Cui Bono?

I have been mildly fretting about September's upcoming doctor appointments. I am due to see my oncologist on the 10th, the plastic surgeon on the 16th, and then the torturous trek up to UVA to see the surgical team on the 29th.

Since it will have been a year since my mammogram, ultrasound, MRI, and subsequent diagnosis, I assumed that some kind of detailed screening or tests would be done at this juncture. Not so. When I emailed UVA and asked that whatever tests they wanted be scheduled tightly so I wouldn't have to make any extra trips, I got this reply from the surgeon's nurse:

"Because you had bi-lateral mastectomies, no further testing is needed. See you in September."

So why exactly am I driving 600 miles to see them in September? Just to say hi-howdy? After pondering this for awhile, I am slowly coming to the conclusion that the appointment is for their benefit, not mine. Because of the state of medicine, they are covering themselves against any legal action by being diligent about patient follow-up. But if they aren't going to do anything except talk to me, look at me, and reassure themselves that I'm doing fine (which I am), write that they saw me in my chart, and train their residents-students using me as a human guinea pig, how does this appointment benefit me?

Apart from the legal issues, there's the other obvious benefit to them, the money for the "office visit," which is not insignificant. Each contact with a cancer-related doctor bills out at about $300, which even with insurance is about $60 a pop out-of-pocket for me. Plus the money-hoovering that will occur at the gas pump getting there and back.

But the other factor that keeps niggling at me is that someone should be taking care of me, making sure the cancer is still gone, that nothing untoward is going on in whatever tissue is left in my chest, and that nothing is percolating in my bones, my lungs, or my brain.

My first line of defense is my local oncologist. If I found a lump or bump, if I suspected there was a problem, he is the first doc I would go to. He checks me now every three months, feeling for swollen lymph nodes, looking for any problems and keeping track of my progress. I have a call into his triage nurse, asking if he is going to want any testing at my one-year milestone. I'm told by other patients of his that he has at least a chest x-ray done yearly. This would reassure me that someone is paying attention.

It's such a weird, gray area, this post-cancer limbo. You're fine, but you always wonder if something is lurking, getting ready to pounce when your guard is down. I hesitate to cancel an appointment they insist I need to keep, but no one can tell me why I need to be there, other than a vague imprecation that "you need to be checked." But they can't tell me how I am going to be "checked," other than being "seen" by my original surgeon.

I don't want to be a rebellious patient, but I'm having a hard time seeing how going to UVA is supporting my care in any tangible way.