Surgeons

I agree with Dr. Feldman's answer - there is no question that complementary techniques can help put a patient in a better physical and mental state prior to undergoing therapy, and can help manage the side effects of therapy. Just as we have come to appreciate the importance of proper nutrition, exercise and sleep in the maintenance of health and prevention and treatment of disease, I think that CAM will also play an increasingly important role in disease prevention and treatment. The surgeon I used for my breast cancer was definitely not open to alternative methods. He would become somewhat irritated and angry at me when I didn't jump through the conventional hoops that he wanted me to. Every time I see him (which isn't often now) he also mentions how I didn't elect chemotherapy and the cancer can go to my brain, bones, lung-he never mentions how well I am doing even without the chemotherapy. But---when the last biopsy came back with no more cancer in my breast he also couldn't explain how that happened. Hopefully more surgeons will allow patients to make their own decisions and not chastise them for deciding on other options.

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.

I find Attai's very interesting. I was referred to a breast surgeon by a Dr of Radiology. My breast surgeon told me flat out "you will need surgery for sure" and then she did the surgery. She is a past President of ACS in my area and one of the doctors on the board of directors at the hospital I had the surgery at. It confuses me to see a statement "Once cancer is diagnosed, the breast surgeon will work with the medical oncologist and radiation oncologist as a team to decide in a multidisciplinary fashion what the best treatment is. " It makes me feel that I am having treatment done backward. I don't know. I return to the surgeon on the 30th (my lumpectomy was done on the 19th). The tumor is stage 2A. No spread to the nodes. I have to wonder how my treatment is going to be handled. I don't think the surgeon will be dishing out what a radiology oncologist is supposed to be doing. This surgeon also said she believes I will NEED chemo. I am not accepting that yet. I did find out about Oncotype DX which will help with MY decision to go ahead with chemo or not. I am just confused about what Dr Attai says here. I need to know that I am on the right road to recovery. My surgeon answered this question when I asked why I needed to keep seeing him after I finished my active treatment for inflammatory breast cancer. He said, "oncologists treat cancer but are not trained to diagnose cancer." When I questioned my oncologist, he basically gave the same answer, saying "I treat cancer once it's been found." In the case of breast cancer, a breast specialist/breast surgeon is typically the person who will do the necessary steps to obtain a diagnosis, then work in tandem with the oncologist to determine how to proceed with treatment. This is my understanding and should not be viewed as medical advice.

It's hard enough to get infection rates on hospitals! Ask your surgeon for his or her infection rate. I don't know if any organization that collects infection rates on surgeons.
It's hard enough to get infection rates on hospitals! Ask your surgeon for his or her infection rate. I don't know if any organization that collects infection rates on surgeons.

John Bendo from NYU John Bendo from NYU