How do I know I have the best doctors

nikrap

Hi Ladies,

I went back to the surgeon today and she set me up with an oncologist, plastic surgeon,and radiation oncologist. I just met this surgeon and she is hooking me up with these other doctors that I need to depend on to save my life. How on earth do I know if I am choosing the best doctors?

We live in Raleigh, NC and I will be heading over to Duke Medical Center on Sept 9th for a second opinion. If I were to decide on going with the doctors at Duke, I would probably be operated on by interns. Maybe it's me, but that does not leave me with a warm fuzzy.

Thoughts? Suggestions?
-Carolyn

cabbott

Hospital Rules
Duke is a wonderful facility. (I say that even though I'm a Tarheel and they were our arch rivals!) You can check with the surgeon you talk to about what the rules are on who does the surgery: the surgeon or the interns. At the teaching hospital I went to where I now live, the surgeon was required to do all surgery. Interns and residents were present during my operations and often accompanied the surgeon during hospital visits. They never showed up for office visits before or after the surgery. Also, I was asked if I minded them coming in when they followed the surgeon around for "rounds". I didn't. It seemed like the least I could do to help them with their education when their hospital had helped me with cancer. Sometimes students are allowed to do non-operating procedures like monitor your pulse and such, but hospitals don't like to take risks with their patients. It's too expensive! Insurance companies frown on that sort of thing too according to my breast surgeon.

You can also consider what operations you are having. I was in a small town where the general surgeon was fairly skilled at lumpectomies, competent at mastectomies though he only did about 12 to 15 a year, and had little to almost no practice at sentinel node operations. I read up on lymphadema that often results from the standard node dissection and didn't need much convincing to go with the teaching hospital breast surgeon who did 14 to 20 sentinel node operations a week as well as several mastectomies a month when I had to have a mastectomy and nodes checked. I knew going in that my kind of cancer was non-aggressive but had to have a mastectomy because the cancer was in 2 spots and I was too small for two lumpectomies. Another thing that convinced me to go to the breast surgeon was that he called for a simple mastectomy and the first surgeon wanted to do a modified radical mastectomy. More doesn't make it better when it isn't necessary and I had very tiny spots. I checked with Susan Love's the Breast Book a lot and it looked like a simple mastectomy made sense to me even before the breast specialist gave me his opinion that that was all that was necessary. That was back in 2002 and so far I'm still doing well. Now maybe that same general surgeon I saw first could do a sentinel node operation. And maybe the modified radical would have been okay. Who knows? But I have read that the guys who do the most of any given operation tend to get the best results, so I bet I would still be better off with the breast specialist. So ask for the stats on the surgeons you see or search their website for the information. They keep records just like ball players and often post them for the public, especially if they are proud of their work.

So look for track records, training, their recommendations and how they fit with current gold standard practice, and finally how the doctors relate to you. Good luck!

nikrap

cabbott said:

Hospital Rules
Duke is a wonderful facility. (I say that even though I'm a Tarheel and they were our arch rivals!) You can check with the surgeon you talk to about what the rules are on who does the surgery: the surgeon or the interns. At the teaching hospital I went to where I now live, the surgeon was required to do all surgery. Interns and residents were present during my operations and often accompanied the surgeon during hospital visits. They never showed up for office visits before or after the surgery. Also, I was asked if I minded them coming in when they followed the surgeon around for "rounds". I didn't. It seemed like the least I could do to help them with their education when their hospital had helped me with cancer. Sometimes students are allowed to do non-operating procedures like monitor your pulse and such, but hospitals don't like to take risks with their patients. It's too expensive! Insurance companies frown on that sort of thing too according to my breast surgeon.

You can also consider what operations you are having. I was in a small town where the general surgeon was fairly skilled at lumpectomies, competent at mastectomies though he only did about 12 to 15 a year, and had little to almost no practice at sentinel node operations. I read up on lymphadema that often results from the standard node dissection and didn't need much convincing to go with the teaching hospital breast surgeon who did 14 to 20 sentinel node operations a week as well as several mastectomies a month when I had to have a mastectomy and nodes checked. I knew going in that my kind of cancer was non-aggressive but had to have a mastectomy because the cancer was in 2 spots and I was too small for two lumpectomies. Another thing that convinced me to go to the breast surgeon was that he called for a simple mastectomy and the first surgeon wanted to do a modified radical mastectomy. More doesn't make it better when it isn't necessary and I had very tiny spots. I checked with Susan Love's the Breast Book a lot and it looked like a simple mastectomy made sense to me even before the breast specialist gave me his opinion that that was all that was necessary. That was back in 2002 and so far I'm still doing well. Now maybe that same general surgeon I saw first could do a sentinel node operation. And maybe the modified radical would have been okay. Who knows? But I have read that the guys who do the most of any given operation tend to get the best results, so I bet I would still be better off with the breast specialist. So ask for the stats on the surgeons you see or search their website for the information. They keep records just like ball players and often post them for the public, especially if they are proud of their work.

So look for track records, training, their recommendations and how they fit with current gold standard practice, and finally how the doctors relate to you. Good luck!

Thank you for your
Thank you for your response... that made a lot of sense to me. I think I am just feeling overwhelmed at having to make decisions my life depends on when I know so little. I am trying to read up on as much as I can but,as you know, the information is overwhelming.

My nephew went to Duke, one of my sons goes to UNC the other at NC State. We have interesting family gatherings!

Akiss4me

From what I know....
I am in West Virginia and my neighbor went to Duke Medical for a second opinion! Then settled on AGH in Pittsburg where I now go as well. I was told that Duke would have been prefered, but of course Pittsburg is closer. I think you would be in good hands at Duke. ♥ Pammy

DEwill

cabbott said:

Hospital Rules
Duke is a wonderful facility. (I say that even though I'm a Tarheel and they were our arch rivals!) You can check with the surgeon you talk to about what the rules are on who does the surgery: the surgeon or the interns. At the teaching hospital I went to where I now live, the surgeon was required to do all surgery. Interns and residents were present during my operations and often accompanied the surgeon during hospital visits. They never showed up for office visits before or after the surgery. Also, I was asked if I minded them coming in when they followed the surgeon around for "rounds". I didn't. It seemed like the least I could do to help them with their education when their hospital had helped me with cancer. Sometimes students are allowed to do non-operating procedures like monitor your pulse and such, but hospitals don't like to take risks with their patients. It's too expensive! Insurance companies frown on that sort of thing too according to my breast surgeon.

You can also consider what operations you are having. I was in a small town where the general surgeon was fairly skilled at lumpectomies, competent at mastectomies though he only did about 12 to 15 a year, and had little to almost no practice at sentinel node operations. I read up on lymphadema that often results from the standard node dissection and didn't need much convincing to go with the teaching hospital breast surgeon who did 14 to 20 sentinel node operations a week as well as several mastectomies a month when I had to have a mastectomy and nodes checked. I knew going in that my kind of cancer was non-aggressive but had to have a mastectomy because the cancer was in 2 spots and I was too small for two lumpectomies. Another thing that convinced me to go to the breast surgeon was that he called for a simple mastectomy and the first surgeon wanted to do a modified radical mastectomy. More doesn't make it better when it isn't necessary and I had very tiny spots. I checked with Susan Love's the Breast Book a lot and it looked like a simple mastectomy made sense to me even before the breast specialist gave me his opinion that that was all that was necessary. That was back in 2002 and so far I'm still doing well. Now maybe that same general surgeon I saw first could do a sentinel node operation. And maybe the modified radical would have been okay. Who knows? But I have read that the guys who do the most of any given operation tend to get the best results, so I bet I would still be better off with the breast specialist. So ask for the stats on the surgeons you see or search their website for the information. They keep records just like ball players and often post them for the public, especially if they are proud of their work.

So look for track records, training, their recommendations and how they fit with current gold standard practice, and finally how the doctors relate to you. Good luck!

I am not sure I would trust
I am not sure I would trust a general surgeon. Fortunately my sister is in the medical radilogy field and had knowledge of a breast cancer specialit in Atlanta. this is all they do there is breast cancer surgery anad treatment. I felt comfortable with them since they have done hundreds of this type surgery.
I had a mastectomy, left breast, because I had a large and small tumor.
I was in shock or my brain was taken over by a higher power to allow me to handle all in store for me.
The hardest think, information wise for me, was knowing what to ask and understanding all they told me. Once I understood that after the surguery only 4 lymp nodes were taken and the path results, once we finally got them, showd clear magins, mine was non hormone.
I am only having to have chemo. Just had 4th treatment and the hardest thing for me has been the weakness and the sinus issues that developed for me within 1 day of the treatment.
Well I got off the subject there some. The Dr. tells me it's called chemo brain, you just cannot keep evverything together.
Good Luck

Marcia527

I was sent to the surgeon by
I was sent to the surgeon by my PCP also. But I checked into her history and she had only been in practice one year. I let her do the biopsy but had decided to get a second opinion when she admitted she didn't know what to do with me. So I ended up going with the second surgeon who had lots of experience plus was recommended by two people. He referred me to the onc and rads doc which I just decided to trust him. I decided maybe it'd be better if they knew each other and could work together. You just have to decide if you like the docs and check to see what their experience is. You have to be able to trust who ever you choose.

KathiM

Ask around, check the specs on the surgeon....
The surgeon for my rectal cancer was the head of surgical oncology for a major cancer center in southern California. But, it was over 30 years prior, and at the point I had an appointment, his nurse was needed to read my chart....LOVELY man, but...wellllll.

I ended up with the current head of another hospital's surgical oncology for my lumpectomy. I listened to my gastric surgeon, who had recommended him. It worked out really well, but even he was surprised when it turned out my lymph nodes were involved.

I said on an earlier post, I think, that it's important to trust your treatment team. And feel comfortable with them. If possible, stay close to home for the chemo/rads. My surgeries were done at a hospital 45 minutes away (on a good day...lol), but my treatments I could get to at another facility close by within 10 minutes.

I've heard good things about Duke...and, as my nurse said to me "Kathi, the first round of surgery/chemo/rads is pretty standard anywhere you go. It's the second round that gets a bit more important, and I'm planning that you won't HAVE a second round!". I didn't...

Hugs, Kathi

sweetgeorgia

Trust your instinct
Sounds like you have a lot of good advice. I too, was first sent to a general surgeon but felt uncomfortable with the long line of men in this network that didn't all specialize in breast surgery. Red flags went up. A friend of mine recommended her specialist and there, I found a group of 6 or 7 women surgeons that specialized in breast care every single day of the year. I felt welcome, at home (away from home), and in safe hands. My instincts were right here and even though I'm not out of the woods, I feel confident I made the right choice.

Good luck!

Moopy23

Doctors, Hospitals
Carolyn, that's what happened to me: my PCP referred me to my surgeon, who in turn hooked me up with local oncologists. There I was, with 3 doctors I'd never heard of.

However, I love my PCP and had asked her for a surgeon. She got me to a good man and a wonderful surgeon. As I told him before my mastectomy, I trust Dr. K with my life; if she referred me to him, then I trusted him, too.

And I was right: though he is a general surgeon and not a bc specialist, his work (that is, my left chest) has gotten repeated compliments from two highly discerning oncologists and one physical therapist who specializes in breast cancer patients and teaches at the top PT school in the country. The scar doesn't impress me, frankly, as I would prefer to have a healthy original breast. But I'll take the compliments for my surgeon. I am not ready for reconstruction, but I'll be going to my surgeon's friend and favorite plastic surgeon with no qualms when that time comes.

As for the chemo and rad docs, I think I was just sent to the the ones that were newest, though I greatly admire, appreciate, and like the rad. onc. I was assigned. Like you, I was not content to have no input on which doctors I would have, and I got a second opinion for the medical oncologist. (Rads is a different story.)

Finding a medical team that you trust and are comfortable with is vital, and it is good that you are being proactive and questioning early on. The only advice I can add is that, since you have 2 NCI facilities right there in the Research Triangle, I would consider them, even if interns are involved. Some states do not have any NCI hospitals, but North Carolina has 3. If I were you, I'd go to one of them, after some research and inquiries.

But that's just me. We all do our best with the many decisions that suddenly confront us after a cancer diagnosis. I am sure that you will find the right individuals/team for you.

peggypeggy

a good surgen
my expierence i went to hershey medical center 3 hours away good hospital as us all this is a shock to us so many decisions diagnosis test numbers overwhelming and now making sure the dr right i met mt surgeon dr stanley smith god bless him he said to my husband and me dont worry not a breast man im a toe manhe made us laugh his motto **** happens move on he explained in a 3 hour meeting what i had we went over mri together i saw everything where it was where it formedand he showed where he was going to cut i knew ahead of time i was going to lose nipple but he assured i would never know and he was right i have a new one just like my old one he froze my tumor with margin and then removed no spreading out of that frozen ball aleays make sure you dr doesnt put you on time limit if you need 3 or 4 hours to understand you take itthat way no surprises my dr said get it right the first time also my dr have his cell phone there nurses and breast care center can get them 24 hours a dayto talk or if something wrong and they call everyday to check on you but this was my experience you should never know another patient is waiting you are number one tke all the time you need with your dr god bless luv peggy