What makes a good oncologist good?

[Faith in Him]

I am a year into this journey and I still do not feel a real connection to my doctor. I was hoping for someone a little more cutting edge. Also, I feel as though his attitude torwards me has shifted a little since my local recurrence. In your opinion, what are the traits of a good oncologist?

Thanks for your wisdom.

Tonya

[Mary Anne in TX]

Hi Tonya!
What I like about mine: he remembers my case notes, he's up on new stuff, he's concerned and friendly, he listens to me, he hears me, he tries to keep me able to "have life", his staff is awesome, his referrals to other doctors is amazing, he gets me into have scans and stuff the next day or very soon, he asks my opinion about treatment and is willing to be agressive, and he's been recognized for excellence in his field several times. He helped to start the practice (STOH) where I go. And Oh yea, he likes to fish!
Hope you get this resolved to your satisfaction. It is so important to have faith in your onc.
Much love, ma

[madubois63]

My answers are very much like Mary Anne's, but I get a little extra...My onc gives me a hug, a kiss and tells me he loves me (in Greek every time I see him. If for some reason Theo can't be there, his nurse practitioner is there for me the same. She is an angel on earth. Can't start the visit without a big hug and a tear. They worry if they haven't heard from me in a while (between the leukemia doctor and all) and will call just to check on me. I truly believe that it all has to come together - your attitude and seriuosness to take care of your self, your family, friends and support, your medical care/medications, prayer and LOVE. Over the last 8 1/2 years, it has not always been easy to get straight answers, and sometimes other people butt in. If you feel like sometimes someone is dropping the ball on you - SPEAK UP!!!! You have to be your best advocate and get what you need. You are the consumer!!!!

[Colleens_Husband]

Dear Friends:

I'm not sure anyone would ever know if their oncologist has the technical skills to be a top-rated oncologist. Being nice and personable is one set of skills and being a able to successfully fight cancer is another set of skills that may not have anything to do with personality.

Colleen's oncologist is a short Pakistani physician who operates in secret medicine mode. He doesn't tell us anything unless we ask. I think he is trying to Pearl Harbor the tumor by sneaking up on it. He was making us nuts.

Then we read a newspaper article in the local fishwrap and we find out he was voted one of the four best oncologist on the west coast by other oncologists and his specialty is Her2 breast cancers. He spends two days a week traveling to other oncologists to train them on the newest advances in oncology. Who would have known?

After finding out that he wasn't a complete dud, we decided to be more assertive advocates in Colleen's fight with cancer. We brought written lists of questions to the consultations and did our best to be as educated as possible. Thats the reason I came to this site in the first place. The more we found out about the state of treatment for Her2 cancer, the more we realized our oncologist was pretty damn good.

Would it be better if he had even a small amount of charisma or charm? I suppose so, but the important thing is that he saves Colleen's life and everything else doesn't matter so much.

Lee

[Faith in Him]

Hi Lee,

I noticed that your wife is having her re-excision today. Sending warm thoughts and prayers to you both.

Tonya

[Faith in Him]

Also Lee,

My oncologist is the same way about getting info. Sometimes it is like pulling teeth and I have came in with a list of questions. I think that he is like this because some people want to know everything and other do not. So, I guess, he waits for us to bring stuff up. Your right, skill is more important than personality. Although, to have a doctor with skill and charm would be nice.

Tonya

[Unregistered]

I am in Mexico City so I am having difficulty logging in. But I changed oncs after one year. He did not remember me even with all the appts you have the first yr and when you are on Herceptin too. He remembers his golf game though. I think you have to have someone who is a partner in your care. Also, you want an onc who truly wants to cure you, stays current but is not embarrassed to have missed a study and appreciates that you send him stuff. He does not have to kiss you or ask about the kids. He has to love his job more than his hobbies. Don{t get a golfer, runner or boater. They seem to be in it more for the money of being a doctor than helping and curing people that{s my take

[AlaskaAngel]

A very good question.

Like Lee, my onc was among the top on the west coast and well-loved by practitioners and patients alike, but never gave me information unless I already knew enough to know very specifically what to ask.

Unlike Lee, I have to be very honest and say that because most of us are in the dark at time of diagnosis and that is exactly when we are having to make very complicated decisions, having an onc who only provides information when asked makes it MUCH more difficult to know what to do.

I think my surgeon, on the other hand, is excellent. He didn't assume anything when I met him. He started at square one and gave me a clear outline, and then started filling in the picture, skipping ahead whenever it was clear that I had a good understanding. In short, I think the best doctor is someone who is constantly learning, and is both able and willing to teach -- someone who isn't afraid of being challenged by new information, even when it is the patient who brings it in.

I believe that by making the effort with patients at crucial visits like the first one, a doctor can save the patient and him or herself a lot of time and energy down the road.

AlaskaAngel

[PinkGirl]

Hi Faith

I have always wondered why we trust the people we trust.
I think it is a "feeling". My onc is a peculiar man who looks
like he combs his hair with a towel. When I ask him questions
he always gives me the text book answer - sort of a generic
reply. Then he switches to a different mode and starts explaining
things to me in a way that I can comprehend. I like him. I'm not
sure why. I know that I don't dislike him. He is very scientific
and not real warm and fluffy but I can contact him at any time and
he will return my phone calls the same day. He called me at supper
time on Easter Sunday to see how I was doing and I know he was
just going through files.

I think you will just know when an onc isn't right for you and when he or she is.

[Linda]

Tonya:
Like others, I think it's a balance between technical expertise and bedside manner, and with oncology I think the skill and personality of the nursing staff is hugely important, since they are the front line of care.
You probably know this, but in No Cal, the docs at UCSF have a fabulous reputation. You could try a consult there, and also at Stanford, to test the waters and see if you find someone else you feel more compatible with. Maybe other northern Californians will post the specific names of drs. at those places for you to try.
I've heard fantastic things about Laura Esterman's office at UCSF -- but she's a surgeon, not an oncologist. Could you call them for a recommendation?
Linda

[Carolyns]

I live in a large city and my oncologist only sees breast cancer patients. The entire practice is dedicated to breast cancer. The practice participates in numerous studies and is a presenter at most of the major breast cancer conferences.

As a bonus, she is like an angel. I can and do tell her anything that is on my mind and her response is always thoughtful. Often times I make her go into detail on changes in my treatment plan and challenge her with my own research. She never minimizes my ideas even if she feels like I am don't have "enough" information to qualify for these types of decisions. She will walk me through my thought process on the treatment plan and then explain hers in comparison. It is very comforting to know that she has considered all of the options (including my research) and then explains the mindset behind her decisions. I need to buy into treatment with my mind and my body without hesitation. As a stage IV girl it is common to change plans.

I am very lucky to have found such a doctor.

Carolyn

[Colleens_Husband]

Tonya:

Thanks for mentioning Colleen's re-excision. It was kind and thoughtful of you. It really makes me feel like I am in a real community.

I have mixed feelings about the surgery. In one way I want clean margins, mostly to avoid another surgery. In another way, I hope that if there are more pockets of cancer in her breast, that the margins don't come back clean and there won't be a hidden time bomb waiting to go off.

It's weird. I've been saying prayers but I'm not sure what I should be praying for. Well, other than one or two years from now that Colleen will be cancer free.



Alaska Angel:

I am glad that you disagreed with me on what makes a good oncologist. If we can keep personalities out of the mix, then other people will be able to look at this thread and get a range of differing opinions. Through the difference in opinions, someone in the future may be able to discern a spark of truth.

To me, the most important thing is that someone who is considering changing oncologists gets the broadest view of what makes a good oncologist.

Lee

[Mary Jo]

Tonya,

I can't add anything. "They've" all said it all (I thinkhttp://her2support.org/vbulletin/images/icons/icon7.gif) but wanted to say "hello" and to tell you your children are beautiful. I think of you often when I come here and see your user name "faith in Him" and hope you are doing well.

May God's Peace surround you today...

Mary Jo

[Faith in Him]

Thank you all for your opinions. It gives me a lot to think about.

Tonya

[Carolyns]

Hi Tonya,

I just re-read your post and I have a couple more thoughts that just occurred to me. I think that the best oncologist will assess the patients communications needs / desires and speak with them accordingly. For example I want and need to know most everything. It helps me to be comfortable. One of my best buddy stage IV friends at the center does not want to know a single thing about treatment or test results unless it is imperative for her to know. My doctor communicates with her different than she does with me although I am confident that we both receive the same excellent and equally great care.

Same doctor / excellent care / totally different communications set based on the individual patients needs and desires.

In reading your post again it sounds like your concerns are specific to your doctor. Please don't hold back any concerns you may have from your doctor directly. Voice any and all concerns and see what kind of response you get. You can be specific just like you were in the post. I think that you really need to be confident in your doctor and you have specific concerns. Best wishes and good luck.

PS - I agree, you have beautiful kids!!!!!

[AlaskaAngel]

Hi Lee,

I appreciate your gentle wisdom and diplomacy, and enjoy your opinions. I agree, the more the better.

Sincerely,
AlaskaAngel

[BonnieR]

Lee,
I expect it matters less what one is praying FOR as long as we are just praying.

[Bill]

I agree, Tonya, you do have beautiful children. As for your original question, all I can do is tell you my and Nikki's story, briefly. She had a surgical onc., and rad. onc., and her regular onc. that worked sort of like a team out of different offices, but communicated regularly. Her surgeon, (chief surgeon of a major hosp. ) would talk about whatever you wanted to talk about when in the office. Nikki called him her boyfriend. We had his home number and cell phone number. When he goes on vacation, he often travels to perform "pro bono" surgeries. Nikki's rad. onc. always gave her a big hig and would spend as much time as we wanted with her. A few weeks ago I went to see the rad. onc. Dr. C. and all I wanted to do was thank her for all the years of care that she gave Nikki and leave a flyer for this site with her and promote it, but next thing I know, I'm sitting in an exam. room, and she's spending almost an hour with me, looking at the flyer and discussing anything I want to and telling me the she's going to put the flyer in a packet for all new patients to receive. Dr. P., the surgeon was the same way. I went to the hospital on one slow Sunday afternoon, and he was there, as I knew. We talked the same talk, as long as I wanted to. Nik's chemo. onc. was the same way. Gave us as much time as we wanted. (I still need to visit her, stopped by the office to drop off fliers, but she was at the hosp.) I'm sorry for the rambling, but, in my opinion, the good oncs. will spend as much time with you as YOU want to, and in their "spare" time, they are traveling around the country, sitting in conference halls and participating in seminars, like Dr. H. always did. I've had people tell me that we were lucky, or blessed to have such great doctors. I do feel that we were blessed; however, you make your own luck. Nicola educated herself constantly on this site and through other research. Fortunately, I was able to be with her during 99% of her visits with her docs. We were like two Rottweilers ganging up on them, and they realized we were not gonna go away. Early on, they understood that we were informed in regards to Nicola's disease, and seriously intent on pursuing every avenue to cure it. Also, when you/we have to sit waiting for hours to see the doc., it doesn't always mean that they have overscheduled. Often it means that they are willing to spend as much time as needed with their patients. Assert yourselves and become the patient that keeps the doc. in the room, while other patients wait in the lobby. Sometimes, you can't just go with the flow. Stay strong, Bill

[sassy]

I had two good onc. Or actually, one good onc and one great onc. The good onc trained the great onc!

The first onc I actually received treatment from talked with me, explained things to me, reassured me and made sure I was comfortable with everything. After finding out I was HER2+ during the course of treatment, we had a major shift in a short period of time. After thinking about the changes for a couple of days, I realized I had quite a few questions. I faxed my questions to my onc. He had a resident call me immediately, then called me himself after rounds to talk about my questions and concerns. He also threatened to put me on disability if I didn't slow down on the work and rest more during treatment. He was right.

My second onc was great. We spent each appointment discussing all aspects of my disease and treatment, current research, etc. He went outside the box in my treatment--very progressive and aggressive. He appreciated my knowledge and efforts to understand and told me he actually learned from me. I shared with him information I had learned from this site, and he checked into it. He also visited this site and was impressed to say the least. He made a point to visit the HER2Support booth at ASCO to meet Joe, Christine, Steph and others.

I think that as a researcher, he recognized the importance of the information gleaned from the patient.

I agree with others that a good onc shares as much information with the patient as the patient is capable of understanding and handling on an emotional level.

[Joan M]

Hi Tonya,

My first oncologist was very nasty and his nurse was vicious so I switched. He didn't like being asked questions and said once, "Do what you want."

Well, in a way he was right. I was going to do what I wanted and I think that's because I really lacked confidence in him. So I think it's important for you to feel that your oncologist is on top of things.

He wasn't. First he screwed up my dose dense schedule by waiting 7 days to give me 1 neupogen shot for three days in a row, rather than waiting 3 days to give me 1 shot for seven days in a row.

No wonder my white cell count was too low when after two weeks I was due for my next treatment.

Admittedly, he did give me Herceptin off-label (after I twisted his arm), but then he messed up on the weekly Taxol dose by giving me one-third of the dose that's given once every three weeks, when actually the weekly dose given with Herceptin is 20% more than that.

I generally refer to him as the village idiot, and he has some kind of top doctor award hanging on his office wall.

My new oncologist is very smart, listens and explains things to me. She doesn't have a big ego and is not afraid of other opinions. In fact, she welcomes them.

I've been interviewing a lot of doctors lately to decide how to handle the second recurrence in my lung and I'm finding out that I favor the ones who talk to me about what's going on. But I think it's necessary to ask questions too, otherwise doctors probably have a tendency not to provide a lot of information in the interest of time and not overloading the patient.

If the doctor has a sense of humor that makes me feel comfortable too. Last week when I was interviewing an intervention radiologist at Sloan-Kettering about radiofrequency ablation he said, "Well, you've certainly done your homework. You get an A+."

I think it's important for the doctor to adjust to who you are, not the other way around.

Joan

[hutchibk]

I agree with everyone here, as my onc seems to fit all of the criteria listed... I feel like the luckiest patient on the planet. He and I make great partners. He lets me engage him and be a compelling patient. Over the last 4.5 years, he has gently taught me much about my cancer, and he has overseen my own research as I have also schooled myself. He wants to see me live forever, he is invested in my longevity. He has a wonderful sense of humor. My health and living as normal a life as possible is of utmost importance. He has a wiley little way of putting me off the scent of a possible side effects from certain treatments - a reverse psychology if you will. And it is actually very effective. He tells me not to worry, that that is what he is for. He is the worrier. He is aggressive, open-minded and thoughtful, and at the same time skeptical and conservative. He knows my limits and I have made it clear to him that I will do my part to tolerate anything and everything that he needs to throw at me. We trust each other. He gives me a voice and he listens to me. He even makes fun of me. He is so much like my big brother it is scary. But that's not an actual criteria that you need to look for... : )

P.S. - perhaps most important of all, he encourages email contact, so if I have a question, I can send it to him and always hear back from him within 24 hours.

[Faith in Him]

Thanks everyone for your imput and for your sweet comments about my children.

Brenda, I like how your onc. wants to see you live forever. That is a very good trait indeed. Oh, and also that he is the worrier. It shows that he is really on your team.

Tonya

[tdonnelly]

Hi Tonya,
I have had a parade of oncologists throughout my treatment - 5 in all... Anyway, in my opinion a Good Oncologist takes the time to listen to my side effects and works with me to lessen my discomfort and NEVER SAYS: "I never heard of that before" or Herceptin doesn't cause this or that and then dismiss me as he/she hurries to write the next script for treatment.

Tamara
Invasive Ductal Carcinoma 10/2006 HER2+

[Unregistered]

I think smart and competent is more important than nice. Mine I don't particularly like on a personal level, but he has always treated side effects appropriately, listened, and is completely up to speed on what is going on in the field. I have had nice doctors who have turned out to be idiots - it would be great to find doctors who are both nice and competent at the same time, but when that's not possible, go for the smart ones always.

[swimangel72]

I really like my oncologist because he has a wonderful bedside manner and is tops in his field (I did my homework and checked him out!) While I was in the hospital for the staph infection he visited me every day for 11 days and his eyes and smile just lit up the room with kindness and intelligence! He was warm - quick to give a pat on the back or a hug - and very reassuring. HOWEVER.....I almost switched when I had to deal with his nurse practitioner (the snippy nurse) - but changed my mind when my onc called me at home and again reassured me that everything was OK - and that I should personally see him for my next infusion. All the other members of his staff are lovely - they get paperwork done so quickly (not like my breast surgeon's office who were so slow.)

Still - I feel like I haven't done as much homework as you have Joan. How did you find out your onc was giving you the wrong amount of drugs? How did you first suspect? Other than asking my nurse if the bag hanging on my pole is Herceptin or Saline (it's obvious when she's giving me the Navelbine) I wouldn't even know what question to ask concerning my dosages. So how does one ask that question without creating a feeling of distrust?

Sometimes I get different answers from my oncologist than the nurse practitioner - he told me they would routinely check my liver enzymes ever time I get a treatment (which is once every two weeks.) When I asked the nurse today if they would be sending my blood out to check the liver enzymes, she said I would only get my liver enzymes checked every three months. So now I'm going to have to call my onc and ask him - I'm not trying to get her into trouble - but who do I believe? Is there a web site that details treatment protocols like mine so I could double-check on everything myself?? It's questions like these that make me feel awkward and uncomfortable in my onc's office.

[chrisy]

I'm going to respond to this without reading what anyone else says.

Here's what I think:

1. Smart, knows his/her stuff, keeps current
2. Not only open to, but suggests you get other/different opinions and work with others for your best interests. If they are not "cutting edge", refers you or themselves to someone who is.
3. Willing to be creative and think outside the box
4. Cares about YOU.
5. Listens to you.
6. Gives you hope.

I've had 3 wonderful oncologists. Each of them different, but all of them shared these qualities to a greater or lesser degree. I've been blessed to have them complement each other so I had ALL of these things at once (just not from a single person).