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Putting their heads together

Even in the field of medicine, two heads are better than one.

At Sentara Obici Hospital, a group of doctors puts that adage to the test every Thursday morning.

Dr. Victor Archie of Virginia Oncology Associates in resurrected the tumor board in October 2007. Today, eight to 15 doctors, from all different areas of treatment, get together to discuss their patients’ cases and treatment options. Tumor board members now include general surgeons, oncologists, reconstructive surgeons, pathologists, general physicians and a breast cancer pathologist.

“Being able to sit down with all the people involved in the care of my patient and coordinate our efforts is immensely valuable,” Dr. Brian King said. “Often you have miscommunications and delays going between offices trying to figure out what other doctors are doing. Here, we’re able to sit down and coordinate to arrive at a consensus. This ensures the best care of patients.

One of the biggest advantages to opening up the communication lines between the doctors is that they can garner advice on treatments the other doctors would recommend. The recommendations can change the care the other doctors might give or provide give them better insight into areas that aren’t their expertise.

For example, King brought a case to the table recently of a patient with a tumor in her breast that may be growing into the muscle in her chest.

“It’s unlikely that through surgery he’ll be able to get out all the cells without cutting into the muscle, which could lead to limited arm movement and other effects,” Archie said.

The discussion allowed doctors to come up with a plan prior to the patient going under the knife.

Without the tumor board, Archie said, doctors may have had to make a last-minute decision without much background on the patient.

Dr. Craig Merrell of Plastic Surgery Associates of Tidewater was also able to tell King what kind of reconstructive surgery he would recommend to the patient, who because of previous radiation might have complications with a traditional skin graft.

“Dr. King might be able to tell his patient a few possibilities of what we might do, but here we can tell him definitively what our recommendation would be, and he can give his patient more concrete details and maybe more peace of mind,” Archie said.

This was one of the four cases brought before the board on Thursday. Each week, three to seven cases are presented.

“Generally, according to national standards and guidelines, 98 percent of cases fall within certain guidelines,” Archie said. “Sometimes we get a unique case that doesn’t fit those guidelines. I’ll ask my patient for their approval, and bring it before the board.”

Patients also can ask their doctor to present their case to the board, Archie added.

During the meeting, mammograms, ultra sounds, MRIs, CT scans and pathology specimens are all reviewed.

Even disagreements within the meetings can have value.

King said disagreements between the doctors allow him to take his patients a second opinion from doctors who are knowledgeable about their case.

“Instead of passing the files around and going office to office, we can all weigh in at once,” Archie said. “One person can’t know everything. Sometimes with these cases, there’s a gray area, so we get together and hash it out.”

Things work well, then, for the doctors and the patient.

“There are no duplicated tests, no running between offices for either us or the patient, and all the care is streamlined,” he said.