Questions For Doctor

I assume that you are asking as to the qualifications of the physician & the facility where this being done.

A) Are you a board certified physician in Gastroenterology or board certified colorectal surgeon? The physician preferably should a board certified Gastroenterologist as she/he is the only specialty physician who is specifically trained for this purpose exclusively for 3 years or more after previously having completed training & then board certified in Internal Medicine for an extra 3 years. Not infrequently, there are other physicians who undergo short courses of training to do colonoscopy & after few years in practice they may become capable of detecting precancerous polyps & removing during colon cancer screening (i.e colonoscopy) but their expertise is very much variable. Some are excellent & others are not so. Board certified Gastroenterologists/ colorectal surgeons maintain a certain degree of standard & are up to date on colon cancer screening/colonoscopy across the board.

You may also want to ask the physician about their complication rates, years of experience & how many colonoscopies they do per year but these are subjective & may not help you to make up your mind.

B) What Facility? If it is a hospital, the safety/quality is not a big issue as hospitals undergo rigorous quality control & inspection by accrediting agencies like Joint commission on a regular basis. If done in a free standing centers or doctors office, please ensure that this facility is accredited by proper agencies, licensed by CMS (Medicare) & local department of community health of that state. Complication rates are high in non accredited/licensed facilities. They are not required report/document any complications to any authorities unless investigated by complaints.

C) Are you & Facility in network with my Insurance company? Most (please note, most & not all!) commercial insurance companies & Medicare cover the screening colonoscopy if you are 50 years or older without any deductible & co pay if the the physician & the facility are in their network (i.e "in network"). Please verify this prior to booking the appointment so that you do not incur any unwarranted expenditures.

These are basic questions one should ask when meeting with the physician, but there can be many more questions like type of anesthesia etc. too based on how sophisticate you want to be! I assume that you are asking as to the qualifications of the physician & the facility where this being done.

A) Are you a board certified physician in Gastroenterology or board certified colorectal surgeon? The physician preferably should a board certified Gastroenterologist as she/he is the only specialty physician who is specifically trained for this purpose exclusively for 3 years or more after previously having completed training & then board certified in Internal Medicine for an extra 3 years. Not infrequently, there are other physicians who undergo short courses of training to do colonoscopy & after few years in practice they may become capable of detecting precancerous polyps & removing during colon cancer screening (i.e colonoscopy) but their expertise is very much variable. Some are excellent & others are not so. Board certified Gastroenterologists/ colorectal surgeons maintain a certain degree of standard & are up to date on colon cancer screening/colonoscopy across the board.

You may also want to ask the physician about their complication rates, years of experience & how many colonoscopies they do per year but these are subjective & may not help you to make up your mind.

B) What Facility? If it is a hospital, the safety/quality is not a big issue as hospitals undergo rigorous quality control & inspection by accrediting agencies like Joint commission on a regular basis. If done in a free standing centers or doctors office, please ensure that this facility is accredited by proper agencies, licensed by CMS (Medicare) & local department of community health of that state. Complication rates are high in non accredited/licensed facilities. They are not required report/document any complications to any authorities unless investigated by complaints.

C) Are you & Facility in network with my Insurance company? Most (please note, most & not all!) commercial insurance companies & Medicare cover the screening colonoscopy if you are 50 years or older without any deductible & co pay if the the physician & the facility are in their network (i.e "in network"). Please verify this prior to booking the appointment so that you do not incur any unwarranted expenditures.

These are basic questions one should ask when meeting with the physician, but there can be many more questions like type of anesthesia etc. too based on how sophisticate you want to be!

Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.

Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?
Generally lumpectomy is offered for unifocal (one site of disease), and the patient is willing to undergo radiation. If the tumor is large relative to the breast size, neo-
adjuvant (up-front) treatment may be given to shrink the cancer before lumpectomy.

Questions to ask would be:
How large is the cancer? Can clear margins be obtained? Should I receive chemotherapy or endocrine therapy prior to surgery to shrink the tumor? How will the incision lines be placed? Will oncoplastic techniques be used? How much deformity will there be? Is there a reason not to preserve the breast?

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 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.

The most difficult conversation I had was when I naively confronted my original doctor with the conflicting advice from my second-opinion doctor at another institution. How was I supposed to decide how to proceed when I had no medical background and two highly respected doctors were giving me contradictory recommendations? I begged my original doctor to talk directly with my second-opinion doctor and resolve the discrepancies. At the time, it seemed like a reasonable request, but it created a very awkward situation with both doctors' becoming annoyed with me. Eventually I resorted to a third-opinion doctor, who served as a kind of tie breaker. Very interesting question, but I think it’s quite individual. Each of us carries our own sensitivities, and wherever those abut our questions it can be hard to address. For some it may be the sexual side effects of treatment, for others the “blame game” of whether cancer is “my fault.” If there is a universally difficult question, however, I would venture to guess it is about prognosis. While most doctors (I hope!) no long give cancer patients an expiration date (the proverbial “you have six months to live”), taking in information about the likelihood that we will survive is never easy. Its one of those things that we often don’t know if we want the answer to…

Davis Liu, MD just made a fantastic post related to your question (http://davisliumd.blogspot.com/), which links to the recently published New York Times piece “How to Find a Quality Doctor.”(http://tinyurl.com/3ug937p).

Dr. Liu takes the question a step further, addressing fundamental questions that should be asked by health care consumers seeking more patient-centric care, such as, “Does your doctor listen and explain? Do they know your medical history? Do they partner with you in your health? Do you have confidence in the care they provided you?” Questions like these are fundamental. They’re the crux of successful, patient-centric care. Davis Liu, MD just made a fantastic post related to your question (http://davisliumd.blogspot.com/), which links to the recently published New York Times piece “How to Find a Quality Doctor.”(http://tinyurl.com/3ug937p).

Dr. Liu takes the question a step further, addressing fundamental questions that should be asked by health care consumers seeking more patient-centric care, such as, “Does your doctor listen and explain? Do they know your medical history? Do they partner with you in your health? Do you have confidence in the care they provided you?” Questions like these are fundamental. They’re the crux of successful, patient-centric care.

Selecting a doctor that suits your individual needs and situation can be difficult, especially if you have moved and are living in a new community. Start by asking co-workers, neighbors, and friends for recommendations, but ultimately rely on your own intuition and research when making the final decision.

Do some preliminary research about the doctor’s specialty interests, credentials and history. And don’t let concern about ruffling anyone's feathers keep you from doing your homework. Richard Klein, M.D., author of "Surviving Your Doctors: Why the Medical System Is Dangerous to Your Health and How to Get Through It Alive", said in a recent interview that "arrogance and ego are real problems in the medical profession, but good doctors welcome involved patients.” http://tinyurl.com/3mhr98t

When you meet or speak with the doctor for the first time, listen carefully for the tell-tale signs that will suggest whether or not he or she is a good fit. Does he demonstrate a genuine interest in you? Is she taking the time to get to know you, your medical history and that of your family? Does he try to put you at ease and encourage questions, or do you feel so rushed you can’t even remember what questions you meant to ask? Selecting a doctor that suits your individual needs and situation can be difficult, especially if you have moved and are living in a new community. Start by asking co-workers, neighbors, and friends for recommendations, but ultimately rely on your own intuition and research when making the final decision.

Do some preliminary research about the doctor’s specialty interests, credentials and history. And don’t let concern about ruffling anyone's feathers keep you from doing your homework. Richard Klein, M.D., author of "Surviving Your Doctors: Why the Medical System Is Dangerous to Your Health and How to Get Through It Alive", said in a recent interview that "arrogance and ego are real problems in the medical profession, but good doctors welcome involved patients.” http://tinyurl.com/3mhr98t

When you meet or speak with the doctor for the first time, listen carefully for the tell-tale signs that will suggest whether or not he or she is a good fit. Does he demonstrate a genuine interest in you? Is she taking the time to get to know you, your medical history and that of your family? Does he try to put you at ease and encourage questions, or do you feel so rushed you can’t even remember what questions you meant to ask?

Congratulations on being 3 years out from your breast cancer - sounds like you went through quite an ordeal. The most important thing to remember is that while you have no visible damage from the radiation therapy, radiation treatment does alter the blood flow to the skin and breast tissue and can affect the healing process from even minor procedures. However most times there are no significant issues. It sounds like you have already done some research on your physician and the fact that you feel comfortable with her is important. I would just confirm that she has experience in working with patients who have undergone radiation therapy for a prior breast cancer - it is not the same as a standard cosmetic reduction. Good luck with your upcoming procedure! Congratulations on being 3 years out from your breast cancer - sounds like you went through quite an ordeal. The most important thing to remember is that while you have no visible damage from the radiation therapy, radiation treatment does alter the blood flow to the skin and breast tissue and can affect the healing process from even minor procedures. However most times there are no significant issues. It sounds like you have already done some research on your physician and the fact that you feel comfortable with her is important. I would just confirm that she has experience in working with patients who have undergone radiation therapy for a prior breast cancer - it is not the same as a standard cosmetic reduction. Good luck with your upcoming procedure!

Great tips. Another thing I've learned are many times doctors aren't familiar or don't necessarily agree with all of the side effects listed on official brand RX website.

Its important to document any side effects you have to medications/treatments and make your doctor aware. Not disclosing something to your doctor can be harmful.

Healthcare treatment data mining sites like Cure Together http://curetogether.com/ can give you insight on success of treatments categorized by disease and patient response/outcome to treatments.

You might also referr to reliable sites like http://health.nih.gov for helpful literature.

I had a doctor wanted to prescribe a medication that is now in litigation for sever side effects. Glad I decided against it and found another option that worked well for me with no side effects. You can also referr to FDA medication guidelines found on official pharma rx site. (e.g. Levaquin http://www.levaquin.com/sites/default/files/pdf/Levaquin%20Med%20Guide.pdf#zoom=100) Learning more about the unintended effects of a treatment can help you decide whether you want to start or continue that treatment. Knowing what to expect can help you to cope with minor side effects and reduce the potential for dangerous ones to harm you. Here are some questions to ask your doctor about side effects:

• What are the common side effects of this treatment?
• Are there any serious side effects that I should be aware of?
• When would any side effects start? Are they likely to get stronger or weaker over time?
• Can I do anything to prevent or manage these side effects?
• Are there other treatments I can take that don’t carry these side effects?
• How might this treatment interact with any of my other treatments?
• Do I need any tests to detect “silent” side effects?
• Who should I tell if I experience side effects?

What usually happens when someone has this problem?

If I wait, will my condition be harder to treat later?

What kinds of tests or monitoring do you recommend while I am waiting?

Is there anything I can do to slow or stop the course of this health problem?

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm
What usually happens when someone has this problem?

If I wait, will my condition be harder to treat later?

What kinds of tests or monitoring do you recommend while I am waiting?

Is there anything I can do to slow or stop the course of this health problem?

For more information about watchful waiting, see: preparedpatientforum.org: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue5.cfm

1.Office Contact information: Obtain phone and fax numbers, office hours, web address, e-mail policy, hours of operation.

2.Office Location: Get the address, locate public transportation, and learn about parking options including whether and how much you have to pay to park or if there is free parking (perhaps a parking ticket will need to be stamped by the doctor's office).

3.Making Appointments: What are the hours to call for appointments? Are there no-show policies? Can they provide estimates of waiting times (both for an appointment and when waiting to see the doctor after arriving)?

4.Medical record: Ask about any instructions for bringing a summary of your medical history, current health status and recent test results or if referral documentation is needed (especially important for specialists and testing).

5.Special needs: Inquire if and how the provider can accommodate any unique or special needs (such as physical navigation, hearing or visual impairments, translation services, etc.) and how to arrange for assistance if needed.

6.Payment: Inquire about the health insurance documentation and/or payment process required for receiving care. Get the contact information for staff administrator or the billing manager.

7.Tests and test results: Request a description of what types of tests are commonly conducted in the practice, by an external provider (with names and contact numbers for commonly used laboratories and radiology facilities), and the practice policy about patient notification of test results.

8.After-hours and emergency care: Inquire about when to seek, who to call and where to go for after-hours and emergency care.

9.Prescriptions: Obtain instructions for securing prescription refills, reporting adverse side effects and decisions to discontinue medication or change any agreed-upon treatment plans.

10.Care companion: Notify your physician group if you would like to bring a companion along with you to visits.

For more information check out the Prepared Patient 411
ttp://www.preparedpatientforum.org/patient411 1.Office Contact information: Obtain phone and fax numbers, office hours, web address, e-mail policy, hours of operation.

2.Office Location: Get the address, locate public transportation, and learn about parking options including whether and how much you have to pay to park or if there is free parking (perhaps a parking ticket will need to be stamped by the doctor's office).

3.Making Appointments: What are the hours to call for appointments? Are there no-show policies? Can they provide estimates of waiting times (both for an appointment and when waiting to see the doctor after arriving)?

4.Medical record: Ask about any instructions for bringing a summary of your medical history, current health status and recent test results or if referral documentation is needed (especially important for specialists and testing).

5.Special needs: Inquire if and how the provider can accommodate any unique or special needs (such as physical navigation, hearing or visual impairments, translation services, etc.) and how to arrange for assistance if needed.

6.Payment: Inquire about the health insurance documentation and/or payment process required for receiving care. Get the contact information for staff administrator or the billing manager.

7.Tests and test results: Request a description of what types of tests are commonly conducted in the practice, by an external provider (with names and contact numbers for commonly used laboratories and radiology facilities), and the practice policy about patient notification of test results.

8.After-hours and emergency care: Inquire about when to seek, who to call and where to go for after-hours and emergency care.

9.Prescriptions: Obtain instructions for securing prescription refills, reporting adverse side effects and decisions to discontinue medication or change any agreed-upon treatment plans.

10.Care companion: Notify your physician group if you would like to bring a companion along with you to visits.

For more information check out the Prepared Patient 411
ttp://www.preparedpatientforum.org/patient411