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Choosing an Oncologist

By Peter Kennedy, M.S., M.D., Metropolitan Oncology Group at St. Vincent's Cancer Treatment Center, Los Angeles

Please Note: Some of the suggestions offered in this article may not apply to your situation if you are in an HMO. Others, however, are valuable, especially in helping you recognize the need for a trusting relationship.

Medical oncology is a unique specialty in that it regularly deals with issues that directly affect both life and death. In this pressure cooker environment, the medical oncologist must provide complicated information, hope, guidance and compassion in an understandable, balanced fashion. The gravity of the diagnosis of cancer demands a degree of trust between physician and patient not seen in many medical specialties.

In fact, if you are to work well with a medical oncologist, he or she should possess qualities that will enable you to (1) utilize the physician fully as an information source, (2) trust him/her—literally—with your life and (3) maximize your quality of life during your fight with cancer.

Getting the Name of a Medical Oncologist

The first step in finding a medical cancer specialist whom you can trust—before, during and after treatment—is to get the name of someone. You have several sources:

Your Family Doctor

Based on tests recommended by the primary care physician, he/she will often recommend a medical oncologist. This is usually a doctor with whom he/she has worked and who has cared for his/her patients in the past.

Friends and Relatives

Sometimes friends or family will recommend a medical oncologist who has cared for a loved one.

Local Medical Society or Hospital Information Hotline

You can call the County Medical Society or a local Hospital Information Hotline for information about available specialists.

Media Reports

Often, the report of a medical "breakthrough" will mention the name of a medical oncologist.

Advertisements

Increasingly, newsmagazines and other lay publications have advertisements which refer to one or more medical oncologists.

Institutional Affiliation

A variation on the theme of "direct selection" is to seek out physicians affiliated with a particular institution. The institution itself may be selected on the basis of its general reputation, or its prior achievements in a particular area of cancer research or treatment. As mentioned above, news publications, media reports and advertisements may suggest or recommend a specific individual or group of doctors who are affiliated with a notable medical institution.

Credentials

Since the most important factor in selecting an oncologist is his or her skill and expertise, after identifying a possible choice, it is important to learn something about the doctors' credentials.

What college/medical school, residency and fellowship program did they attend?

Are they board certified or eligible in medical oncology?

What is the extent of their hands-on experience in patient care?

What are the qualifications and experience of their colleagues and associates?

Access to Clinical Trials

In addition to credentials, an important factor in choosing a medical oncologist is that person's access to new and experimental treatments called "clinical trails". This is important because, in the rapidly changing field of cancer treatment, many patients are best treated by being enrolled in clinical trials. These are scientifically rigorous therapy plans (called protocols) which provide access to new treatment methods under the guidance of the National Cancer Institute or pharmaceutical companies and the FDA. [See Clinical Trials for Progress and Cure for further explanation.]

Evaluating Several Possibilities

Unfortunately, none of these selection methods provide any specific information about the skills and strengths of a particular doctor. After all, all board certified cancer chemotherapy specialists have a fairly similar base of information. They share a reasonably standard armament of treatment tools, whether in private practice or the university setting. Differences become notable, of course, in the areas of investigational therapy (clinical trials). In any large urban center, however, experimental drugs and treatment devices are accessible with a telephone call.

In short, there is no "ideal" medical oncologist. How, then, can a patient learn about those essential qualities, noted earlier, that are needed for a good doctor-patient relationship—particularly when he/she has been traumatized by the shock of a diagnosis of cancer? Recommendations from friends and physicians can be helpful, of course. Nevertheless, the patient must draw conclusions about his/her new doctor and whether a positive relationship is possible at the time of their first few meetings. The following is designed as a sort of "checklist" of things to keep in mind at these first meetings.

General Impressions on Your First Visit

The first meeting is very important, yet you are likely to be nervous. Therefore, it is advisable to bring a friend or family member with you. This can help you "size up" the new doctor, remember information and instructions and provide you with personal support in a stressful time. Without dwelling on details, get a general impression by noticing:

As you enter the office, is it comfortable, clean and inviting?

How long is the wait? Even more important, perhaps, is why must you wait?

Do you feel the doctor spends an adequate time with you (and others) or do you get the impression that things are rushed and chaotic?

Communication Skills During All Your Visits

While the doctor should be confident and to some extent authoritative, he/she must also convey humility and flexibility. Notice:

Is he/she a patient listener?

Is the oncologist interested in learning about you as a whole person? After all, you are more than a disease.

Is the language he/she uses understandable, simple and direct?

When you ask questions, do the answers make sense to you?

Does the doctor seem to have a sense of compassion and trustworthiness?

The Nursing Staff

These people will provide much of the care that you'll receive in the office. As you talk with them during the first few meetings, notice the following:

Are they friendly, solicitous and patient?

Do they appear to be professional?

Does the office seem to run smoothly or does it appear to be chaotic?

Availability of Other Cancer Treating Specialists and Medical Specialists

The complexity of cancer treatment means that you will likely need more than one medical specialist. To avoid having to go from one building or area of town to another, answers to the following questions are important and can help you make a selection.

Is the office easy to get to? This is especially important in case of an emergency.

Are the hospital and emergency facilities with which your doctor is connected nearby?

If those facilities are not nearby, what arrangements does your doctor have with your local hospital in case of unforeseen problems?

Are there facilities for radiation therapy, diagnostic radiology, and medical and surgical sub-specialties within your doctor's office or close to it?

Are there facilities for nutritional support and social service?

Does the doctor work with sub-specialists in areas like pain control and mouth care?

What sort of back up does the doctor have covering him/her at night or on weekends.

Can someone always be reached promptly in case of emergencies?

Can they be reached for non-emergencies?

How Well the Doctor Understands Your Illness

Although it can be difficult to do, try to find out how well the doctor understands your particular illness. No doctor is equally knowledgeable about all types and stages of cancer treatment.

Is he/she familiar with all available treatment options?

What does he/she think about getting a second opinion? (You should know that all doctors are at least slightly "stung" by such a request. It implies a rejection of the physician personally and professionally. But ALL physicians should be willing to support a request for a second opinion. After all, the patient is a consumer and the doctor is a commodity which is for sale.)

What is the doctors' attitude toward alternative therapy? (Again, be aware that most physicians look with anger and disdain at unproven claims of cancer treatment; they object to the fact that alternative medicine is not held to the same rigorous scientific standards as is traditional medicine.) Ideally, however, the doctor should offer a lucid, honest explanation of his assessment. [Note: There is a great difference between therapies that purport to be a viable "alternative" to standard treatment and those that are "adjunctive" or "complementary" therapies intended to be used in addition to traditional treatment. See Alternative and Complementary Treatment—Making an Informed Decision for more information.]

Professional Competence

As noted earlier, the doctor needs to be confident of his/her perspective, yet also flexible. Therefore, notice:

Is he/she willing to entertain other perspectives related to your disease?

Is he/she able to accept criticism?

What is his/her demeanor during an emergency; is he/she decisive or reflective?

How does he/she interact with his/her staff and with his/her peers; are they considerate, practical, effusive or reserved?

How is he/she viewed by his staff and by other physicians; is he/she respected, loved, feared or admired?

Making a Choice

As you can see, there are many factors that enter into your choic of a medical oncologist. An overview of what we've discussed can be helpful, after the first meeting or two, in making your selection. If you print out this page, you can check off the following items (or give each one a rating). In deciding if this particular oncologist would likely be best for you, remember that there is no "perfect" selection. No one will rate 100% in every area. On balance, however, you need to make your choice based on those things that are most important to you.

Remember, you are looking for a medical oncologist who will enable you to:

utilize that person as an information source

trust him or her—literally—with your life

maximize your quality of life during your fight with cancer

— © Peter Kennedy, MD, Learning Place Online, 2002