Last week I received a letter from my oncologist stating he was ending his practice at my clinic.
Just when I am finally becoming really comfortable with my oncologist, just when he is starting to smile a bit more during my appointments, just when I am finally starting to feel a bit more in control of my post-cancer treatment life, he decides, “after thoughtful consideration,” he’s had enough and is moving on.
What?
How could my oncologist just “drop me” (and all his other patients of course) and end our “relationship” so casually?
Immediately I went through a wide gamut of emotions. I felt surprised, let down, concerned, abandoned, panicked and even slightly angry. On top of that I felt a bit betrayed. I wondered if he already knew his decision at my last appointment. Why didn’t he tell me? Didn’t he owe me that?
Next, I was immediately transported back to the day of my first oncology appointment about a year and a half ago. I sat there in the waiting room that day probably feeling a bit sorry for myself saying to hubby, “I can’t believe I need an oncologist.”
“Well, you do,” was his simple and honest reply.
After reading and then re-reading the “termination letter” last week and again every day this week, I realize the relationships we establish with our medical team members, perhaps especially our oncologists, run deeper than I thought; no surprise there.
Our oncologists are the ones who “walk with us” through diagnosis, treatment decisions, side effects, fears and follow-up appointments. They listen to countless questions (some of which are asked over and over again), offer coping suggestions, write prescriptions, observe our changing bodies, deliver bad news, encourage us to stay the course, show compassion, offer alternatives, take notes, order tests, acknowledge our anxieties, comfort our partners and above all listen to us.
They deal with life and death issues every single day.
When you boil it all down, they help us face cancer. They help us face our mortality. They help devise a personalized plan to enable us to live as long as possible.
When you put it like that, it’s no wonder they grow weary, need a change, move on or even change careers entirely. The work must be exhausting.
I understand my oncologist’s decision and wish him only the best. I will always be grateful to him for his solid and compassionate guidance through the past year and a half.
But I must admit, I’m a bit anxious about finding a new one.
Part of my anxiety about finding a new oncologist is starting over with someone who doesn’t know me. I will have to start over with someone who doesn’t know me from “that day.” I will have to rehash my cancer story. I will have to condense it down. My new doctor will be “sizing me up” and I will be doing the same with him/her. First impressions will be made once again. Maybe I’ll like my new oncologist better. Maybe I won’t.
Relationships evolve. Relationships end. New ones begin. Even with oncologists.
Some days I still can’t believe I ever needed an oncologist. Some days I still wake up and forget for a few moments cancer barged into my life.
Then I remember.
I can’t believe now I need a new oncologist.
Once again hubby gently reminds me, “Well you do.”
Have you had to change doctors and if so, was it by choice?
How do you determine if a doctor is a good fit for you?
What is an oncologist’s (or any doctor’s) most important role?
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pinkunderbelly
I can’t believe there will come a day in which I’ll wake up and forget I had cancer! Can’t wait for that. Sorry about your cod. You’re right–it stinks to have to start over. I think oncology might be the hardest field bc of all the misery and loss involved. Good luck in your search!
Nancy
Pinkunderbelly, I wonder if that day is possible too. I do manage to forget for moments… I think you might be right about the difficulty/stress of this particular specialty. I wonder if there is a high turnover. Thanks for commenting. Hope you’re feeling better.
Andrea Hutton
I’m afraid you will never wake up and forget you had cancer. Some days it’s farther in the back of my mind than others – but forgetting? I don’t think so. It’s always the bald, pink elephant in the room.
Nancy
Andrea, I totally agree with you. Thanks for sharing your good description.
Holly
I, too, have deep respect and gratitude for my oncologist…plus…he’s CUTE!! I even turned down a new job because it meant having to find new providers. I believe the oncologist (or really any doctor) has two primary responsibilities to a patient – 1.) to be as skillful and knowledgable as possible and 2.) to be forthright, honest and upfront about what is going on, options, etc.
I work in a medical setting alongside oncologists and other MD’s every day. So many are wonderful and so many others fall far short of my expectations.
Nancy
Holly, I understand about turning down a job for that reason, I really do. We become attached to certain care providers don’t we? It must be really interesting working side-by side with oncologists and other medical people every day. I wonder, is it hard to keep quiet sometimes when you see so many falling short? I like the two primary responsibilities you mention. I think they must be good listeners too. Thanks so much for your comments.
Ginny Marie
I’ve had my oncologist for 15 years, and if he moved, I’d move with him!
I did switch doctors when the whole breast cancer issue came up, but that is way too long of a story for my comment. I think I wrote it down somewhere on my blog. I also just wrote a post about my oncologist!
I think compassion is very important in a doctor, and also listening skills. If you go to a doctor’s appointment and don’t feel like you’re being heard, it’s time for a new doctor.
Nancy
Ginny Marie, Wow that’s a long time to have the same oncologist. You are very fortunate, well that sounds a bit odd saying you’re fortunate to have an onc for that long, but you know what I mean! I will check out your blog post soon. I’m a bit behind. I agree with the compassion and listening skills being vitally important. They are a must! Thanks for commenting!
Chandra
I’m on my second oncologist after diagnosis in January 2011…and really need a third. The first didn’t call for Oncotype DX; the second doesn’t understand that recurrence score trumps tumor size and grade. So I envy you your relationship and wish you the very best with this change. To me, the most important quality in a doctor is respect for my ability to do my own research and make my own decisions…with input, of course, from the oncologist. In my case, however, I’ve yet to find a local oncologist that I can respect!
Nancy
Chandra, The respect thing must be a two-way street, you are so right about that. I’m sorry you’ve had some trouble finding an onc who is on the same page as you, so to speak. Good luck finding number three! I’ll probably go with one of my present onc’s colleagues. I’ll start there anyway. Thanks for adding to this discussion. Hope to hear from you again soon.
Cancerfree2b
Oh Nancy,
I am so sorry. I don’t know what I would do if I heard that from my oncologist. I do fear that I might lose her one day, maybe some other opportunity will come her way, etc.
I am so sorry that you have to start all over with someone else. I switched oncologists three times. It was hard to find someone I felt comfortable with, whom I could trust.
I love my oncologist and if you’d like, I will ask her if she knows of someone in your area that she would recommend . . . I know that sounds like a bit of a stretch, the distance. But, you never know.
I hope your current oncologist is giving you some time, some advance notice of ending his practice. I am so sorry. Like you need this right now, or ever.
My thoughts are with you.
Lisa
Nancy
Lisa, Thanks for your comments, concern and offer to help. You are very sweet. I’m sure I’ll get along fine with a new person, it just came as such a surprise. I plan to start by checking out the other oncologists at my clinic/hospital. My next appt isn’t until the end of January, so I have a little time. I’m glad to hear you like yours. Thanks so much for your kind comments, Lisa.
Caroline
About six months after my last chemo, my oncologist ditched me and went to research. I liked him, he knew my health, I was concerned. But then I did some asking around and realized this was my opportunity to choose who I wanted. My new oncologist is young – going on the theory that she won’t retire before my demise – and she focuses not just on breast cancer but women’s cancers and women’s health. There was a bit of a transition but now I am very happy with her. So go find yourself someone you like… My suggestion would be to ask one of the nurses in the oncology department to describe the other oncs to you – you don’t need to know their CV but they can tell you about their bedside manner which is really what is important. Good luck!
Nancy
Caroline, I guess you have been through something similar then. You approached it the right way – viewing it as an opportunity to choose someone new. I’m glad your transition went pretty well and that you are pleased with your choice. Your suggestion to ask the nurses on the onc floor might be a good one. Thanks for sharing your thoughts. I appreciate it.
Jackie Fox
Nancy,
I’m sorry you have to go through this. I cried when we got the retirement “dear John” letter from our family doctor in June but I had seen one of his young partners while he was in Iraq and liked her. All I can tell you is go with your gut. My first oncology consult was highly recommended but a terrible fit for me. My second consult was as well respected and recommended but his approach just felt right. He spent over an hour with us on our first consult and told me he would respect my decision and support me even if I didn’t follow his recommendation, and that meant the world to me. Best of luck to you.
Nancy
Jackie, I agree with you about the “fit” needing to be right. Sometimes you can tell right from the start can’t you? I’m glad you are happy with your choice and found someone who respects your decisions. That’s so important. Thanks for sharing, Jackie.
Chez Radford
Nancy, my thoughts are with you as you as you come to terms with the dilemma of finding a new onc.
My story of change is a very positive one, and I wish the very same for you. I really did think my oncologist was great, and accepted the fact that she went on maternity leave, believing she would return. She did not return! Her ‘replacement’ has turned out to be my ‘Dr Amazing.’ I could not have ‘hand-picked’ a better replacement to walk with me on this journey. Wishing the same for you, you deserve the very best.
Nancy
Chez, I know from your blog that you are really happy with your “Dr. Amazing” and I am so glad you found someone you truly like. Sometimes things work out for the best don’t they? Thanks for your good wishes and for sharing about your experience. I hope things are going alright for you. My best.
The Dirty Pink Underbelly
I was assigned to my doctor by chance, and it was indeed a blessing. I absolutely love him, and now, with metastatic cancer, he is one of the most constant people in my life, and I hope and pray he will be with me until the end. I don’t think I could do this without him.
I’m so sorry you have to make this change against your will, and I totally understand everything that went through your head! I hope you find someone wonderful.
Nancy
Shelli, I was actually merely assigned to my present oncologist too, but it worked out fine. There aren’t that many to pick from in my clinic, so I guess it won’t take too long to decide on my next one. I’m thrilled that you are so pleased with your oncologist. The relationship must become even more important as a metastatic bc cancer patient. You really need someone you can trust and speak your mind with I would imagine. But actually, that’s always critical isnt’ it? Thanks for your comments and for understanding what this transition means. It’s nice to know so many others get it.
TC
I am an oncs nightmare. I test-drove 3 before I settled with the one I currently have. Our first appt, I was so onc-weary I just went straight to the bottom line and told her about my hx with oncs, and why I did not stay with each of the prior. I laid out in no-uncertain terms what my expectations were, and my mindset on the whole treatment offerings. She smiled, nodded, and said…okay. A relationship was born. If Robin sent me a Dear Jane letter, I think I just might not bother going through the interview process again. It is just too taxing. Don’t be me. LOL. As a Hubby said…You do [you need one]. A necessary evil…hopefully, not so much.
Nancy
TC, I admire you for doing all that “test driving” although I’m sure one does grow weary. Sometimes going straight to the bottom line and laying out your expectations is the only way to go. Saves a lot of time and anguish doesn’t it? I’m glad you are satisfied with your choice. It still seems so unreal that I need an oncologist at times, but… Thanks for commenting.
Dianne Duffy
So sorry you have to go through this again.
I’m on my third oncologist also. I consider him mostly useless. The second one was unresponsive. The first one just minimized any complaint I had until I ended up in the hospital because of a serious drug reaction.
I was talking to another oncologist this past week and he said that many oncologists prefer to keep a distance from their patients. I can see why if you think about it. It must be painful to watch others suffer so much and go through such a difficult time.
I find that I often forget to look at things from the other perspective.
I also find that going through the whole cancer story again is very emotionally draining. My story has been long, painful and filled with many complications and mistakes. It might help just to write down a summary that you can give and not have to go into it too deeply.
Wishing you the best in your search for a replacement.
Dianne Duffy
Nancy
Diane, I’m sorry you have had such bad experiences with your oncologists. One that’s useless, one that’s unrespsonsive and one that minimizes your experience – that’s terrible. I understand the need for an oncologist to “keep his/her distance,” but that doesn’t mean he/she shouldn’t be involved or show genuine compassion. If it’s too difficult to “watch others suffer” so much, they probably should choose a different specialty I guess. It is emotionally draining at times isn’t it? I’m sorry you have had so many difficulties. Thanks for your comments, advice and good wishes.
Being Sarah
Nancy, I hope your new oncologist turns out to be even better than this one, you never know? But I totally get how attached we are to our docs… and how frustrating to be moving on from one, but not by your choice. The thing I like about my good doctors is that they listen. I think that’s the most important thing – to listen to me. And then to reply to that. I always hate it when I feel I’m just ‘processed’… individual doctoring always stands out to me.
All best with your search for a new oncologist Nancy.
Sarah
Nancy
Sarah, I’m trying to look at it that way – that perhaps I’ll like my new one even more. We do indeed become attached to our doctors, especially our oncologists. How could we not? They so directly impact our lives on such a personal level. I agree with you about the listening, it’s essential in any good doctor/patient relationship. Actually, it’s essential in any good relationship isn’t it? Thanks for commenting and I hope your healing is going well.
Beth L. Gainer
Oh my gosh, Nancy! I’m so sorry about you needing to find another oncologist and especially how yours ended it with an impersonal letter.
A change of docs is an upheaval for sure. I’m going through that with my Primary Care Physician, who was my doc for about 14 years and whom I loved.
Of course, an oncologist is a different matter entirely. The key is to know, as some others have commented, that you might even get a better one. Ask nurses whom they would trust their lives with, ask your general doctor for a rec, and remember, if the onc that you choose is not the right one for you, seek another until you find the right one.
Hang in there. Unfortunately, once we are part of the “C” club, we cling to our doctors like lifesavers….because that’s what they can be.
Nancy
Beth, Thanks for understanding. Do you think the letter was too impersonal? I go back and forth on that one. I think it would have been “nicer” to have been told in person, but perhaps that wasn’t practical with so many patients, I don’t know. Sorry you have to find a new primary care doctor, that’s no fun either. I like your advice about asking the nurses for their input, although I’m not sure if they’d say for professional reasons. And you’re right, our doctors can and do often feel like actual lifesavers. They offer invaluable support and advice at a time when we are at our most vulnerable, so how could we not view them that way? Thanks for your insights, Beth.
Kel Muller
Hi Nancy,
Yes, I have had to change oncologists. It is a seriously frightening experience, because as you said: you are putting you life- literally- into their hands. You are trusting them to help make decisions that will allow you a longer life when cancer is working against both of you.
When I had to change Oncs I talked to several. I found two equally passionate doctors, and selected the one that would best complement my emotional/intellectual needs.
It is so much work finding them, scheduling appointments, preparing for appointment, analyzing the appointment, making a decision…. But, this is a vital decision. Don’t stop the search until you have one that you will trust.
On the bright side, you will be able to gather a lot about their work style and approach to you as a patient based on how they review the medical history in your current medical record. Do they read it before? Do they read it in the room with you and ask questions as you go along? Which approach to you prefer?
In the end, do the treatment plans you used make sense to them? Do they agree with the choices you made with your first Onc? If you liked #1, #2 should share beleifs with him.
Best of luck!
Nancy
Kel, I guess you understand exactly what I am going through then – that does help a little. I guess in some ways it will be nice to compare and see if the new person has a different philosophy at all about post treatment monitoring and follow up. I’m not too worried about the personality thing as long as they listen to me, take time to thoroughly address all my concerns and seem knowledgeable and compassionate. I can’t really imagine an oncologist disagreeing with past decisions, I mean what would be the point? Thanks for your great comments. Hope to hear from you again!
Stacey
Hi Nancy, I feel your pain, although I haven’t had to find any new doctors yet. My oncologist recently took on a partner and I dread the day I find her in the little room rather than him. I love him! He’s always cheery, positive, huggy, in a grandfatherly way. I know that would all be hard to find with someone else, but even more disturbing, as you say, would be the starting over. Who wants to explain everything again? Actually, you know what might be worse than having to find a new oncologist? Finding a new plastic surgeon! Ack, that’s something I hope I never have to do. Good luck in your search!
Nancy
Stacey, I’m glad you have not had to make the switch. I like the idea of a partner, then you have two doctors familiar with your case. Is your onc thinking of retiring soon? Hope not. I think it’s the starting over with someone new and rehashing everything that I dread the most. It’s such a long story… especially with all my family history. It’s funny you mention the new plastic surgeon because actually I did need to find another one to do the finishing touches as my initial plastic surgeon doesn’t do all procedures. And yes, that too was stressful. Thanks for adding to the discussion, Stacey. I always appreciate hearing from you.
The Big C and Me
Nancy, losing your ONC is like jumping back into the vat of uncertainty. Who needs that? Major drag that you have to deal with this.
The flip side/good news is that your new ONC will have a fresh set of eyes and his/her own opinion. If he agrees with your old ONC, that is reassuring. And if he doesn’t, it gives you an opportunity to look at his point of view and decide what is best for YOU. Always a good thing in my book!
Keep us posted!
-Renn
Nancy
Renn, You do have a way with words! Yes, it is like jumping back into the vat of uncertainty I guess. I like your way of re-framing this (thank you Deb if you’re reading this). A new onc will indeed be a fresh set of eyes/opinions. That just might turn out to be a good thing who knows? I will keep you all posted. Thanks much for commenting.
WiFiscanning
Dear Nancy,
I am in such a different situation from you in Wisconsin, since I live in NYC where oncologists abound. But so does breast cancer, and we fight like hell to get the oncologists and perhaps more importantly to me, surgeons, that we want.
My favorite way to pick either one is to choose a major metropolitan hospital where clinical trials are conducted. My feeling is that I can decline any weird trials, and nevertheless have access to the most recent research from all over, which those people read all the time.
Hometown docs may not do that, since they cannot offer some state-of-the-art procedures, new stuff, whatever, they may neglect to inform you of their availability elsewhere. (I read that somewhere, don’t recall where).
Like for example, there are cancer patients in NYC who fly to the Mayo Clinic for their treatment, and then for their follow-up for years.
Here in the city, going to the hospital all the time is so crowded and elbow-pushing, it feels like the scene of a car crash every time, I swear. The stress level is so high, and I can hear it in my doctor’s voices.
There is only one thing that the oncologist is interested in about “sizing you up” and that is your tumor markers – e.g. you prognostic indicators. That is where all the latest research of the past ten years can make a difference in your treatment. Your tumor markers are bits of your cancer cell’s DNA. (not really sure about this stuff – bunch of articles on my blog recently).
Those cells differentiate the kind of cancer you have, and they tell the oncologist how they can best be killed.
That’s what I care about, personally. More that having an oncologist who listens to me, because I am just saying “I don’t feel well” anyway.
During chemo, I was really fortunate to have a humane oncology nurse practitioner, and she listened to me and talked to me with such kindness each week, and also over the phone and email, that made a big big difference to me. That was during treatment.
Wouldn’t you know, after my gruelling chemo clinical trial was finished and my boss fired me, I lost my health insurance, and the oncologist stopped making appointments with me altogether or answering my calls or emails.
I went two years uninsured without breast cancer follow-up.
Talk about being scared of my mind.
Friday, I have my first appointment at Sloane-Kettering, and they take my medicaid. I do not wish to go back to the old oncologist, despite the fact that the clinical trial drug probably saved my life, in combination with my lumpectomy.
Love, Evelyn (WiFi Scanning)
Nancy
Evelyn, I’m sorry you had to go two years without follow-up. That’s a real shame and must have been quite stressful. I don’t think our situation in regard to oncologists is all that different really, although you surely do have many more to choose from. I am close to Mayo Clinic and have access to doctors/care there, plus my clinic/hospital is affiliated with Mayo, so I feel like my doctors are up on the latest procedures/treatments etc and they are avaliable to me. I guess I assume the oncologists are knowledgeable and up on things, so I am interested in a good personality fit and a good listener. I’m glad you had such a kind onc nurse during chemo, that can make so much difference. Thanks so much for your comments. They weren’t scary! Good luck on Friday, hope all goes well for you.
WiFiscanning
Dear Nancy,
Wow, I just proof-read my comment, and reading it scared the hell out of me. Think I’m going to pass out! (kidding).
Anyway, I didn’t mean to scare anyone, things are challenging in NYC, and it takes constant self-advocacy and a big posse of friends and family to make it through. Every medical record has to be ordered, filed and checked. Sometimes they say “Right Breast” sometimes “Left Breast”. You have to be on top of your own care.
Love, Evelyn
OMG, I just scared everyone even more!
sorry
I’m so sorry, I am such a whiner. I didn’t mean to be!
Nancy
Evelyn, I think a person must be a self-advocate no matter where they are. You are so right, you have to be on top of your own care and can’t just sit back and assume everything is being taken care of. If you can’t advocate for yourself, having a family member or friend to help out is vital. I’m sure it is challenging at times navigating everything in NYC just due to the sheer volume of patients. Thanks for your great comments and you aren’t whining!
ButDoctorIHatePink
It would be awful if I lost my onc, especially being Stage IV. I’m so sorry.
Nancy
Ann, I think it would be tougher to change being Stage IV for sure. I hope you don’t ever need to. Hope you are feeling better post liver surgery. My best for your continued healing and thanks for taking time to comment.
BreastCancerSisterhood.com
I’m amazed oncologists last as long as they do. I would think their chosen profession would be emotionally taxing and depressing. My chemo nurses are the ones I loved, and like you, I was devastated when one of them left the practice. Thank God for angels like that.
XOXOXO,
Brenda
Nancy
Brenda, I’m amazed oncologists last as long as they do too – talk about a stressful job. I imagine the rewards are quite great as well though. I never got that close to any particular chemo nurse, but I know many people do. Thanks for commenting.
All Things Caregiver
Nancy,
Your dilemma popped into my mind today as I listened to the interaction between the young lady who works for me and her client. This client was concerned with the fact my co-worker was going to be out of the office for the next few weeks, leaving this client no choice but to get her pain management massage elsewhere. This client was not concerned with her possible pain, she was upset she may be “cheating” on my co-worker by going elsewhere for the two weeks she wouldn’t be able to come to our office.
What my co-worker told her, I thought, was very insightful:
“please feel free to always explore other options. Although I am proficient at what I do, having a different set of eyes and pair of hands on your body can only be beneficial. We are all human; what I may have missed, someone else may catch.”
Although I would NEVER compare the severity of the two situations, and the stress you must be feeling trying to determine your next step, try and see this as a fresh set of eyes willing to help you and improve your situation.
Best of luck,
Tory
Nancy
Tory, Your advice is perfect. Someone else mentioned “re-framing” the situation in much the same way by trying to view it as an opportunity for a fresh perspective. That’s what I’m going to do, or at least I’m going to try to. Thanks for your comments.
Lisa
One reason hubs and I are holding back from moving to another state is that I can’t bear the thought of losing my surgical oncologist! My hema/oncologist,eh, I could find a replacement, but sweet Dr. Hagans–shudder the thought! Good luck Nancy!
Nancy
Lisa, Oh I so understand. Some doctors are simply irreplacable aren’t they? (and some are!) Thanks for commenting and for your good wishes, Lisa.
Alli
It had taken me over 2 years to finally find a GOOD Family Dr. I adored him, great personality, he really had taken time to make sure all my needs were met. I could finally take a breather. Well not so fast!! There was a falling out of sorts with the chief Dr at the clinic. He left to work in another city, to far to go so I stayed with the other new Dr. Happy Days!! He was coming back they kissed and made up! That was short lived. Received a call from the clinic. My Dr went back to Libya right after the death of Ghadaffi (He was from there) So now I have another Dr. I do like him, he’s very nice but I would rather have the other one back……
Nancy
Alli, Sorry you’ve been going through such a “musical chairs’ ordeal with your doctors. We just keep adapting don’t we? Thanks for sharing.