Relationship with the departments of Surgery, Urology, Medical Oncology, and Radiotherapy:
The relationship between the Kelly Gynecologic Oncology Service and the above listed departments is unusual. Our opinion is that Gynecologic Oncologists should be physicians adroit at supplying all levels of Gynecologic Cancer care, serving as the primary surgeons and chemotherapists for women with malignancies of the genital tract. Therefore, we have aggressively integrated all possible care-related activities directly on to the Kelly Service, using extra-service referrals as little as possible and limiting them to Interventional Radiology, Internal Medicine consults, and extra-abdominal/pelvic surgery.
- SURGERY: We have, as a faculty member on our Service, a sub-specialty trained hepato-biliary surgical oncologist, who has a secondary appointment in the Department of Gynecology and Obstetrics. His special skill is utilized intermittently when unique procedures are being performed. The Gynecologic Oncology Surgeons on the Kelly Service perform the vast majority of the small and large intestinal procedures necessitated in the care of Service patients.
- UROLOGY: We rarely utilize the services of the Department of Urology. All faculty members are facile with the performance of urethral, bladder, ureteral, cystoscopic, urinary diversion, and neo-bladder construction surgery.
- MEDICAL ONCOLOGY: The Gynecologic Oncology members of the Kelly Gynecologic Oncology Service faculty all have joint (i.e secondary) appointments in the Department of Oncology at the JHMI. This allows the utilization of resources that are outside of the Kelly Gynecologic Oncology Service and are core/shared resources of the NCI designated Comprehensive Cancer Center. All first and the majority of second and third line chemotherapy is administered directly under the auspices of the Gynecologic Oncologist members of the Kelly Service faculty. Patients that are participating in certain Gynecologic Oncology Group Trials, Institutional Chemotherapy Trials, or have been directly referred to the Medical Oncologist who is a faculty member of the Kelly Service, will not receive their chemotherapy immediately under the direction of the Gynecologic Oncology faculty members. The joint appointment of the Medical Oncologist at JHMI who is recognized as an expert in Gynecologic Cancers within the Department of Gynecology and Obstetrics and The Kelly Service allows a degree of integration and flow of patients that otherwise would be difficult. There are few, if any difficulties with issues of who is directing patient care, as there is an easy flow of patients with in the faculty membership of the Kelly Service, independent of the Department of primary appointment.
- RADIATION ONCOLOGY: The Radiation Oncology Service at the JHMI is part of the Department of Oncology. The Radiation Oncologists at this facility do not have hospital admitting privileges. All patients who have gynecologic malignancies that are being treated with ionizing radiation at JHMI have, as their primary oncologists, a gynecologic oncologist. All inpatient procedures are performed as a joint procedure by a faculty radiation oncologist and a gynecologic oncologist, with the patient being admitted to and cared for by the faculty Gynecologic Oncologists and the residents on the Kelly Service.
The utilization of consults in the disciplines of Surgery, Urology, Medical Oncology, and Radiation Oncology is more fluid and less well defined at GBMC than it is at JHMI. The Gynecologic Oncologists at GBMC have the same perspective on the role of the Gynecologic Oncologists as the primary provider and director of oncology care for the woman with a gynecologic malignancy as do the Gynecologic Oncologists on the Kelly Service at JHMI. However, because there has not been a formal integration of a Medical and Radiation Oncologist, or a General or Urologic Surgeon into the Gynecologic Oncology Service at GBMC, the utilization of consults from these four disciplines is more frequent and decided upon on a case by case base. It should be stressed that physicians from these four disciplines are consultants and that the woman with a gynecologic malignancy continues to have her care supplied and, when need be, directed by her Gynecologic Oncologist.