How do I find the best doctor for me?

On the surface, one would idealize the perfect physician for oneself as a medical blend of Albert Einstein and Mother Theresa. But the truth is more complex because we are more complex. In fact, it is our contention in this brief summary that it is virtually impossible to generalize about what qualities that you should be looking for in a physician (of course that won't keep us from trying).

The primary reason for this is that each patient's circumstance is different. The range of variation in patients' situations is extremely large. For example, issues include the extent of disease, patient personality, desire-to-live, financial circumstance, the possible existence of a primary caregiver and the possible existence of a web of personal emotional support. Personal qualities include depression, acceptance, resignation, equanimity, spirituality, pugnacity, anger, a willingness to fight, etc. These are not general qualities-they are highly individual.

Oncologist

The specialist who deals with cancer is called an oncologist. Generally, an oncologist has specialized in the medical field of Internal Medicine, and has further become a sub-specialist in oncology. This training is long and arduous, and thus tends to indicate an extraordinary amount of dedication. And oncologists have chosen to work with people who have cancer; this tends to show an orientation to compassion. Often the oncologist is the leader or at least an integral part of a team which clusters around an individual patient, whose team members also may include a surgeon, a radiologist, oncology nurses, nutritionists and others. For the most part, we are addressing the assessment of oncologists in this portion of the answer.

First, you may already have a physician. And it may well be that this is the best person for you to work with for a variety of reasons: you are presumably already known, you may already have a sense of the character of this oncologist, practical considerations may have led you (in the context of the health-care system) to this person, they may have come well recommended, there may be issues of convenience, of location, etc. But apart from all this, here are some things to consider in evaluating a physician.

1. Congruity

Is the physician's overall orientation congruent with your deepest wishes. For example, has the physician dismissed the idea of making extraordinary efforts, when you stand ready and willing to fight. Conversely, is the oncologist suggesting big efforts (for example, having you enroll in clinical trials) when you are more resigned to circumstance. Only you will know what your real desires are, but they should generally comport with the general orientation of your physician. Of course, this is one time for direct communication. It may be that, even though each of your individual personal orientations are not completely in sync, this gulf can be bridged by honest and forthright communication.

2. Competence

It is difficult for patients to evaluate the competence of their physicians. And there is not one good way to accomplish this. Word of mouth can be useful; but it also can deceiving. Our view is that though physician referral can be very useful, even physicians are often not in the best stance to evaluate the functioning competence of their fellow doctors. Sometimes nurses are in a good position to see how physicians function: how thorough is their hospital work, do they come in at 3 a.m. when needed, etc. Certain institutions tend to attract great physicians. These approaches can all give pieces to the puzzle, but they each have their drawbacks. So to a great extent you are on your own with this, using a variety of approaches to try to come to an understanding.

One approach, again with potential pitfalls, is to use aggregated data which exists about individual physicians on the Internet. For example, though it is possible to read too much into this data, the American Medical Association has physician profiles about most practicing physicians in the U.S., including their medical school and training institutions. The American Board of Medical Specialties provides information about certified specialists (in the U.S.) These are physicians who have generally undergone written specialty examinations after meeting certain training requirements, and are thus "board certified" in one or more specialties. And, with limitations, some U.S. states carry certain disciplinary information in regard to certain physicians. The American Society of Clinical Oncology ("ASCO") has a searchable database of world-wide member oncologists.

3. Compassion

Kindness and wisdom are invaluable qualities in a physician. At difficult points, a strong bond with a compassionate and trusted physician can make every difference.

Surgeon

One stands in awe of the surgeons who regularly perform the Whipple procedure and other operations related to pancreatic cancer, as these are among the most arduous of operations - requiring great stamina and skill. Increasingly, the site of the performance of these surgical procedures in regard to pancreatic cancer in the U.S. has tended to move to major medical centers. And even there, more and more of these procedures are increasingly being done by fewer surgeons -- who may tend to specialize in these kinds of oncology surgeries. This is not always true, and there are accomplished surgeons in U.S. private practice who are renown for their work in pancreatic cancer.

Each of the three "C's" as listed above in regard as to what one might look for in an oncologist also applies to surgeons: congruity, competence, and compassion. In additional we would add a fourth "C" for surgeons: Common. How commonly does the surgeon do this procedure. All things being equal (which they rarely are), you would generally be advised to work with a surgeon who performs these complicated procedures, for example, twice a month -- rather than twice a year. Of course, for any rule that one might make in areas like this, one can certainly find exceptions.

Second Opinions
Finally, there is the issue of second opinions. There are a number of instances where second opinions are highly recommended. The microscopic histology of many pancreatic tumors is complex. There can be as much art as science in some of the diagnostic and therapeutic considerations in pancreatic cancer. If there is any thought of seeking a second opinion, do not hesitate to do so. Your physicians will (or should) understand. There exist sites on the Internet about this topic. We have selected a couple of representative links.