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This is the second article in a series on how to find the right breast cancer doctor for you.

I have to start by explaining my own attitudes and biases. When I look around me, I see two different kinds of physicians. There are those who view themselves as objective professionals, very much like judges. Their attitude is impartial; the patient and the cancer stand before them at the bar as equals. Such doctors are at great pain to explain to cancer patients the "reality" of the dangers of the disease and the difficulties in fighting it. They are certainly pleased if the patient "wins," and they certainly take appropriate action in the treatment to try to achieve this end. But they don't seem to be passionately on the patient's side, a feisty adversary to the cancer. Then there is the defense attorney, the man or woman who gets in there -- the tougher the case, the bigger the challenge -- and fights for the client. That is the kind of doctor we all want: one who will not be intimidated by a grave illness, but who will fight it with all the vigor, skills, and techniques that can be mustered. Find that kind of doctor and you have a better chance to win your case.

There is another, subtler question I want to get into and that is to define for myself as a doctor how to be caring of my patients and yet not be overwhelmed by my sympathy. Like anybody else, when a doctor is overwhelmed, he's not in very good shape to make the best decisions.

I see my patients as individuals I care about and I want them to understand that. On the other hand, I want to be able to bring their illness the kind of objectivity that good diagnosis and treatment require. To draw that fine line takes most doctors a long time to learn.

Once, many years ago, I was on my way home after a full day of tension and tragedy. In particular, one of my patients was doing very poorly, and I was lamenting the fates that had put her in such a position. And then I had an insight that has been a great help to me since then. I saw clearly that my role as a physician is not to lament but to find a way out -- to look at the situation as it presents itself and to focus on finding constructive opportunities to make it better. It would not be helpful to the patient if I allowed myself to be paralyzed by anxiety. The patient needs a strong advocate, but one who can take an objective view of what is wrong, and then, with a cool head, develop a strategy for overcoming it.

This does not mean your doctor should not be closely involved. It's very important to find a physician with whom you can have a personal relationship, to whom you can give your confidence and from whom you feel a warm concern. Many doctors shun such a relationship. They try to stay emotionally detached. It's easy to understand why: They build a wall to protect themselves from getting hurt if the patient does not do well. But though this is not their intention, by reducing their vulnerability it seems to me they are also reducing their commitment. When the chips are down, such doctors may not fight as hard as they could. They may give up earlier than someone who has permitted himself to develop a warm, caring relationship with the patient.

And that is what you should look for: a doctor who will fight for you like a close friend. Avoid physicians who you think will insist on keeping their distance.

When you first meet a doctor you are considering, make sure that she is patient in hearing your story and evaluating your condition. It is up to the doctor to establish the kind of atmosphere that allows you to feel that you are getting all the time you need.

Some medical offices are so busy and the consulting rooms so tense that you feel you are being rushed, and that the doctor is anxious to get you moving through her "assembly line." If that is the feeling you get, trust it and look for someone else. Patience, the virtue our mother talked about, is essential in a doctor who deals with breast cancer.

On the other hand, capable doctors are in demand and their waiting rooms are often crowded. I wish I could say that women never have to wait in my office, but they often do. We try to schedule enough time for each patient, but emergencies arise, or somebody needs an especially long and painstaking explanation of her situation or extra time for comfort and reassurance. It can be difficult to balance giving the person before you all the time she needs, and worrying about the patients you know are anxiously waiting outside.

Some of my patients handle the problem by calling ahead, before they leave for their appointment, to ask how we are doing, whether they should come right in or perhaps wait a half hour or so until the office traffic has eased.

This quality is closely related to patience. It takes a fair amount of time during the first visit to take a patient's history and to give her a complete physical examination. If the doctor isn't thorough, it is almost certain that important details will be missed. Note whether the physician gives you a chance to tell her everything that has happened since you discovered a lump or were told that your mammogram was suspicious.

She should also take a full history of past medical problems, allergies, drugs you take, and all relevant family and social details. These should include questions such as: When did you begin to menstruate? What was the date of your last period? How many pregnancies have you had? How many children? How old were you when you had your first child? Does anyone in your family have cancer? Breast cancer? Your mother? Grandmother? Sisters? Cousins?

Watch to see whether the doctor takes her time during the physical examination. Does she examine both breasts? Does she carefully review the mammogram and any other test results you brought with you? Pay attention to these details and others like them to make sure that you are putting yourself in the hands of a meticulous person.

A good physician will encourage you to ask questions and will answer you thoughtfully and understandably. She will carefully explain to you the available options in your treatment and will ask what your feelings are about them. If a physician uses medical or technical terms that are not familiar to you, ask for a "translation" immediately. Do you understand what is wrong? What alternative treatments may be available?

It is probably a good idea to bring someone with you to any early, exploratory appointments. Your companion can help you evaluate how the meeting went, and you will have someone to act as a sounding board in your later consideration of whether this particular doctor is the right person for you.

Your personal advocate can also help you remember the questions you should be asking as well as the answers the physician gives to them. In that regard, it's a very good idea to take with you to the doctor's office a small pad on which you've written your questions and can record her answers. Even if you ordinarily have a good memory, you may find that under stress you "lose" some information you need.

You should not feel any embarrassment about asking questions, consulting your notes, or writing down what the doctor says. More and more patients follow this procedure and find it very helpful.

It is essential that you feel comfortable with the doctor who will be in charge of your care. It is equally import that you be convinced that the particular approach to treatment that is being suggested is right for you.

These considerations are primary. If you are uncertain about any of them, you have every right to look further. This is much more important than worrying about hurting a doctor's feelings, or being embarrassed about asking for your x-rays or records to take to another physician.

No one wants to be discourteous, and it's pretty safe to assume good intentions all around. But you have an absolute obligation to take the best care of yourself you can. That may mean "shopping around" and getting other opinions. It may mean insisting upon the release of the reports of the tests and diagnoses you have received (and paid for), taking your time in making decisions, and, if you like, having someone with you to consult with you and the physician.

Don't feel rushed to make a decision about a doctor. Breast cancer should be treated as soon as possible, but that does not mean within a day or two and it certainly doesn't mean that speed is more important than making sound decisions.

The least satisfactory visits in my practice occur when a colleague calls and says, "There's a woman sitting across the desk from me whom I've known for years. She found a lump in her breast this morning and I want you to see her right away." If I examine that woman immediately, tell her she probably has cancer, and outline a proposed plan of treatment, it's likely to be a disaster. Here is a person who woke up that morning, presumably healthy, and suddenly her world has caved in. There's someone talking to her about the loss of her breast or how to conserve it. She's had no time to talk with her family or friends, to find out whom she really wants to consult with, or even to think about the questions she should be asking.

The first hours after you've been told that you may have breast cancer are bound to be upsetting. Anybody would feel, in those circumstances, as if the world had turned upside down. Give yourself time to talk to your family and friends and to compose yourself. Take your time. Tell any doctor who may be urging great haste upon you that you'd rather go home now and that you'll call him tomorrow or the next day. You may decide, in the end, to go to the specialist he's recommending, but you'll get a lot more out of that relationship if you haven't hurtled into it.

Click here to read Part One.

Click here to read Part Three.

-- Adapted from BREAST CANCER: THE COMPLETE GUIDE by Yashar Hirshaut, MD, FACP, and Peter I. Pressman, MD, FACS; © 1992 by Yashir Hirshaut. Used by permission of Bantam Books, a division of Random House Inc.

First published May 17, 2001
Last updated March 17, 2008

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