5

How to Choose a Doctor and Hospital

IN THIS CHAPTER YOU’LL DISCOVER

→ How to Select Your Doctor

→ How to Choose a Treatment Center

→ Second Opinions

→ The Role of Patient Navigator

→ Questions to Ask: Finding the Best Doctor for You

WHEN DIAGNOSED WITH CANCER, you will be instantly faced with what may seem like countless decisions to make. Choosing a doctor and hospital will undoubtedly be the most important of these decisions — and of your life, for that matter — yet many people just go along with the first recommendation they are given by the diagnosing physician. Doctors often bristle that people put more work into choosing a car than they do into selecting a physician; sadly, they are right.

Sometimes, immediate treatment is necessary, but in most cases, you do have the time to do a little research and make an informed decision on which doctor should oversee your care and where you should be treated.

Some people choose their doctor first, while others choose the cancer treatment center. There is no right or wrong way to approach this. Often, the doctor who ends up heading your cancer treatment team will be one referred to you by your internist or primary care doctor. If you are comfortable with that doctor and his or her qualifications, this may work out very well. But if you are not, or if you are referred to more than one specialist, you may very well need to go about your own selection process.

Selecting Your Doctor

There are three major types of oncologists, and based on their titles, their functions are rather obvious, but it’s worth mentioning in order to get you to begin considering all of the pieces of the cancer-care puzzle.

MEDICAL ONCOLOGISTS

The most general type of cancer doctor, these physicians specialize in diagnosing and treating the disease by using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. During your treatment, you may very well see different types of cancer specialists, but your medical oncologist will often be your main medical provider and should be considered the “captain” of your medical team.

SURGICAL ONCOLOGIST

Biopsies and, of course, surgical procedures are the main responsibility of the surgical oncologist. The biopsy is one of the most important diagnostic tests you’ll undergo, as it can lead to the correct staging and treatment for your particular cancer.

RADIATION ONCOLOGIST

If radiation should be part of your cancer treatment plan, this medical professional would perform it. Radiation is a very important procedure that carries risks similar to surgery, and so you select your radiation oncologist with the same care as your surgeon. This statement seems obvious — that one would select any of one’s healthcare practitioners with an equal degree of care — but with so many decisions to make, it’s sometimes easier to go on recommendation rather than putting forth the effort to research.

“Generally, your best choice is a doctor who has the most experience treating the specific type of cancer you have. Usually, such doctors are found in the nation’s top cancer centers, although this isn’t always so,” says Dr. Lee Tessler, neurosurgeon and executive director of the Long Island Brain Tumor Center. “Clearly, you need the best team, but you don’t want your doctor 500 miles away. You want to be able to call your oncologist or surgeon and get an appointment to come in without a long wait,” Dr. Tessler adds.

The oncologist to whom you are referred may turn out to be the right doctor for your case, or you might decide to seek another. Again, this is one of the most important choices you’ll need to make, and it is solely in your hands. Below are organizations with searchable online databases that can help you find a doctor or do a credential check. For further information on how to contact them, refer to the appendix.

How to Choose a Treatment Center

These days, cancer treatment centers abound, and these facilities, whether large or small, are all using slick marketing strategies. When you are diagnosed with cancer, your inclination may be to drop everything and head for one of these branded centers. This may or may not be the right choice for you.

“On one hand, the top cancer centers are now more accessible than ever, and many people don’t realize that you don’t need connections to go to them. On the other hand, a smaller hospital nearby may be better for you as long as the expertise is there because during cancer treatment, having friends and family on hand to support you can give you the all-important boost you need,” notes colon cancer survivor, Dr. Laura Porter.

“During the first year of my colon cancer treatment, I was never alone. I had people coming from Baltimore a couple of times a week, I had friends who would take off work — my cousin’s wife, my sister — they all came to sit with me so that I wasn’t alone,” Porter recalls.

CANCER CENTERS OF EXCELLENCE

The National Cancer Institute (NCI) has a program that identifies the best cancer facilities in the United States. There are three designations within this program:

GOOD ADVICE

If you have a rare form of cancer — one that is particularly difficult to treat — or you are at high risk due to age or complicating medical conditions, you may do best at an NCI-designated treatment center due to their multidisciplinary approach.

NCI-DESIGNATED COMPREHENSIVE CANCER CENTERS

This top designation given by the NCI recognizes facilities for both the superiority of their treatment and the breadth of the programs they offer. They are also acknowledged for their research programs in innovative cancer care. As of this writing, 41 of the 68 NCI-designated cancer care centers were comprehensive treatment centers.

NCI-DESIGNATED CANCER CENTER

As with comprehensive cancer care centers, these facilities are recognized for the expertise of their doctors in addition to their work in the forefront of cancer research.

And again, like comprehensive cancer care centers, these facilities must also excel in the following areas:

These centers are also very prestigious, so they draw top cancer experts from around the world and they also see large numbers of patients with all different types of cancer.

NCI-DESIGNATED BASIC LABORATORY CANCER CENTERS

These centers do not provide patient care, but only conduct cancer research. There are currently seven NCI-designated basic laboratory centers.

ACCREDITED CANCER TREATMENT HOSPITALS

There are 1,400 hospitals and medical centers accredited by the Commission on Cancer (CoC) of the American College of Surgeons. This voluntary accreditation program is designed to ensure that patients at these centers receive the following services:

GOOD ADVICE

These days, terminology similar to “cancer center of excellence” and “comprehensive cancer center” are used by many hospitals for marketing purposes, but they don’t necessarily denote NCI-designated programs, so make sure to do your research.

NATIONALLY ACCREDITED PROGRAM FOR BREAST CENTERS (NAPBC)

The NAPBC is a program to identify and recognize breast cancer treatment centers in the United States. A consortium of leading health organizations chooses those facilities that meet the program’s 28 standards and 17 components. These treatment centers are deemed to provide the most efficient and contemporary care available for patients diagnosed with diseases of the breast. The components include meeting certain criteria in terms of diagnostic testing, staging, medical oncology, nursing, education, outreach, quality improvement, cancer survivorship programs, radiation, and plastic surgery, among other facets of care. For treatment centers that meet NAPBC requirements, check the appendix.

Second Opinions

There are many reasons for wanting to get a second opinion. You may be newly diagnosed and seeking confirmation that your doctor’s recommendations are the best. Or you may have concerns about your current treatment and want to explore other options.

“There is nothing more that I want to tell people than not to be afraid to make a change,” says Joanne Filina, mother of two who was diagnosed with chronic lymphocytic leukemia at age 37.

“I know how hard it is to leave a doctor. I stayed with my family doctor for two years before he finally did tests that gave me a diagnosis, and then he referred me to a specialist who told me I had 18 months to live. My husband said, ‘I will fly you to China if I have to.’ I didn’t have to do that, but I did go to see another specialist and that was a whole different ball game,” says Filina.

Many people worry that their doctor will be offended about getting a second opinion, but if this is the case, that might be a tip-off that a second opinion is needed. If the second doctor’s opinion is different from the first doctor’s and you are still uncertain, you can go back to your family doctor for advice, or you can seek a third opinion to see if there is a consensus from two of the doctors as to which treatment course is best.

The Role of the Patient Navigator

If you are a newly diagnosed cancer patient, you may feel that your whole world has changed. That’s understandable, because in essence, it has. But what can really help you through the process is having a skilled professional by your side. This is where the American Cancer Society’s (ACS) Patient Navigator program comes in.

“Usually at that first appointment, patients are overwhelmed. They have seen three or four doctors, and they have so much on their plate they just can’t even take anything in. We are here to help guide them, so they don’t have to go through this alone,” says Stacey Huber, an ACS cancer navigator at Mercy Medical Center in Baltimore, Maryland.

This is a free service sponsored by the ACS, and is offered in most cancer centers. There are individuals who perform similar functions, but go by other names, such patient advocates or hospital social workers. Whatever they are called, these are people who can help you through your treatment, assisting you in finding the help you need, whether it is financial support, insurance, transportation, caregiver support, or even just to lend an ear — right from the start.

“If you’ve been newly diagnosed, ask the hospital what they have to offer. Ask for any and all support services that they offer. Set up a meeting with them and listen to what they have to say,” says Huber.

Financial issues are often among the top concerns of patients. “A lot of people are in the middle-class income bracket; they have mortgages, utilities, two kids, and they may be out of work while they are being treated, so they are only getting 60 percent of their paycheck and the costs can add up,” she notes. This adds to the stress, so Huber helps her clients work out payment plans and find whatever financial help is available.

In addition, such an advocate can help you in talking with your spouse, children, and relatives about cancer and refer you to support groups for these topics.

So when you are facing a cancer diagnosis, reach out. Find a patient navigator, advocate, or caseworker. You don’t have to handle it all alone.

QUESTIONS TO ASK

The following are questions to consider when choosing a doctor: