Your Health Care Team
Choosing and Interacting with Your Doctors and Health Care Team
Breast cancer is a complicated disease that is almost always treated by a multidisciplinary team of physicians, nurses, oncology social workers, techs, and other allied health professionals. In the beginning, it can be difficult to make the best choices of providers, and, as time goes on, the focus changes to how best to work with your team.
Let's begin with those first choices. Appreciating that there may be restrictions placed by your insurance coverage, there are almost always decisions still to be made about which doctors and which institutions seem right for you. In large cities, there are numerous fine hospitals, and the question will be where you feel the most comfortable and best cared for. In more rural areas, there likely will be fewer possibilities, but you then may want to consider the possibility of traveling at least for initial consultations, surgery, and/or treatment planning. At BIDMC, we often take care of newly diagnosed women who have breast surgery here, meet with radiation and medical oncologists to decide on the best treatment plan, and then receive needed radiation or chemotherapy closer to home.
How do you find the best doctors for you? Your GYN or PCP may make suggestions and referrals, but you are not bound to those ideas. Ask around. If you can, talk with other women who have been treated for breast cancer and ask if they were happy with their care. Once you meet with a doctor, if you are wondering if a second opinion would be wise, it likely would be. My own rule of thumb is this: "If you are considering a second opinion, you should get it. You don't want to look back later and wish that you had done so." You will know when you have found the right doctors. You must trust, respect, and like them. The human connection is very important, and you deserve the best possible care and relationships. Generally speaking, your choice of doctors will dictate most of your other caregivers. Obviously, individual radiation techs or chemotherapy nurses work in particular medical institutions or practices, so they will be assigned based on your physician's affiliation. One exception may be an oncology social worker. I certainly see, both individually and in support groups, many women who receive their medical care at other Boston hospitals. If you are interested in psychological support (as I think you should be!), and if the oncology social worker who generally works with your doctors does not seem to be the right match for you, feel free to explore support resources elsewhere.
Once you have begun treatment, you will discover how closely you work with your medical team. For the next months, you will see more of them than you do of most of your friends, and you will come to rely upon them for much of your support and sense of well-being. It is smart to ask in the very beginning how best to contact them. Who is available 24/7? How quickly will someone call you back if you have a problem during the workday or in the middle of the night? Do your providers like to communicate via email? What is their coverage if they are away or unavailable? Different providers have different systems, but your priority must be quick and reliable access. Ask specifically if, during your active treatment, they want to hear from you about any medical concerns or whether some things (and, in that case, which things) should go first to your PCP.
Most of the time, relationships and care proceed smoothly. You can maximize this likelihood by remembering the old Golden Rule: Do unto others as you would have them do unto you. This translates to being on time for your appointments, organizing your questions, being clear with your concerns, expressing your needs, and expecting that your health care team will do the same. If you are not feeling heard or well cared-for, speak up. Remember that doctors are human, too, and describing your feelings in a non-angry way will reduce the changes of their becoming defensive and making things worse. If, for example, you feel that you are not being given time to ask all your questions, say something like: "I understand that you have many patients and are very busy. However, when I am with you, I need to feel that all of your attention is with me. I need you to answer all my questions and listen to my fears. Is there something I could do differently to make this work better for us both?" The bottom line is that you are hiring these specialists to provide your cancer care, and they should be giving you their very best professional and human effort. You deserve and need nothing less.