"Choosing Your Physicians"

The death rate due to medical error is about two times the death rate from automobile accidents. So, I hope you choose your physician more carefully than your vehicle! That is assuming you have a choice. In rural areas you may not have many options. In this case, I would suggest traveling to get the care you deserve. Finding a physician who is a good fit for you is so important since it can be the difference between feeling supported and feeling as if you are only a number to be rushed out the door. It can be the difference between making your cancer journey bearable and adding another difficulty. I know; I had remarkable physicians throughout my cancer journey. They were positive during appointments, listened carefully to my concerns; and in general, were very supportive. They were the ideal guides to lead me through my dark valley.    

Because your physician can affect your well-being so significantly, let’s look at some considerations when choosing an oncologist or surgeon. There are several factors to take into account when selecting who you will be consulting with long term during cancer. (1) Find one whose schedule will be able to accommodate you without long delays. (2) Look for an oncologist who has expertise in his field plus knowledge about your particular type of cancer. (3) Search for a physician who is caring and communicates well.

Caring physicians should be the norm, but they are not, as oncologist and author Azra Raza points out. She writes that she wondered “about how and why our medical culture has evolved in such an anomalous manner that patients are surprised by finding an emotionally engaged physician. That should be the rule rather than the exception.” She explains: “We have become a health-care system highly skilled in pursuing a cure but not healing, dealing with acute emergencies yet alarmingly lacking in simple acts of empathic communication.” [1] 

No need to despair. Compassionate and well-informed physicians really do exist. It may take a bit of looking to find them, though. To start your search, look at respected rating sites such as Healthgrades or Vitals where you will be able to read reviews. The drawback is not all reviews will be truthful. For example, Healthgrades does not check that the person commenting is even a patient of the reviewed doctor. There is no system in place for the doctor to respond or to remove a fabricated review. Yet, you should be able to get a general idea from the majority of reviews. Of course, personal references are ideal. If you belong to a support group, ask others about their oncologists or surgeons.

After you have a couple doctors in mind, then call to make an appointment. Here’s when you will learn about the number one criterion: if scheduling is done efficiently and within a reasonable time. If you are unable to reach the office, or forced to leave a message without receiving a return call quickly, keep looking. It is unfortunate to judge oncologists by their office staff, but if the staff isn’t handling routine matters efficiently, they may drop the ball when it comes to important insurance concerns or scan results. If you are able to see the oncologist within an acceptable timeframe, that is a positive start. If appointments are only available months ahead, your treatments could be unnecessarily delayed. No matter how excellent the oncologist is, if you can’t be seen in a timely manner, it is pointless.

If you are able to schedule an initial consult and the oncologist meets all your expectations, you still need to learn if he or she is an expert in your particular type of cancer. Questions to ask include: Do you offer clinical trials? Do you routinely handle my type of cancer? (Ask especially if you have a rare type such as triple negative.) Are various treatment options offered? Do you recommend genomic testing so treatments can be designed to target my mutations? Over the course of talking and asking questions about the second criterion, you will begin to discover the answer to the third criterion: is he or she caring and capable of clear communication?

In any relationship, spending time with the person is key. There are some time constraints in a doctor’s office, of course, but your visit should not feel rushed. The doctor should have time to (a) go over any relevant questions; (b) view and explain any scans; (c) get a complete medical history with relevant information about cancer; (d) explain standard protocol for your stage and type of cancer; (e) sincerely interact with you, not keep looking at a computer; and (f) actually listen to your concerns and answer your questions. In this regard, Azra Raza quotes a shocking statistic: “Doctors are known to interrupt patients every 18 seconds on an average.” [2]

As for selecting a surgeon, I refer to the advice of my surgeon, Dr. Chanu Dasari. He has a list of questions on his website to ask a surgeon. For one thing, he or she should be willing to tell you what options are available. “Every surgeon needs to be prepared to discuss the risk and alternative to surgery. They need to discuss non-operative treatment options, non-opiate pain regimens, as well as different surgical approaches (minimally invasive when applicable).” Familiarity with the type of surgery you will be facing is necessary in order to avoid complications. However, it is also important, Dasari adds, to be “technically proficient at newer techniques.” So, both experience and keeping up with modern modalities are essential. Some patients may think it is rude to inquire about a surgeon’s experience. It is not. Dasari frankly advises patients: “Do not be afraid to ask how many procedures s/he performs each year.” [3] We have a right to know the facts before we put ourselves in their hands.

You don’t want to “settle” for less care than you deserve since too much is at stake. Your peace of mind as well as your physical health is dependent upon selecting doctors who are empathic and who you can trust. Trust is earned by speaking the truth. Even in difficult situations, we want doctors who will honestly explain our diagnosis and expectations. In a doctor-patient relationship, as in any significant relationship, trust is vital. As cancer patients, we are in a particularly vulnerable position. Unless we’ve done extensive research, we are at the mercy of our doctor’s knowledge and proficiency.

We literally put not only our health, but the quality of our future in our oncologist’s and surgeon’s hands. We need doctors who exemplify the adage: “A good physician treats the disease; the great physician treats the patient who has the disease.”

Reflection:

1. What quality in a physician is most important to you?

2. What have been your best interactions with your physicians?

[1] Azra Raza. The First Cell, New York: Basic Book, 2019, 51.

[2] Raza, 156.

[3] Chanu Dasari, “Blogs,” Dr. Chanu Dasari: Renowned General Surgeon & Researcher, Ashkan Maher Site, October 4, 2020. https://dasarimd.com/.