“How to Survive the Health System and Get Good Care” (Philip Leming, MD, and Jillian Hunt, AOCNP)...

Brad Power

July 2, 2025

“Patients are going to have better outcomes if they get engaged in their care, and they are not passive participants. They've got to challenge, they've got to ask questions, and we've got to figure out a way. All of those things are absolutely true. But the reality is the uneducated, motivated patient who doesn't know what questions to ask. Those aren't the patients that are seeking support. Those aren't the patients that are engaging with additional services. Those are the patients that are being spoon-fed whatever answer the doc is giving them, and they're not questioning that at all. So we have to figure out how to engage the patients and how to empower them to be part of their own journey and not just take everything at face value.” – Jill Hunt, AOCNP

“We really try in this role to empower patients; to make sure, number one, you know who's driving your bus, but number two, you make sure that all of the people that are on the seats in your bus are communicating with the bus driver.” – Philip Leming, MD

“If I can't do better than the guidelines, I need to not practice. I separate out oncologists into those oncologists that do nothing but quote guidelines, versus those that think beyond the guidelines. Because anything that's on a guideline is automatically somewhat out-of-date. Yes, you want to be aware of guidelines, but if you're working at the level that you should, your level of thinking should be far beyond any guideline, knowing that whatever you think is standard of care, there are researchers and people that are five to ten years ahead of that. Once you understand that, you're forever tortured because you can't just be happy with a patient getting something on the guideline. They're important, but they're what the consensus thinks. The guideline things aren't necessarily the best for that singular patient. If you work on the philosophy like we do, which is, if you can walk in the door, you're curable until proven otherwise in our eyes. You don't want to be taken care of by a physician who doesn't have that mindset. Because anybody that thinks that they know everything, then they're wrong. The research world and that science level is far beyond what's accessible on a guideline or a day-to-day practice. It doesn't mean you can always get access to all that, but your horizon should be at that level, not at a flat level guideline.” – Philip Leming, MD

Meeting Summary

Navigating the dysfunction of our current healthcare system is challenging. A squamous cell carcinoma patient recently said, "We don't know who is in charge of taking care of us." You need to grab one of your doctors and tell them to be in charge or find someone who will. It is disturbing how many patients have never been examined. You need a comprehensive review of all your medical history and develop an understanding of the core structure of your issues with your physician, e.g., your psycho-social issues. Every treatment you get is like another illness. You may have an issue that is four times your cancer risk. The basics are not being done correctly. Physicians are being asked to see too many patients with too little time, so they send patients to specialists. The economics of a medical education drive physicians to pay off their loans, e.g., leaving training sooner to start working.

Philip Leming, MD, Medical Director, Cincinnati Cancer Advisors, and Jillian Hunt, AOCNP, are uniquely qualified to lead a conversation about healthcare system dysfunctions and the approaches that cancer patients and caregivers should take to address them.

Dr. Leming’s extensive educational credentials include receiving two Oswald undergraduate research awards at The University of Kentucky , Graduating from The University of Louisville Medical School with High Honors and a member of AOA honor society and Phi Kappa Phi medical fraternity. He completed an internal medicine residency at The University of Cincinnati and was selected as Chief Medical resident. He also completed a fellowship in Hematology and Oncology at UC. He was then chosen to attend The National Cancer Institute, NIH which at the time was “the West Point of Oncology” where he spent two years in Cancer Research. He then returned to Cincinnati where he founded The Christ Hospital Cancer Research Department and remained the director until 2019. In addition he was a member of an elite oncology group providing hematology/oncology care to patients in Greater Cincinnati. In 2019 he was offered an opportunity to establish an independent oncology second opinion program supported by The Cincinnati Cancer Foundation headed by Dr. Bill Barrett. The program has grown from Dr. Leming and Jillian Hunt CNP to 20 members and now a second branch in Naples, Florida. Dr. Leming remains as the Medical Director.

Jillian Hunt, AOCNP, is an oncology nurse practitioner who has worked with Dr. Leming for the past 21 years. Jillian completed her undergraduate studies at the University of Cincinnati where she obtained her degree as a registered nurse. Her early career began at Cincinnati Children's Hospital in pediatric hematology/oncology/bone marrow transplant. In 2004 Jillian shifted her career to the adult setting working as an infusion nurse with Dr. Leming in private practice. As her passion for oncology grew she continued her education at Indiana Wesleyan University and obtained her Master of Science in Nursing and began her career as a Nurse Practitioner in 2011 continuing to work alongside Dr. Leming. In 2019 Jillian and Dr. Leming started the Cincinnati Cancer Advisors. This program aimed to “fill in the gaps” of cancer care, started initially as an independent second opinion program and has grown into a multi level approach to cancer care in both the Cincinnati and now Naples, Florida areas. Jillian serves as the Executive Director of Clinical Operations at both locations and continues to see patients with Dr. Leming.

What are the potential downsides of being a passive recipient of treatment?

  • Incomplete understanding of your diagnosis and treatment options

  • Potential missed opportunities for better care or alternative treatments

  • Risk of receiving fragmented care without proper communication between specialists

  • Possible medication errors or inappropriate treatments

  • Higher likelihood of experiencing unnecessary procedures or tests

  • Increased anxiety from not fully comprehending your medical situation

What are the potential upsides of being an active participant in your cancer care?

  • Better outcomes

  • Longer survival rates

  • More personalized care that considers your whole health, not just the cancer

  • Better understanding of your diagnosis and treatment options; empowerment to make informed decisions about your treatment; ability to ask critical questions and challenge medical recommendations

  • Reduced fear and anxiety through comprehensive education

  • Ensuring proper communication between different healthcare providers

What are common dysfunctions you may see in your cancer care journey?

  • Fragmented communication: your multiple doctors (oncologists, primary care, other specialists) not communicating with each other about your treatment, unsure who is "quarterbacking" your overall care

  • Inadequate examinations: Doctors often document exams without actually performing thorough physical examinations, and rely more on technology and scans instead of basic medical practices.

  • Time constraints: Your doctor has limited time with you due to system pressures and is forced to focus on documentation for billing rather than your comprehensive care, leaving them unable to provide detailed explanations about your diagnosis and treatment.

  • Referral problems: You are shuttled between multiple specialists working in "tunnel vision" without understanding your complete situation.

  • Treatment decision challenges: Potential conflicts of interest, such as academic centers recommending specific clinical trials that serve their institutional interests, while you have limited understanding of your treatment options.

How can you effectively advocate for yourself and ensure you receive the best possible care and outcomes within the fragmented healthcare system?

  • Ask questions: Be proactive and don't hesitate to ask detailed questions about your diagnosis, treatment, and potential side effects; ask about the rationale behind treatments, potential outcomes, and how different aspects of your care interconnect; do not accept surface-level explanations; challenge your doctors when something doesn't seem right; do not be afraid to "be a pain" by persistently asking questions and seeking clarity.

  • Get second opinions: Consider consulting independent experts who can provide comprehensive explanations and help you understand your specific situation.

  • Bring family members to appointments: Having support can help you process information and remember details.

  • Educate yourself: Try to learn as much about your diagnosis and testing and treatment plan as possible, so you can be an informed and active participant in your care.

  • Get a good doctor to take charge: Find a “quarterback”; seek doctors who take time to explain things in common sense terms and help reduce your fear and anxiety.

  • Ensure all your doctors are communicating with each other: ask your doctor to call the referring physician, not just make an electronic request

  • Verify basic medical practices are being followed: like accurate weight measurements

When should you get a second opinion?

  • When first diagnosed with cancer, especially with a rare or complex type

  • If you're unsure about your treatment plan or have doubts about the recommended approach

  • When facing advanced or metastatic cancer

  • If you're not responding to current treatment

  • Before starting a major treatment like surgery or aggressive chemotherapy

  • When considering clinical trials or experimental treatments

  • If you feel your current doctor isn't addressing all your concerns or providing comprehensive care

How can you find and access a second opinion?

  • If you’re in the right state, you can contact Cincinnati Cancer Advisors, which offers free second opinions sponsored by philanthropy, or use online resources like Cancer Commons which is also free.

  • Check with local cancer centers or academic medical centers that offer second opinion services

  • Ask your current oncologist for a referral to another specialist

  • Verify the credentials and expertise of the physician providing the second opinion

  • Gather all your medical records, test results, and imaging studies to share with the second opinion doctor.

  • Check your insurance coverage and potential out-of-pocket costs

How can you learn more about navigating the health system to get good care?


The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

For the video recording of this conversation, please see here.

For a transcript of the conversation, please see here.