Team or step-oriented approach
My gyn is an independent provider (not connected to a hospital) and only recommended I see a surgeon first as priority (she recommended several to choose from), but my primary care doctor with a large hospital is suggesting I see a medical oncologist and radiation oncologist as well - she seems to be more comprehensive and team-oriented.
I guess each method has its merits: The step-approach cherry picks the best surgeon, then oncologist and radiologist as necessary on recommendation. Benefits of the step-approach is you may get better doctors but care is less coordinated. The benefits of the team-approach is that's it's more coordinated, all in one place, & requires less transfer of records, but not everyone on the team may be the best doctor.
Just wondering what any of you suggest, what you have done and what your opinions are.
Thank you all,
HopeHeal
Comments
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Hello HopeHeal. Since I live in the Houston area and was diagnosed with IBC, I made a beeline for MD Anderson because they have an IBC clinic and are a highly-rated facility. I was assigned a team, and I have wondered what my options would be if I didn't "click" with any of them. So far, so good with the Medical Oncologist, but when preparing for a mastectomy I want to know more about who's going to be doing the cutting on me, and if that person will hear my concerns. I'd really like a "Consumer Reports" of surgical oncologists instead of having to sift through sketchy internet reviews.
I will meet with my assigned surgeon in advance so if I don't get a good feeling about her I want to know how I make a change, which I suppose is a question for MD Anderson's patient advocate.
I will be interested in other responses to your post, as I wonder what choices others have made.
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The facility I used (a smaller hospital in an urban area, affiliated with a large teaching hospital here) has a breast center adjacent to the hospital. It's where I went for the mammogram I'd put off, and when that found an area of concern, they scheduled me for an ultrasound and possible biopsy, both in the same place. Once those results were in, I got scheduled with a breast surgeon, also at that breast center. I really liked everyone I dealt with there, and appreciated that I didn't have to schedule anything on my own. The MO was in a different medical building, but still part of the same system, and the RO's office was in the hospital but the breast center handled the initial consultation appointment for me.
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I am going to a local hospital with a breast center and everything has been done within the system. I really like how seamless everything is. I have never wondered about the next steps and if I do have questions or issues I know who to ask.
When I had some weird issues crop up with my port, all of the doctors could get into the system and easily review all of my records and communicate about the best way forward for my case. They decided it would be safest to have my port removed — I had a call and an appointment scheduled with the surgeon to remove the port hours before my oncologist called me back to let me know the decision.
I am also sure that if I didn’t like a specific doctor I was seeing then I could request a different one.
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I had second opinions every step of the way. I was insistent on my MO since he had treated my best friend for pancreatic cancer. Ended up that my BS & PS worked with each other often but were at different facility than the MO. My MO made sure everything was coordinated and invited them to his faculty tumor boards or made it a point to go to theirs. When it came time for rads, I chose yet another facility because it was closer to my home for traveling every day for 5 weeks. Again my MO & RO kept in constant touch.
It's much easier now since most records are digital and can be access by most doctors. As I said on another thread where I think you were posting - I made a point to meet & visit & choose an MO first. If you end up needing chemo or other drugs, the MO is the one who drives the bus. Surgeon's cut and then the care is usually turned over to an MO. I know everyone doesn't agree with my method, but it worked very well for me.
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Thank you everyone, each of your posts were enlightening. The seemeless of care is what attracted me to a team. MinusTwo you made an interesting point about the MO. I chose my team based on my surgeon but I just hope the MO is just as good.
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LW422 the "consumer reports" that I sometimes use is Best Doctors Magazine for your city (i.e. Best Doctors New York, etc.), which pulls in the Castle Connolly Top Doctors list and further rates them. I have found good doctors there & it's good for cross-referencing doctors we may have heard of or already know.
Honestly, I wouldn't know what t do if I liked my surgeon or didn't the MO or vice versa. Transfer to a different member maybe, but what about a different hospital team? I think we can't. Once we are with one team we have to stay with it.
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Hi, Hope. I suppose I'm more interested in patient reviews of doctors, particularly surgeons. I know there are a lot of tragic looking results from mastectomies, and I want the best result possible (as does everyone) because I don't plan on reconstruction. I'm going to ask my MO next week about the breast surgeon that was assigned to me. She appears to be relatively new and has no reviews to be found.
I'm sure she is qualified, but I want someone with a LOT of experience. Originally my team included a male doctor who has been a breast surgeon for several years and his patient reviews are very good. I want to know why he was replaced by the young woman and how I can see him instead, so I'm just going to ask. After all, I should have some input into this thing, and so far... I was "assigned" to the IBC team and away we go.
One limiting factor for me is that I don't know which MD Anderson doctors are specific to the IBC Clinic, and whether that even matters. I'm not participating in a clinical trial, so I imagine my course of treatment will be the same no matter which MDA doctor I use.
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I don't know if it's allowed here, but I'd like to start a thread called "Did You Have a Mastectomy at MD Anderson in Houston" and ask a ton of questions about surgeons.
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LW - I don't think there would be any prohibitions, but remember - most people who have had successful treatment don't stay on BCO. They have moved on. You might try sending a PM to Whippetmom. She keeps a list of good docs all over the country.
HopeHeal - unless you are on an HMO plan or something like Medicare Advantage, I see no reason you can't go outside the group or the hospital.
Edited to say - this is exactly why I have chosen to stay on a traditional Medicare plan. I can go anywhere, anytime and pick my own docs.
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