It's always hard to choose a doctor. Who do you call? Do you use Yelp? HealthGrades? Health plan directories? Those have too many choices - and I didn't have time to call and interview a dozen doctors. How about people who treated other members of my family? My mother's oncologist was long retired (if still alive) and based at Cornell Medical Center in New York. My sister's oncologist at Stanford was also retired from practice. So, those familiar options were off the table. My mother's second oncologist at Stanford specialized in women's bladder cancer - not me.
I needed to narrow my list, so I asked people who knew oncologists in our area. I asked the breast surgeon who delivered my diagnosis. I asked Dr. Harriett, the breast imaging radiologist who cared for me for 20 years, for a recommendation. I asked my sister to ask her close friends. I asked my close friends.
My oncologist was going to be my hitting coach. They would assess the pitch speed and trajectory, develop the medical approach to the pitch, be the one to talk with me if I swing a strike, and the one who would figure out the approach. Figuratively and literally, my life would be in this doctor's hands. Choosing the right one felt essential and urgent.
There are a lot of oncologists in my immediate area (and this is not the case for everyone). Thankfully, I didn't have much experience choosing one, but that blessing left me unprepared for how to choose. Professionally, I spend a lot of time identifying ideal customer profiles and the qualification criteria for sales and marketing professionals to identify them. I applied this process to my oncologist selection.
Joelle’s Ideal Oncologist Profile
Referred and recommended by people I trust. Dr. Harriett, for example, had more weight than a friend of a friend.
Focused 100% on breast cancer. This may not be possible if you live in a less medically populated area - but knowing how much of the oncologist's practice is breast cancer is a good indicator of how much time they can spend tracking innovations and treatments for breast cancer. This applies to any cancer or other disease. The more of your doctor's focus is on your disease, the closer they are likely to be to the research and best treatments.
Active in ASCO - American Society of Clinical Oncology. Do they go to the conferences (good)? Do they speak at the conferences, and how much of their time is spent in clinical practice?
Clinic hours that work for me in a place I could get to without a lot of stress - I had a lot of flexibility with my work, but I preferred not to get bad news or have bad reactions over the weekend since I saw how hard that was on my sister or mother. Clinics on Monday - Thursday were more attractive. I don't like battling traffic, and the thought of doing that while potentially queasy was very unattractive. I wanted an oncologist with low-traffic access and a parking lot. Again, this assumes that I had choices I was lucky enough to have.
An active and compassionate listener - this may be found in all oncologists, as the ones I've met all have this characteristic. Cancer was happening to my body, and I wanted someone I could talk with about my body who listened and considered my thoughts.
They can see me reasonably soon. I was in a rush - the sooner I was ready to swing the bat, the sooner the pitch would be hit. All other things being equal, I would see the physician who was earliest available. One of the referred doctors was very transparent, saying he was about to start a 10-day vacation, and I probably didn't want to wait. His honesty was appreciated.
For me - the referrals of the doctors and friends of friends all pointed to the same oncologist, Dr. Amy Jo Chien. I was fortunate that she was able to squeeze me into her clinic. She was unassuming but confident. She was compassionate and clear. She could develop my approach, observe all the metrics of my swing (otherwise known as my labs and side effects), and recalibrate my approach because she has had countless other batters in the box facing the same pitch. She was part of a breast cancer-focused practice (this is unique to major medical centers - if you don't live near one, you can ask if your prospective doctor has doctors they collaborate with on cases - so that they have thought partners to view your curveball and make your swing as smooth as possible.
My doctor's initial reaction to my offer to help facilitate some logistics was skeptical because she trusted her health system. New batters may need to learn how curveballs spin and move. I was an experienced batter from my time in the dugout for my mother and sister. I knew that she needed my biopsy slides from another hospital and that twelve weeks of weekly chemo could be scheduled all at once - if you talked to the infusion center directly. She quickly realized that I was a good batter and often could anticipate the speed and trajectory to adjust with enough time to swing successfully. We were going to be great partners.
Dr. Amy Jo Chien explained multiple pathways (approaches in baseball are the mindset for a particular "at bat," and in cancer are the treatment protocol) and why she recommended the Carboplatin-Taxol plus Pembro option for my first treatment loop. All treatment plans depend on the patient's health and medical history, as well as the stage and pathology of the cancer. Her willingness to explain the other options and educate me on why this protocol best suited me conveyed respect. Those are the final criteria for the Ideal Oncologist Profile - do you trust them?
There are places in the world where there are few choices about who your oncologist is. I'm lucky, and I know it. If you live without options, consider getting a second opinion or "a consult" over telehealth with a National Cancer Institute (Memorial Sloane Kettering does this). You will need your scans (get CDs), your pathology (print it out), your diagnosis, and your treatment plan (if your doctor is using an Electronic Medical Record, which most are, look for the After Visit Notes from your oncology appointment often are the repository for the plan).
I also printed out the information about the drugs that were going to be infused into me and had those print-outs in my binder with highlights about side effects to act on quickly.
Even if you only have one choice for an oncologist, through telehealth, which post-pandemic is often covered by health insurance, you can and should get a second opinion. This is your curveball, and medical science is continuously improving to make the pitch visible and your swing easier and more effective. I expected to feel like I was tossed and flipped - and instead, I felt a little rattled, but that was all.
Dr. Chien was the right choice for me. My chemo buddy, JS, adores her oncologist - and it's not Dr. Chien. There are a lot of right choices that result from these criteria. Your oncologist is your hitting coach - invest in building a trusted relationship on the foundation of two-way communication, and your swing will be smoother.
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