Doctor-Patient Relationship

I was fortunate to have my chemotherapy up front, which allowed us to actually see the tumor respond and shrink......therefore also get any cells that may have escaped (the REAL Bad Guys). This also allowed me time to really explore my surgical options. I had a fabulous general surgeon and interviewed 3 plastic surgeons. I learned that a nipple sparing mastectomy might be an option, even though I was told by at least one surgeon that it was not an option. I subsequently learned that very few surgeons do this new proceedure. Anyway, I found out through a friend of a friend of a friend (litterally) that there was a great surgeon at Emory who did the nipple sparing proceedure. I met with him and he felt that I would be a good candidate (small breasted and the tumor was far enough away from the nipple). Also, he was an oncoplastic sugeon, meaning he would do the entire proceedure himself, mastectomy and reconstruction. This meant a more cohesive surgey and less time under anesthesia. I have to say, the before and after photos did make a difference to me as well. No visible scar and a natural nipple, not a tatoo. I feel so Blessed to have even had a CHOICE. I am Blessed :o) I was his 50th nipple sparing mastectomy.

I agree with the above answers. Statistics only tell part of the story. Medicine is a science, but it is also an art, and people overcome insurmountable odds. Feel free to tell him that you don't work well with statistics and that you cannot deal with pessimism.

You can also get a second opinion from a doctor who is hopefully more optimistic. Sometimes hearing another doctor's opinion can be healing to the soul.

Hi Debbie,

You ask an excellent, important question. There are many clues that can indicate it's time to fire a doctor. Sometimes you know immediately that a doctor is not the right fit, but other times, it may take awhile. Here are some tell-tale signs that may indicate a doctor should be fired:

-- He/she doesn't return your phone calls in a timely manner (for me, this is within a day or two).
-- He/she comes to your appointment, armed with statistics printed from the Internet.
-- He/she is dismissive of your concerns.
-- Put out an emotional prompt, such as "I am scared." If the doctor is not compassionate and doesn't address your emotional needs immediately, this could be a sign he/she is not the right one for you.
-- He/she does not allow you to have a say in your own medical care.
-- He/she does not answer your questions in a way you can best understand the answers.
-- He/she interrupts you and/or scolds you, is rude, and is arrogant.
-- He/she contradicts him/herself and keeps changing his/her mind.
-- He/she doesn't listen to what you have to say.

These are just some indications that a firing is in order. I fired doctors who had a combination of several qualities. I have encountered doctors with all the aforementioned qualities. As upsetting as it is to let a doctor go, you have to make the decision to choose a doctor who is right for you.

If you have symptoms that are worrisome of IBC or Paget's disease of the breast it is important that you have a skin/punch biopsy to rule out this diagnosis.
I would urge any woman who is experiencing symptoms to get a second opinion such as seeing another pcp or even going to a dermatologist. If your insurance does not require referrals make an appointment to see a breast specialist/surgeon. Do NOT ignore any symptoms because every person has a different severity in their presentation of IBC or Paget's disease of the breast.
Hope that helps.
Heather
www.mybreastcanceranswers.com

I appreciate when my doctor takes genuine interest in my story - asking about life, family, activities, exercise, diet. Yes, we cover the medical bases and essential information, but it's great when, for just a second, everyone is normal and a nice conversation happens. Like Bernie says, it creates a shared respect.

Because I feel my doctor has a genuine interest in my life, it's easier to trust him.

Each member of the breast treatment team has their role. The breast surgeon will describe the surgical options of lumpectomy versus mastectomy, wire localization of a lesion if needed, and whether sentinel node biopsy is indicated, and if so, how that would be performed. Since the breast surgeon is usually the next person a patient with breast cancer sees, after the breast imager, the surgeon usually also introduces the topics of radiation therapy and systemic therapy (endocrine versus chemotherapy or both).

As a breast surgeon, I explain different methods of radiation to my patients, such as accelerated partial breast irradiation and external beam whole breast radiation, with the caveat that the radiation oncologist will go into more detail during their consultation. Similarly with systemic therapy, I bring up the topic and give an overview, explaining that a specific regimen will be detailed by the medical oncologist.

The radiation oncologist and medical oncologist may also discuss lumpectomy and mastectomy during their consultations. A multidisciplinary approach works best. Weekly or bi-weekly working conferences where team members from all disciplines come together to discuss new patients, is a great format for each team member to give their input.

don't be a good patient which is a submissive sufferer. be a respant or responsible participant. and on my web site read immune competent personality. www.berniesiegelmd.com

PreparedPatient your answer was excellent advice, and I think the article is a very helpful resource. I'd add that as physicians, we're used to hearing personal, intimate and embarrassing information - if you can't ask your doctor, who can you ask? We're here to give support and advice, not to judge. It's important to get answers to your questions. And I agree - if you don't feel comfortable opening up to your doctor, it's probably time to find a new one!

This is a tough one, as the question sounds like "How do I challenge my physician's choices in my care?" The best way to address this is to speak with your physician directly and explain that you are interested in low-cost, or lower-cost forms of care. Before the discussion, however, do some research on your treatments, on other treatments, and on the cost-benefit of each. Ultimately this is a matter of trusting your doc, and if there is ever any question or insecurity you might want to start shopping for another doc or another provider organization. Good luck!