Should You Call Your PCP or Oncologist?

Is Your Cough Due to COVID-19 or Cancer? Should You Call Your PCP or Oncologist? Or Visit the ER?

It is often confusing to know what needs to be reported to your doctor. Is my fever high enough that I should report it? How worried do I need to be about this headache that has lasted for two days? Which doctor should I call to ask about my lingering cough? During the COVID-19 era, these questions can seem even more urgent. Is my headache or cough a symptom of COVID-19, a side effect from chemotherapy, a sign of cancer, or just something normal? We all may move very quickly from mild worry to panic.

In Cancer World, there are times when it is imperative to make a call right away: If you are on treatment and your temperature goes above a certain point (usually 100.2, but varies by doctor); if you think you are experiencing an acute crisis like a heart attack or a stroke; or if there is a sudden and dramatic change in a symptom. It is pretty easy to recognize these moments, but what about all of the others?

During these challenging times, there may be additions to the Emergent List. If you have been experiencing fever and/or other possible COVID-19 symptoms and become short of breath or feel a heaviness or constriction around your chest, call now.

Your doctor or nurse does not need hourly updates unless you have been asked for them. They do need to know if there is a real problem. Whenever I speak with someone who is soon scheduled to begin chemotherapy, I remind them that, the first time, all we can do is make our best educated guess about symptom control. We know what helps most people, but everyone is different, and your reactions may be less common. The reminder is: Don't suffer in silence and think that chemo is just like this. It does not have to be. If you are miserable, call us!

At BIDMC — and other cancer treatment centers — there is someone available 24/7. If you are miserable at 2:00 am, it is OK to call. That is their job, and that conversation may have you feeling better by 3:00 am. There are no gold stars to be earned by toughing it out and not calling.

Another variation of this is the Two Week Rule. This mostly applies to people who have completed active treatment and are going on with life and sometimes worrying about cancer. We all know that, especially in the first months, every single ache or pain or cough panics us. Oh no! The cancer must be back — forgetting that we helped to move a piano the day before. Again, obviously, if you are in the midst of a medical emergency (a possible heart attack or stroke or something else equally frightening), call 911 immediately. Most things, however, fall in the worry, not the panic, bucket. If your shoulder is sore or your back aches or you have a lingering cough, give it two weeks. You may even want to make a note somewhere of when you first noticed it as it is easy to forget the timing.

If two weeks passes and you still have X symptom, the next question is who to call. Some people prefer to start with their PCP. Others prefer to go directly to the oncologist and acknowledge what they are scared about. My advice here is to call the person with whom you have the most comfortable relationship and whom you know will call back quickly. Most of the time, X turns out not to be cancer or anything else awful, and this experience then serves you well next time when Y occurs.

The core advice here is to have a plan in advance of having a need, let alone having a crisis. Speak with your doctor(s) about the best way to reach her/him and what kinds of things s/he wants reported. Decide how and whom you will contact when you have a concern. Remember that most things are not emergencies. It is imperative that you feel secure and heard and know that your needs will be met and your questions answered.