It’s a seemingly easy, but extraordinarily difficult question to answer! Yet, what could possibly be more important than finding the right physician to help guide you through your journey with cancer! Though there may be no definitive answer, there are criteria that you may find highly useful in assembling your care team. Here’s where Lori and I would start the process:
· Participation in your insurance plan. Because of the extraordinary cost of health care services, the first screen that most people use when considering a physician is whether they participate in the patient’s insurance plan. Unfortunately, some physicians may be inaccessible to you by virtue of being out of network—meaning that your insurance company has not contracted with these doctors to be part of their physician panel. Unless you are willing to pay heavily out of pocket, which can be financial devastating, you will need to find an in-network provider.
· Reputation for clinical excellence. Though it is difficult to quantify, every physician knows that there is tremendous variation in quality among doctors. Let’s call it medicine’s dirty little secret. There are ways to improve your probability of finding a clinically excellent doctor: 1) Begin by searching out physicians who enjoy a strong reputation within the community among both consumers and health care professionals—there is probably a good reason for them to be viewed positively; 2) consider a physician who practices at a nationally recognized cancer center.
· Training and credentials. Lori and I feel this issue bears repeating because the depth and breadth of a physician’s training can also provide a proxy for quality. A basic starting point is to ensure your physician is Board-certified. You may then want to consider a physician who has received sub-specialized training in the form of a Fellowship (it should be noted that there are no fellowships in certain sub-specialties). Some patients also consider where their physicians trained—believing that a Fellowship from a prestigious cancer institute provides yet another level of assurance. As you go through this discernment process, please realize that there are also superlative physicians who do not possess these credentials.
· Experience. Nothing trumps the value of experience—and the insight, proficiency, and wisdom that can be gleaned through years of practice. Reams of data exist showing the correlation, for instance, between the number of surgical procedures performed by a physician, and his or her outcomes. As Malcolm Gladwell discusses in his book, Outliers, it generally takes a great deal of time to achieve mastery in any endeavor: “In fact, researchers have settled on what they believe is the magic number for true expertise: ten thousand hours.”[i]
· Alignment with a specific hospital or health system. Your physician is but one cog in the medical “machine” that provides care to cancer patients. The comprehensiveness, quality, and cutting-edge nature of this care will vary dramatically between freestanding centers, hospitals, and health systems. What may be available at your local community hospital could be a mere subset of the offerings at an academic medical center. Depending upon your type of cancer, where you are treated could have a significant impact on your outcome. Remember, if your PCP is an employee of a hospital or health system, he or she is probably strongly encouraged to refer you to specialists within this system. That may or may not be in your best interests.
· Referral Network. It is important that, when selecting your first specialist, you have some sense of the other physicians to whom you may be referred. If your initial referral is to a surgeon, he or she will likely have a preferred medical and radiation oncologist. Together, they will form your cancer treatment team. Ideally, you would want to conduct some level of due diligence on all of these doctors—but recognizing that timeliness of treatment may be important, that is probably not feasible. Therefore, there is even more reason for you to be comfortable with the system into which you are referred. It is essential that you be confident that all of the physicians meet a minimum standard of excellence.
· Regular Participation in a Tumor Board. Many cancer specialists attend regularly scheduled meetings in which a panel of diverse specialists review patients’ findings and recommended treatment plans. It allows a specialist, and their patient to receive a multi-disciplinary review of their care and make any recommended course corrections. Lori and I feel strongly about the importance of tumor boards. We would consider making participation a pre-requisite when selecting a specialist. Keep in mind, however, that the treatment of many early stage cancers is so straightforward as to not warrant multi-disciplinary review. Ask your specialist if he or she plans to present your case. If so, request a follow-up report on the consensus of the tumor board regarding your treatment.
· Gender. Whether you seek care from a male or female physician is primarily a matter of comfort for some patients. This issue most frequently comes into play in cases of breast cancer and genito-urinary tract diseases such as cervical cancer.
· Interpersonal style. The communication style and emotional intelligence of their physicians matters greatly to some patients and far less to others. Some patients simply want a physician with unquestionable clinical skills and are willing to defer to their physician’s judgment. Others want to actively participate in treatment decisions and need a physician who is an extremely effective communicator, demonstrates clear empathy, and welcomes you as partner on this journey. For patients facing a difficult prognosis, the emotional intelligence and emotional availability of their physician can make a pronounced difference.
This post is an excerpt from After You Hear It's Cancer: A Guide to Navigating the Difficult Journey Ahead (Rowman & Littlefield, July 2015).
For readers interested in exploring these topics in more detail, please also consider reading my earlier book: The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield, September 2014). Chapter 5 focuses exclusively on physician-related issues and elaborates on a number of the aforementioned topics.
[i] Malcolm Gladwell, Outliers (New York: Little, Brown & Company, 2008).