Medical Team

Medical oncologist are routinely involved in the care of patients who are diagnosed with non small cell lung cancer. No matter what stage (I-IV), our practice at Beth Israel is that a medical oncologist should be involved at least initially in all patients diagnosed with lung cancer. Medical oncologist are routinely involved in the care of patients who are diagnosed with non small cell lung cancer. No matter what stage (I-IV), our practice at Beth Israel is that a medical oncologist should be involved at least initially in all patients diagnosed with lung cancer.

I just wanted to say that both Dr. Attai's and Jody's answers are great, and I wanted to offer confirmation of both based on my experience.

As Dr. Attai said, having an involved primary care doctor counts for a lot. I had been seeing mine for many years, and he recommended my surgeon because they work together a lot. I figured my surgeon would be good because my PCP is pretty picky, but I later found out he's very highly regarded and doctors send their own family members to him. I did find out he's board certified and did ask him if he does a lot of breast surgery as a general surgeon, and he said, "All the time."

To support what Jody said (great question!), bedside manner is a deal breaker for me, but I'll trade bedside manner for skills when you're wielding a scalpel in my direction. I was blessed to have both, as my surgeon is as famed for his bedside manner as his considerable surgical skill. (Nurses tell me how good my breast/gallbladder scars look and then say, "Oh, you had Dr. K.") And a big yes to those nurses! I had never had surgery before and was so relieved when my PCP's nurse told me how much my surgeon's patients like him. Every OR nurse I talked to said "He rocks" or "You hit the jackpot" or something like that, and I KNOW nurses are picky. I asked one OR nurse what she does when she hears about a doctor who's not so great, and she said there's not much you can do. She tries to casually bring up the name of someone good, as in "Oh, did you know Dr. So and So also does that?" (hint hint--so keep that in mind if a nurse says that to you :) )

Excellent discussion! Dr. Attai,I'm not sure we realize how lucky we are to have you explaining all this stuff. It's more helpful than you know. Thanks for your question - it is difficult to determine if any physician is "good", just like any other professional whose services you rely on - attorney, accountant, car mechanic...

The obvious initial things to check are board certification, and training location such as medical school and residency. Professional society memberships usually indicate an interest in staying current and following the latest treatment recommendations. Some professional societies relevant to breast surgeons are the American Society of Breast Surgeons (http://breastsurgeons.org/) the American Society of Breast Disease (http://www.asbd.org/) and the Society of Surgical Oncology (http://www.surgonc.org/).

Publications and research are important, but realize that many excellent community / private practice surgeons stay current and practice state of the art care by reading the literature and attending meetings but may not have the time or resources to be involved with research themselves.

Referrals from a good, engaged primary care physician should count for a lot - if that primary care physician is working closely with his or her patients, they will have feedback from their patients regarding the surgeon's personality, practice style, and of course results.

Talk to other patients, local hospital (and operating room) nurses. Many hospitals have a "doctor finder" physician referral service - it can be a good start. Talk to the mammographer or nurse navigator at the breast center where you get your mammograms done, or talk to the mammography technologist - these women see patients back from all the surgeons and often hear the good and bad stories. There are a tremendous number of on-line patient resources as well - as just one example, http://www.savisisters.com/about-savi is an on-line resource and support site for all women with breast cancer, but it focuses on women who are undergoing 5-day partial breast irradiation - patients have the opportunity to talk to other patients who have "been there, done that" and get some feedback.

Also ask your surgeon - "do you have any patients with my similar type of tumor/proposed surgery, etc that I can talk to to get their experience?". Very reasonable question.

At the end of the day, you have to make a decision and it can be overwhelming especially if you've received input from multiple sources. Interview all the doctors, and keep an open mind. Take notes, and bring someone with you who can help ask questions but also be an objective observer. After you've received your opinions, review them just like you'd review any other important proposals. And don't hesitate to call or return for a follow up visit to get clarification on issues to help finalize your decision.

When the radiologist called me with the news, she recommended two doctors and said I should call them right away. I hung up the phone, it rang again and it was my ob/gyn. He recommended the same two doctors. I enquired why neither had recommended a nearby particular big-name cancer center. He said “You have breast cancer, you need someone who will care for you with your best interests involved”. I was stunned. Apparently I thought this was the case at all cancer centers. I was wrong.

I researched both doctors. I needed to read that they were the best in their field. I needed to know that they were current in their methods. I needed to know they could help me.

I called the first doctor, gone for the weekend. my diagnosis was given to me on the Friday of a long weekend. Called the second office, gone for the weekend. Great. I then called back the radiologist and told her. She said she would make the call to the doctors..at home! she called me back and said one would see me that Monday, yes, the holiday. The other would take me the following week. My husband and I saw the first surgeon. A lovely man, quite paternal, who explained the cancer and the options to me. We liked him, but left scared. We had not expected to hear that mastectomy was really my only option and we thought perhaps his methods might be outdated, or the way things have always been done. We saw the second doctor. He walks into the room smiling, and the first thing he says is “First let me tell you, you are going to be fine.” And he meant it. No scary words, just a strong plan of action, one of which I was part of. I could see why he'd performed more mx's than any other surgeon in NY, this guy cares. Being part of the team and plan are a huge part of healing. We knew he was our ticket out of this mess. I asked him about options and he told me of some I was not at all aware of. I made requests and he listened to and agreed with me. He then asked if we would like him to go get the plastic surgeon, one he works with as she is fantastic. He says he will ask her to see us now so we don’t have to make another appointment. She comes in and allays more fears. I am to come out of this looking good and sans the cancer. I have found the right team. They care about me and my cancer.

When the radiologist called me with the news, she recommended two doctors and said I should call them right away. I hung up the phone, it rang again and it was my ob/gyn. He recommended the same two doctors. I enquired why neither had recommended a nearby particular big-name cancer center. He said “You have breast cancer, you need someone who will care for you with your best interests involved”. I was stunned. Apparently I thought this was the case at all cancer centers. I was wrong.

I researched both doctors. I needed to read that they were the best in their field. I needed to know that they were current in their methods. I needed to know they could help me.

I called the first doctor, gone for the weekend. my diagnosis was given to me on the Friday of a long weekend. Called the second office, gone for the weekend. Great. I then called back the radiologist and told her. She said she would make the call to the doctors..at home! she called me back and said one would see me that Monday, yes, the holiday. The other would take me the following week. My husband and I saw the first surgeon. A lovely man, quite paternal, who explained the cancer and the options to me. We liked him, but left scared. We had not expected to hear that mastectomy was really my only option and we thought perhaps his methods might be outdated, or the way things have always been done. We saw the second doctor. He walks into the room smiling, and the first thing he says is “First let me tell you, you are going to be fine.” And he meant it. No scary words, just a strong plan of action, one of which I was part of. I could see why he'd performed more mx's than any other surgeon in NY, this guy cares. Being part of the team and plan are a huge part of healing. We knew he was our ticket out of this mess. I asked him about options and he told me of some I was not at all aware of. I made requests and he listened to and agreed with me. He then asked if we would like him to go get the plastic surgeon, one he works with as she is fantastic. He says he will ask her to see us now so we don’t have to make another appointment. She comes in and allays more fears. I am to come out of this looking good and sans the cancer. I have found the right team. They care about me and my cancer.

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. 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.

often times the breast surgeon is the central doctor within the team looking after a woman who develops breast cancer. in my hospital, the breast surgeon also does most of the needle biopsies that reveal cancer, and then i for instance am the doctor who breaks the bad news. surgery is often the first part of treatment, and then i would direct the patient subsequently to oncology and radiation. in the longer term, a patient may stop going to see the oncologist and radiation specialist, so sometimes it is indeed the breast surgeon who also follows a patient the longest and develops the strongest bond. often times the breast surgeon is the central doctor within the team looking after a woman who develops breast cancer. in my hospital, the breast surgeon also does most of the needle biopsies that reveal cancer, and then i for instance am the doctor who breaks the bad news. surgery is often the first part of treatment, and then i would direct the patient subsequently to oncology and radiation. in the longer term, a patient may stop going to see the oncologist and radiation specialist, so sometimes it is indeed the breast surgeon who also follows a patient the longest and develops the strongest bond.