Choosing a Cancer Doctor

  Choosing a doctor is never easy. When the problem is cancer, however, the stakes often seem even higher than usual. Let's be clear about a few things at the start: No one has any magic, and all competent oncologists or radiation oncologists or surgeons go to the same conferences and read the same articles and have the same knowledge base. If something new and wonderful appears, they will all know about it.

  Making a decision re a surgeon is a somewhat unique situation, and I am going to focus more on the other doctor choices. For a surgeon, in addition to the concerns discussed later, you want to know how many surgeries of your type s/h has performed, how often they operate, and do they operate in a hospital where you will be comfortable and feel reassured by the availability of other specialists should the need arise. The last point can be a problem at some small or community hospitals. There might be a fabulous surgeon on staff, but, if something goes wrong, there might not be the appropriate specialist a phone call away.

  If the diagnosis is cancer, you are likely feeling overwhelmed and scared. Remind yourself that cancer is rarely a medical emergency, and you usually have some time to consider your options and make the best choice for yourself. Exceptions include a new leukemia diagnosis or a brain tumor that is symptomatic or something else that is an immediate threat to your health or your life. 

  Remember that you, the patient, are the consumer, and you can think about this in some ways that are not so different from buying a house or a new car. Of course it is not really like buying anything, but the point is that you have the power to make the choice and you want to be fully informed. An important first step is to understand your medical insurance. There may be restrictions on where you can go. There may be tiers of coverage, so you can go to Tier 1 at no cost (or only a small co-pay) while Tiers 2 or 3 would not be fully covered. This might or might not matter for a single appointment, but you are going to have an ongoing relationship with your oncologist, and the bills could quickly become astronomical.Some people opt to see a particular expert who is out of network for a second opinion, but expect to have their ongoing care from a doctor whose bills will be more manageable.

  Geography matters. Again, you can travel once or twice without too much inconvenience, but you will be spending a lot of time at the hospital, so it makes life much easier if the commute is reasonable. This is often the reason that people meet with a specialist at a university hospital or cancer center, but then receive most of their ongoing treatment closer to home. Think about associated costs, including gas and parking.

  Think about the hospital itself. In Boston, we are blessed with a number of world-class hospitals. At all of them, the cancer care is very similar and often identical. The cultures, however, vary place to place, and you may feel more comfortable at one spot vs. another. For example, Dana Farber Cancer Institute is just down the street from us, and some people feel safest in an institution where everything is focused on cancer. Others prefer a general hospital (like ours) where more of life is happening, and not every single person is dealing with a similar problem.

  Character matters. There are doctors, just as there are all kinds of experts, who are extremely smart and competent, but who may be less-evolved as human beings. Another way to think about this is personality and the fit. You have to respect and like your oncologist as you will be spending a lot of time together. Here are some things to consider: Does she listen to you? Does she understand what is important in your life and what informs your decisions? Is she always kind? How can you communicate with her outside of regular appointments? Does she explain things in ways that you understand and does she make time for all your questions? Does she help you with those decisions and, if you want it, give you her opinion on what is the best choice? 

  The list goes on as you think about all the people who will be part of your care. Does the doctor work with a Fellow or an NP or a PA? How is the work load shared? Can you always speak with/see the senior doctor (the attending) if you want? Is someone available 24/7 for emergencies or serious concerns? During regular office hours, where can you leave a message and can you reach a person, not just a machine, and how quickly will someone call you back? Does your doctor communicate by email? Who else is part of the team and available to you? Is there an oncology social worker and a dietitian and a PT and an OT? What support resources are available?

  These same questions and issues apply if you are considering making a doctor change. The bottom lines are your physical and psychological comfort with your caregivers, the cost (including insurance coverage), and  your trust that you are in the best possible hands.