, please do not think like this!   You can't possibly have any rational justification for this; patient lists, stages, medical notes etc.   

    But when your consultant (should have been) advising you about the plan to handover to the registrar, followed by the introduction, of course) they would have said "anything you prefer to talk to me about, please ask the registrar to arrange a meeting".  

    Do you have a named consultant accountable for your care?  That's how it works where I am, regardless of who I see at check-ins.  Even though you see the registrar, your consultant is still accountable.  

    I'd just bring it all up at the next meeting and ask for an explanation, and ask for a meeting with your consultant to ask the question.   Just because you are seeing the registrar at the moment doesn't mean it's always going to be the case.  

  • If I am seeing a registrar I know that the news will be ok.

    Concur!  My oncologist has confirmed it too.  For bad news he delivers it and no registrars are invited.  

  • Hi Hi  I have stage 4 renal cancer and am stable on immunotherapy and I usually just speak to my specialist nurse but I know my Oncologist is responsible for any changes in my treatment and if I feel I need to speak to her I can just ring her secretary and I will be seen quickly. I am happy with this arrangement but this plan was made at an appointment with me, the specialist nurse and the consultant all present and it was made clear I could see my consultant if I felt I had a need. You probably would feel better if you had had the same type of communication because I'm sure you haven't been dumped but please tell your team how you are feeling so they can explain their process as  says

  • don't think bad...I am now on secondary brain cancer. 1st time it was breast cancer, I only saw the oncologist ONCE to give me the diagnosis, after that the entire year I saw registrars, now, I just been diagnosed so don't have a measure but that's why they have registrars...

  • Hi  

    I'm sorry you are feeling this way and I understand that it is disappointing to psyche yourself up to asking something then not seeing the person you wanted to ask. I know, because I've been in the same position. 

    However.....I know that you are overthinking the situation. In my own personal experience, I worked in the same type of NHS clinical setting and the patients on the list are decided by the Consultant as to who he/she sees and who is seen by the Registrar, always for learning experiences. The Reg is guided by the Consultant and the cases are discussed. There is no more to it than that. 

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  • Hi Harebelle I hear what your saying  . They cannot just side line you. I was seen by someone I hadn't seen before the oncologists underling  . She said I had cancer in my neck ok 8.5 cm  tumour on liver and lungs , What both lungs ? Yes . Oh . Am I brown bread ? Yes . I was a bit chocked to be honest and she said the oncologist wanted to see me . I said I didn't want to see him , But  I did . Someone has to deliver the bad news and some are still learning well my one is , You couldn't  make this s hit up . Just don't let it all grind your gears All the Best Minmax

  • I understand where you’re coming from. I now take some reassurance in that nothing is worse, things are stable, think I’d sh*t myself when the consultant does appear