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Robin McGee Show Notes
Family history of colorectal cancer
0:07:00
Robin grew up in Ottawa, Canada as the 6th of 7 children - and now lives in Nova Scotia (Canada) - went to university and got her PhD in Clinical Psychology and practicing clinical psychologist for 30 years
0:08:00
Robin's mother had colorectal cancer - in 2008 Robin had some rectal bleeding and went to see Doctor #1, who was a locum for Robin's family doctor, Doctor #2 - Doctor #1 dismissed Robin's bleeding as perhaps C Difficile, a pretty serious infection, and sent Robin away to get tested for it
0:09:00
But the C Difficile test was cancelled because Robin didn't have a liquid stool, a prerequisite for C Difficile testing - the test results came back to Doctor #1 who did nothing - Robin's bleeding continued and she went to Doctor #2 but was bleeding heavier with skin sluffing - but Doctor #2 also dismissed the bleeding - Robin reminded the doctor of Robin's family history of colorectal cancer and the doctor made a note - she sent Robin for C Difficile test (again) and it was cancelled (again)
0:10:00
Doctor #2 sent a referral to a general surgeon, Doctor #4 (yes, #4), but her note didn't mention severity of Robin's symptoms, duration or family history - Doctor #2 was also closing her practice and Robin found a new family doctor, Doctor #3 - both # 2 and 3 knew Robin professionally
0:11:00
Robin arranged herself for a cancer test and it can back positive: Robin had cancer - that positive result went to Doctor #3 who did nothing - Robin went into to see Doctor #3 and reported greater symptoms and he said Robin needed an colonoscopy and would follow up
0:12:00
Robin felt relieved that a doctor was going to take her symptoms / cancer seriously - but Doctor #3 did nothing at all - he knew Robin was positive for cancer, but did nothing - but Doctor #3 wrote in the electronic health record that he had followed up with referrals0:13:00Robin waits for referrals but her symptoms are getting even worse, so she calls Doctor #3 and the office says 'not our problem, call doc #4' - Robin immediately calls #4 / surgeon and they say 'not our problem - there are no resources and there is an 18 month queue - you have to wait'
0:14:00
Meanwhile Robin's symptoms get worse, including dark red blood - and she continues to try to get a correct diagnosis - she tried 18 times - finally Robin gets into Doctor #4 - dark red blood is a sign of cancer, but the doctor says Robin is fine - Robin pushes for a colonoscopy and the doctor schedules one for many months later - Robin gets the scope and finds out she has Stage 4 cancer - according to Canadian guidelines, there should be no more than 8 weeks / 60 days from patient's first symptom report to diagnosis
Secretary triaging cancer patients
0:15:00
But Robin waited 661 days - subsequently, the provincial College of Physicians took a look at Robin's case and found other serious failures - and those doctors were disciplined by the College
0:16:00
Doctor #4's conduct was disturbing: had many, many years before had abdicated triaging of patients to her high school educated secretary - who decided patients under 50 don't get colorectal cancer and didn't schedule Robin for a colonoscopy
0:17:00
Initially they thought Robin's cancer was stage 3, 'curable' - it was a horrifying and devastating time with a 15 year old child at home - Robin had to drop everything and for the next 2 years suffered brutal cancer treatment, multiple surgeries, chemotherapy
0:18:00
The treatment worked, and Robin was in remission for 6 years and then the cancer returned - Robin experienced another serious medical error: the 2 cm cancer was missed by a radiologist and wasn't noticed until 6 months later when it was 9 cm - Robin had to endure more brutal treatments, more multiple surgeries, more chemotherapy - some of the surgeries had complications that required more surgeries - Robin has only been out of treatment for 6 months
0:19:00
Colorectal cancer is one of the most preventable if caught early - expert testimony confirmed that Robin would not have had to endure all the treatment, surgeries, chemotherapy if she had proper care and diagnosis initially - in the 7 years of medical malpractice lawsuit, the defence could not find one expert able or willing to defend the standard of care Robin received
0:20:00
It is unusual for Colleges of Physicians to find against their doctors, so the decision in Robin's case attests to the severity of negligence, it was 'indefensible'
0:21:00
The 4 doctors had made multiple efforts with Robin - these errors they'd done 1,000s of times, but because all 4 behaved irresponsibly collectively, the result was Robin with stage 4 cancer - Robin approached her medical error experience in 3 ways: complaint to College of Physicians and 3 of the 4 were disciplined
0:22:00
The lawsuit took 7 years - but with the radiology error, Robin decided on a 3rd approach: since it was in a hospital, she used the internal complaint process
0:23:00
There were also errors and challenges with that process - the 'apology practice' was kind of bungled - but in Robin worked with the province to change that policy - a positive remedy coming out of her complaint
0:24:00
"Error and apology practice" - hospital policy about responding to patient harm - there is legislation in Canada that a doctor's apology is not admissible in a court of law - Robin notes that a physician's apology has never been used against them in court
College of Physicians complaint experience
0:25:00
The complaint process with the College of Physicians and Surgeons was lacking - when Robin first contacted the College she said that she knew 2 of these doctors and considered them colleagues, and asked if they could all get in a room to discuss - Robin was very, very sick at this point with chemotherapy and radiation and at the brink of death a couple of times and needed to minimize her energy outlay
0:26:00
The College responded rudely, bruskly with a huge back in tone - Robin was ambivalent about making a complaint until that call - she realized this was the thin edge of the wedge of how medicine defends itself and shuts down people
0:27:00
Robin was inflamed by the call and decided to take her complaint as a result of how the College responded - the process was in favour of the doctors - psychologists are really good at documenting and created a binder for each doctor
0:28:00
Listed all the errors of each of her doctors with index and references and appendix and gave her 4 binders to the College - the physician gets to respond to Robin
0:29:00
The College said they would talk with her but she had to show up on X date, the same day Robin was to have surgery - the College response was "that's your problem, these doctors are busy"
0:30:00
Fortunately for Robin, another hospital bungle had her surgery date postponed - Robin did get to meet with just 2 people from panel of 7 that were to hear her complaint - but all of those 7 got to speak to all 4 physicians, but Robin the patient only got to speak to 2 - so not a patient friendly process - Robin feels strongly that any time a patient is harmed the hospital should speak to the patient as well as all of the investigation committee
0:31:00
They need to see the human face of the victim - the investigative panel of 7 is made of 6 physicians and the wife of a physician is the 7th, representing the 'public' - Robing says the College complaint can enforce a change in the doctors practice
0:32:00
The College sent Robin a letter saying 'this is what we said to Doctor x' - Robin is not sure if she received all the text of the letters sent to the doctors - they did force Doctor #4 to do her own surgical triage, and not her secretary - did they audit her to make sure she did that? Robin doesn't think so.
0:33:00
They identified a number of errors and factors with each doctor and instructed all doctors to make changes
0:34:00
Robin believes Doctors #1, 2 and 3 were conscientious physicians who would adhere to the Colleges instructions - Robin is less confident Doctor #4 changed her practice, but has since retired
Too young to get cancer?
0:35:00
Robin felt the remedies for the doctors was insufficient - Robin thinks all of them should have been sent for specific training on diagnosing colorectal cancer because each of them told the College that people under 50 don't get colorectal cancer - the College said, 'but she's got symptoms and family history, so....' - in the US the screening age has been lowered to 45 - no longer an old man's disease
0:36:00
Robin thinks they needed that training so they practiced correctly - but that wasn't a remedy the College applied
0:37:00
Robin found the College process, not destructive because she did a thorough job on preparing her documentation and relied on that knowledge to manage her emotion of fear they would not listen to her
0:38:00
Robin felt it was their obligation to protect the public, she could only do what she could do as a witness - but as the things got worse with the College, Robin was also dealing with vomiting, bring burned by chemo, and feeling horrible - but getting to the keyboard to work on her complaint was therapeutic and empowering - it also empowered her when she launched legal action with a team of lawyers
0:39:00
Medical malpractice is not for sissies - lawyers for physicians take a scorched earth policy, hire investigators to spy, they stoop to low levels to intimidate a patient - even though there was much pain and struggle in the lawsuit it was empowering - in the end her case was settled out of court for an undisclosed sum of money
0:40:00
But it was a 7 year process to get a settlement - the secret hope of physicians and their attorneys is that the patient will die so the case will die with them
0:41:00
Robin had to move to Toronto for 6 months to get cancer treatment and she had to pay those expenses - she had a lot of cost attached to care and she needed that money to survive
0:42:00
After Robin finally got a diagnosis, and after she found out all the doctors had failed her, and after her surgery, she found out that the best chemotherapy treatment for her type of cancer was not available in Nova Scotia, it was available in every other province, in the US, New Zealand, Australia, Europe, but not where Robin lived - Robin lobbied the govt to include that chemo treatment
0:43:00
The opposition party got involved and in the end she was successful in getting the province to include that chemo treatment, but it was too late for Robin to receive it - but since then over 1,000 Nova Scotians have had access to that treatment, no small feat - Robin's book, The Cancer Olympics, tells Robin's story
0:44:00
But it was a bitter sweet victory, as it was too late for Robin and that may be implicated in why her cancer re-occurred - Robin will die a martyr for her own cause
More medical error with another cancer diagnosis
0:45:00
Robin first bout of cancer and treatment was 2 years long in 2010 - it came back in 2017, 6 months late due to radiologist error - Robin endured more horrible cancer treatment, lost her hair, her mouth turned into 1 big sore, horrific suffering - worse then any thing she'd ever experienced - she had 10 hour surgery to debulk the cancer and that had horrific complications causing more suffering, but had to wait 15 months for surgery in Toronto to correct complications
0:46:00
The surgery was March 2019 and she returned home June 1st - Robin's wisdom is for cancer patients to feel the feelings they are having
0:47:00
Instead of fighting those emotions and trying to supplant them with 'positive thoughts', she let her emotions come - don't give yourself the burden of not validating your own feelings
0:48:00
Taking on the medical establishment in multiple ways brought meaning to her life, when the establishment treated her like her life meant nothing - one doctor said to Robin 'you're in my margin of error'
0:49:00
Advocating has given her suffering and eventual death, meaning - while the complaints to the College and hospital are noble, they don't do anything for the patient - the lawsuit got Robin money that paid for her care (caused by medical errors)
0:50:00
Her family is deprived of Robin's income when she dies, and they are entitled to that - recently a mother of 3 with a terminally ill husband with a missed diagnosis, didn't want to sue and 'look greedy' - Robin explained that she was entitled to compensation to care for the kids
0:51:00
Many people fear launching a lawsuit against the Goliath medical industry - Robin encourages those with strong suits to move forward, it won't be as bad as they think - they have every right to pursue lost income
0:52:00
Some cases may be futile, but others will be worth it - in the US there is 'pain and suffering' compensation, but in Canada those amounts are capped at about $350k
0:53:00
After legal fees, Robin got about 60% of what she would have earned in income - that money is helping her survive today - and do some traveling with the time she has remaining
0:54:00
Robin would hear about medical errors from clients - she had a lot of medical admin bungling in the past and had learned to follow up on referrals herself - as many as 30% of fax referrals go missing - a 1 in 3 chance your referral never made it to the specialist
0:55:00
Robin has one surgery postponed because the fax machine at the hospital ran out of ink, for days images sent to the hospital were unreadable
80-15-5 Rule
0:56:00
Robin goes for scans in the new year to see if the cancer cells have proliferated - eventually they will grow and kill her - her latest chemo usually gives about 48 more months of life, so she has about 2 years
0:57:00
Robin learned from another patient that it is good practice to demand that any of your imaging gets read by 2 radiologists - and Robin gets this done now
0:59:00
Lived experience is important for any profession to be better at their job - as a child psychologist, it is known that there is the '80-15-5 Rule' - meaning 80% of people are conscientious and follow the rules
1:00:00
15% of people are impaired, addictions, personal problems, distractions - 5% are rogues: stop signs and traffic lights are for other people - every profession has this, including the medical profession
1:01:00
The average person does not know if that there is a 1 in 5 chance of encountering incompetence and potential harm, a 20% chance
1:02:00
Robin's physician clients were in the 80% of conscientious people and she remembers them respectively - but her nursing clients were more likely to tell Robin about medical errors and how they couldn't report it because they'd lose their job
1:03:00
Whistleblowers are brave, and vulnerable people in this backlash culture - due to all the medical errors, Robin had to find a new family doctor - she learned that other doctors in the community were against him for taking on Robin
1:04:00
Robin's book, The Cancer Olympics, is well researched, 'no stone unturned' - sometimes she wonders if the doctors that were against her new family doctor read her book and realized that Robin really was harmed repeatedly and their colleagues did screw up
Lawyers, lies and lawsuits
1:05:00
Robin has had a number of people in the medical profession contact her after the book was published - some of them were supportive and confirmatory - some doctors do take patient stories and use them to improve their profession, but other doctors just don't want to hear - you can't make a purse out of a sows ear
1:06:00
One of the doctors in her case, a colleague she'd known for years, they'd been at many meetings, testified under oath that he didn't know Robin
1:07:00
After the lawsuit, Robin thought 'he'll never forget my name for as long as he lives' - lawsuits seem to bring out the worse in people - but the lawsuit exposed some horrible practices
1:08:00
The Cancer Olympics is available on iTunes, Amazon, Indigo - also available on Audible in audio
1:09:00
Robin has become super active in patient advocacy - setting standards of care for physicians and colorectal cancer - now with Patients for Patient Safety Canada Robin is doing presentations and advocacy work, and recently spoke with the Nova Scotia Minister of Health
1:10:00
The asked the Minister to ensure that patients harmed by medical care, should get a copy of the investigative report in writing, and a patient on the investigative committee
1:11:00
Robin is doing a little bit of her psychology work, but has another surgery in the new year - Robin doesn't have a ton of time left to live, but is committed to fighting cancer and her intent is to help patients broadly and cancer patients specifically, and all harm to patients, for as long as she can, until the end.
1:12:00
People have asked if Robin will write a sequel - she does have a blog, The Cancer Olympics were she describes her cancer experience in classic rock and roll songs
Connect with Robin McGee
Twitter: https://twitter.com/TCOrobin @TCOrobin
Facebook: https://www.facebook.com/TCOrobin/
Website and blog: http://www.thecancerolympics.com/newsblog