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nternists are doctors with greater considerations in decision-making than most other specialists. That is why in many places, internists, despite their capabilities, do not treat cancer patients by prescribing chemo or radiotherapy.

Newly graduated internists have been taught how to be semi-oncologists, general internists who can provide chemotherapy. At the end of oncology rotation, they are asked whether they will provide chemotherapy in their practices. Most, like me, agree to do so.

But after graduation and general internist practice, that confidence tended to fade as I no longer met cancer patients anymore. This was the case even with my fellow internists in rural areas.

There is a gap between general and oncology internists but even when there are bridges between them, through oncology workshops etc., there are some things that general internists will not do. All my colleagues that finally opted for oncology as their sub-specialty had at least considered it long before they finally chose it.

The rest of my fellow internists choose not to take oncology workshops because chemo is provided in their hospitals. They chose to deepen their sub-specialties of choice, because in the end general internists are not so general after all. They all have interests that can only be mastered if they study them throughout their careers.

Oncology in Indonesia must thrive and finally flourish in spite of this. As a science and practice, oncology is badly needed in this country given the fact that cancer is increasing over time. But the field is notoriously hard to master. We have heard stories about doctors who spend years longer than they should have until finally being deemed worthy of the title of oncologist. Practitioners who are already in this field understand the reasoning behind all the '€œhardship'€. But even after becoming an oncologist, he or she cannot do much without the support of other people.

Cancer treatment requires teamwork. The team should at least consist of an oncology internist, a surgeon, a pathologist and a radiologist who are able to diagnose and perform radiation treatment, not to forget nurses and pharmacists trained in handling toxic substances. Without those people, cancer patients will be let down.

Patient treatment should not be compromised. Can an internist prescribe chemotherapy but leave people who handle the drugs partly clueless about what they are handling? Even in our work as residents, we have had to concoct chemotherapy drugs in a place with people passing by, not adequately ventilated and without proper sanitation equipment.

What about the hospitals currently treating cancer? As an ordinary citizen I once met a patient with a malignancy that as a result of complicated bureaucracy had not been operated upon and who went home without medication or reference to any oncology internist. In the end, the young patient died without receiving cancer medication but his family felt that eventually some treatment was at least given before he died, in the form of palliative care, analgesia. Not only was this patient not treated accordingly by the first doctor but also time had beaten him.

Time is a crucial factor in cancer management and in most cases we simply do not have it. Time in cancer means a choice between life and death. Most cancers in Indonesia are diagnosed at an advanced stage as we lack national programs to screen cancers in their earlier forms. There are no surveys on how often primary care physicians remind their patients to undergo prostate, breast, colorectal and cervical cancer, or even the much-debated lung cancer, screenings. And if they do remember, how many patients have their screenings covered by medical insurance?

It is time for the government to do these kinds of surveys in order to finally make this screening available, at least to people with a high risk of cancer. The information on cancer screening is so scarce that not even daughters and sisters of breast cancer patients know that they should be screened and take genetic tests to determine their risks.

The time from diagnosis to treatment can last weeks and even months. While patients wait for treatment, the chance of the cancer reaching more advanced stages also increases.

Cancer treatment is expensive, unaffordable by most people and not all treatments will be covered by insurers, since full cycles of treatment can cost hundreds of millions (even billions) of rupiah and our current government healthcare scheme is still understandably unable to bear all the costs. Even the much-vaunted Obamacare in the US could not provide universal coverage as promised, as insurance premiums have become higher and higher. But alas, Indonesia promises to provide universal coverage with premiums much lower than those in the US.

The future of cancer treatment lies in the people who make regulations. We need better facilities, better screening, a better referral system and all of this should come hand-in-hand with better coverage that not only covers medication but training and appropriate incentives for healthcare personnel.

We all need to see these through if we ever want to form a team. If we want Indonesia'€™s cancer treatment to be great then we cannot and should not make compromises by treating cancer half-heartedly as the situation dictates. Call me a perfectionist, but shouldn'€™t we all be?
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The writer is an internist