Selecting A Doctor

I saw a Reproductive Endocrinologist, Dr. Randall Dunn, in Houston, Texas. I saw a Reproductive Endocrinologist, Dr. Randall Dunn, in Houston, Texas.

The hardest part of IBC is diagnosing it. Once you have the diagnosis, it is probably less challenging to find the right person to treat it.


I live in a rural area and was not expecting to get adequate care here. However, I was referred to one of the five oncologists in town, and she is fantastic. She trained at MD Anderson in Houston, which I would argue is the premiere place for inflammatory breast cancer treatment. But I have since learned that as long as you are in the care of a knowledgeable oncologist, there is no reason to travel to a place like MD Anderson. I received the same treatments here that I would have received at MD Anderson.

In short, of primary importance is finding an intelligent and caring oncologist to supervise your care. You might not have to travel very far at all.

Secondly, find a surgical oncologist who you trust to remove all breast tissue. I understand that some surgeons and patients are more concerned with the cosmetic outcome of the mastectomy than with the mastectomy itself. But with inflammatory breast cancer, you do not have that luxury. Make sure you have a surgeon who understands the importance of a careful and thorough mastectomy.

Again, both of these points have less to do with location than with individuals. You can find crappy doctors at major cancer centers just as well as at rural cancer centers. Don't be afraid to try out a dozen different doctors in search of the right one for you. You just have to make an appointment and meet them! The hardest part of IBC is diagnosing it. Once you have the diagnosis, it is probably less challenging to find the right person to treat it.


I live in a rural area and was not expecting to get adequate care here. However, I was referred to one of the five oncologists in town, and she is fantastic. She trained at MD Anderson in Houston, which I would argue is the premiere place for inflammatory breast cancer treatment. But I have since learned that as long as you are in the care of a knowledgeable oncologist, there is no reason to travel to a place like MD Anderson. I received the same treatments here that I would have received at MD Anderson.

In short, of primary importance is finding an intelligent and caring oncologist to supervise your care. You might not have to travel very far at all.

Secondly, find a surgical oncologist who you trust to remove all breast tissue. I understand that some surgeons and patients are more concerned with the cosmetic outcome of the mastectomy than with the mastectomy itself. But with inflammatory breast cancer, you do not have that luxury. Make sure you have a surgeon who understands the importance of a careful and thorough mastectomy.

Again, both of these points have less to do with location than with individuals. You can find crappy doctors at major cancer centers just as well as at rural cancer centers. Don't be afraid to try out a dozen different doctors in search of the right one for you. You just have to make an appointment and meet them!

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.
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.

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.

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?