Monday, July 17, 2017

When is it time to find a new oncologist?

When the mail came and I found an envelope from my oncologist’s office, I felt fear rising in my chest. A knot developed in my throat as I slid my finger underneath the pre-moistened flap of the long, white envelope. Sliding my finger along the flap, I held my breath until the letter was finally opened. As I withdrew the enclosed letter, I braced. I had no idea why I was receiving any form of written communication from my doctor. I hadn’t had any recent blood work or other tests. I began to read the letter and was instantly put at ease. It was just a standard letter. My upcoming appointment had been canceled. I needed to call the office and reschedule. I wondered why. I’d made the appointment several months earlier with the scheduling clerk. She’d offered me that specific date and time.  

At first, I wanted to give my doctor the benefit of the doubt. Maybe he’d had a surgery scheduled that he’d forgotten, or perhaps he’d been called out of town on a conference. Maybe his wife wanted to go on a family vacation. Then, I remembered this was not the first time I’d received a rescheduling letter in the mail. This was actually the third time in several months. I wondered why they didn’t just try to call me, like most of my physicians did when they needed to change my appointment time or date. The more I thought about the letter in my hand, the more I realized things hadn’t been quite right with my doctor for some time.

I noticed it almost immediately after I was diagnosed. When I refused chemotherapy, my doctor seemed to become closed toward me. Although I explained I wanted to conquer my cancer as naturally as possible and avoid conventional treatment as much as I could; he seemed disinterested in me. Each visit after my initial diagnosis seemed extremely uncomfortable. The doctor barely spoke to me and only spent a few minutes of time with me. I chalked it up to a busy practice with many patients scheduled each day. So when I saw him, I tried to get straight to the point and not take up his valuable time. One of my friends suggested that perhaps he wasn’t pleased with me because I had decided not to take the anti-hormone therapy. She even said some doctors take kickbacks from pharmaceutical companies though they’re not supposed to do that. I didn’t want to believe he’d stoop that low, but I just didn’t know.

When I discovered a small, grape sized lump in my side, I made a mental note to bring it to my doctor’s attention. On my next visit, I asked him to feel it and let me know if I should be concerned. He lightly rubbed his hand across my abdomen and said he didn’t feel anything. The lump was palpable even to my untrained fingers. There were several incidents afterward that caused me to wonder if perhaps my doctor was losing interest in me. He’d slip out of the room to have a personal conversation on his cell phone. He’d pay more attention to his watch as I talked than he’d give to me. I didn’t understand why the sudden shift in interest. When I first began to see him, he seemed so kind and caring. I wondered if it was because I’d voiced concerns over my regimen of care. I hadn’t ever dismissed his suggestions and always deferred to his medical expertise, but I did explain my desire to avoid any unnecessary side effects along the way. That was why I’d refused chemotherapy and had stopped taking the Aromasin, Arimidex, and Tamoxifen after several months.  I wondered if maybe he thought I didn’t want or need his help but I’d never missed an appointment or scheduled test. I’d always respected and listened carefully to him.

I talked the situation over with my husband and explained how I’d noticed a decline in my relationship with the doctor over the past three years. He suggested I look for another oncologist and advised that I needed a doctor who was genuinely interested in my health care. If I felt uncomfortable with my current doctor and didn’t feel the freedom to discuss things with him, it was time to move on. I’d never given this option a thought. I assumed when you began treatment with an oncologist you were with them for the duration. After all, this wasn’t a minor health care issue. This was a lifelong illness. So I promised I’d consider it and I began looking.

The first concern I had in seeking a new oncologist was wondering if he’d accept a patient not currently in active treatment. Would an oncologist take on someone like me who seemed to be in remission and might just need to come in for periodic “tune-up” scans? The first thing I needed to do was make a list of potential doctors. Next, I’d have to check with my insurance company and make sure the doctor I was considering was “in network” under my plan. If he was not, I’d have to keep checking until I found one who was on my plan. After finding a new oncologist, I’d need to check credentials. I preferred a board certified oncologist. It was important to me to find a doctor who’d been practicing for a number of years, one with a good reputation, and one with  a good education. The most important requirement for me was to find an approachable doctor with a good bedside manner. I wanted a doctor who would not only listen to what I had to say but hear what I wasn’t saying. Was it too much to ask that I could feel comfortable enough around him to consider him a friend? This was going to be a long term relationship. I also needed him to talk to me in a way that I could understand. I didn’t want to be afraid to ask him questions. The more I thought about all the things I needed and wanted in a new oncologist, the more I realized I didn’t have any of those things with my current doctor.

I made the first step today.  I called our new cancer treatment center. It’s within ten miles of my home. I wasn’t able to speak to a human but I did leave a voicemail. If I can find a new oncologist, the next step will be transferring all of my medical records. With access to most digital files online, it shouldn’t be much of a problem. I’m nervous about forging ahead but feel like I need to do what’s best for my medical care. A doctor with an attitude of indifference doesn’t make me feel very confident. I think my husband’s right, it’s time for a change.

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