I love my oncologist . . . and looking for a new one

I see my nurse practitioner alternating visits with the onc.  Actually I like her MUCH better, personality wise, but she always defers on the complex questions "Oh you'll have to ask the doctor about that." So I know what you mean.  Am still in active treatment (getting Herceptin) so don't know how they will do it when I get to your point.
But what is at issue here is  YOUR comfort level. And if your comfort level isn't being met, then you have to make a change. However -if you really like him, I would encourage you to speak up, not in terms of 'making a fuss' (which is a self-defeating term to use) but more as an honest conversation, with him or with her, OR with his assistant if he has one. My onc has a right-hand-girl who pretty much keeps him organized. She might be the one I would bounce this off of first. - the exact stuff you wrote to us above.  I don't know if this is more the way practices are moving now and you might only find the same thing if you switch - that the docs see the patients in active tx and then hand you off afterwards. I don't know. But I DO know that having an onc you love is a big thing to walk away from, and I would try to discuss it with someone at the practice first.

GOOD LUCK

NatsFan: This is really very common in the health care industry. They aren't doing anything unusual, and, unfortunately, don't even realize that it's a problem. I have a professor who makes it a point to request the "new patient-extended" office visit every time she makes an appointment with her gyno. Of course the appointment clerk alerts her that her insurance company will only pay up to the non-new-patient rate, and she is okay with that. There is a medical code for everything, and who you see on which visit, and how long that visit is is all part of it.

I did not even know the "code" existed, but have since started using it myself. I make sure when I book my appointments that I book them for the one where I am actually talking with the doctor and for a minimum period of time (whatever or however that office codes it).

It's what I call an "end around."

I live in Toronto, so my experience may be different than some of you ladies in the States.

I was treated at a big downtown Toronto hospital, and during treatment I did not see my onc. every time - sometimes it was a onc. resident.  But if I had a question they did not feel they could answer properly, they would go and ask him. 

Since I have finished treatment, going from 4x/year, to now 2x/year - the policy at my hospital is that I see my onc. at every visit.  I specifically asked the sec. who books the follow up appointments and she told me that all the follow ups are booked ONLY with him.  And I like that.  He does the best physical examination, and really "knows" me.  I am never rushed, and he is always willing to discuss any new treatments, studies etc. that I bring to him.

It may be different elsewhere in Canada, but that is the way it is for me at my hospital. And of course this is all covered by our universal health care system.

Nats, I think you should follow cp418 's advice and tell the office you only want to see your onc.  I believe that is your right.  And it's your life at stake, not the PAs.

EZ- It's not perfect, nothing is - but it is equal to all Canadian citizens.  And you really feel it when you are going through a medical life or death crisis - no worries about payment, no filling out forms, no fighting with insurance companies, etc.

My husband had a brain aneurysm 9 months before I got my BC diagnosis.  We were very lucky, he had successful coiling surgery, and is fine.  Then I got my BC diagnosis - 2006 was not a great year at my house - I cannot imagine going through those stressful days worrying about payment, and keeping track of bills, etc. 

I am thankful every day for our wonderful health care system.  Again, I say it's not perfect, but what is?

Hi Nats

I agree with the others, it might help to put your foot down and request that your appointment will be with the Onc, not the PA. Double check with the secretary a week or two before your appointment. And if they say it's not their policy, simply state you don't agree and why. I would guess they will accomodate you. Good luck!

-Helena.

My $0.02 for what it is worth.  I have a policy of ONLY allowing fully qualified doctors to see me. That is, no residents, no med students, no trainees of any kind and certainly no PAs if I feel like I need my doc.  I've been totally upfront about this throughout all my treatment at a major teaching hospital and everyone gets it and respects it and has NO problem meeting my request.  I even asked them to change their surgery schedule at the very last minute because they'd scheduled a resident to do my anaesthesia! I feel bad about it - not least because my husband is a 3rd year medical student at the same hospital! - but hey I am going to do everything I can to maximize my chances of getting through this.

 So, I guess I am agreeing with everyone who said, just tell your onc what you need and see what happens.  Don't get emotional about it - even though obviously it is an emotional issue for us all.  Just flat out ask and give your reasons.  And change your onc if you don't get what you need!  That's what every doctor I've ever talked to has said they would do. 

My onc's office automatically switches patients back and forth between the onc herself and a PA every six months. I don't like the PA - I've only seen her once, but she is VERY young and I found her to be condescending and not particularly encouraging. Somehow, after I see the actual oncologist, I always feel positive. She's good at her job, and she's just about my age (46) and so seeing her is sort of like having coffee with a fun friend who is extremely knowledgable about a problem I'm having.

I had a funny experience early on: I saw the oncologist briefly for the first time between surgery and radiation, and as they'd forgotten to call me in advance to tell me what my oncotype DX score was, it was at that visit that I learned that they wouldn't be offering me chemotherapy due to a low score (11). The pleasant surprise of that in conjunction with it being so early in the process meant I didn't take good advantage of that visit to ask follow-up questions. So six months later, they tried to schedule me with the PA. By that time, I was done with radiation and had a lot of questions about Tamoxifen and follow-up in general. The woman who was insistent upon trying to schedule me with the PA suggested I fax in my questions so that if there was any research needed, the PA could do that. I faxed in my 12 questions, and an hour later got a call from the office: they were calling to schedule me with the actual oncologist, due to the nature of my questions. Which is what I'd tried to tell them - I was NOT yet in maintenance mode, I was technically a new patient with treatment questions.

On the one hand, I try to view the switching back and forth as an indication that I'm not high-risk, nor am I having a difficult time or undergoing difficult procedures. I'm just grumpy and sweaty and lumpy from Tamoxifen, annoyed that I had breast cancer in the first place, and pretty much convinced that it is more likely to come back 10 years from now than this year. The patients making decisions due to recurrence or questionable test results and those undergoing difficult chemo treatments are the ones who really need the actual oncologist's time. That said, if I could just see the oncologist herself and go only once a year, that would be just fine with me. I don't really need that other appointment that leaves me feeling icky and sort of violated.

My oncology practice hands you a form early on that clearly lays out their scheme of alternating visits with the onc and the PA, with wording that suggests that you calm down and work with their system. That said, I think in your case, since you are like me, still getting your footing in treatment, you might consider making a list of your questions (including ones like "Why are my follow-ups scheduled for every three months? Could we switch to every six months? Why or why not?") and faxing those in AND requesting an appointment with your actual oncologist. The PA didn't say you HAD to see her (which is the policy at my office) - she said if you want to see the actual onc, you have to say so when you make your appointment. So say so!!!

Coleen

NatsFan, can you PM me you new onc info? I may need a new one myself after this Thursday. tks.